There are many definitions of healthcare that can be confusing. Luckily, the following information has been compiled to help you navigate the process.
A health plan with exclusive provider organization (EPO), which combines the best of both a HMO/PO, is an EPO. This type of plan can store electronic medical records. Therefore, you will only need access to providers within your network. If you have to seek care outside the network, you'll be charged more. You might also be charged a higher cost sharing.
A health maintenance programme (HMP) covers all medical expenses. This includes deductibles, coinsurance, as well as copayments. Your benefits are not dependent on who you see, unlike a PPO. Your insurance will only cover services provided if you see a provider not in the network.
The Patient as a Partner Approach allows patients to become involved in healthcare. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. It encourages patients to be involved in their own healthcare. For example, a patient may choose to get a second opinion or consult with a doctor over the phone.
Electronic Medical Records (EMRs), which are computerized systems that store all clinical data, are called electronic medical records. They are often used to track and monitor your care.
Behavioral healthcare is a term that refers to a range of treatment options for substance and mental abuse. Counseling and medication management are two examples. In both hospitals emergency rooms and ambulatory healthcare facilities, behavioral healthcare is available.
Electronic prescribing allows pharmacies and doctors to electronically share patient data. Electronic prescribing is a method that transfers prescription information from a doctor's office to a pharmacy using computerized systems.
Your claims may be reviewed by insurance companies before being paid. If the claim meets the required standards, the insurer will reimburse you. Some insurance plans require you to precertify or authorize before you can receive specific procedures.
HIPAA, also known as the Health Information Privacy Act (or HIPAA), seeks to establish security standards that allow for the safe exchange of sensitive data. It is enforced at the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable care Act (ACA), mandates that health plans must provide basic coverage. These levels can vary depending on income, dependents, as well the government's assistance.
Your annual deductible caps your healthcare costs for the year. For instance, if you have an accident or suffer from a major illness, your deductible limits the amount of healthcare that you can spend before your insurance kicks in. This does not include visits to hospitals or doctors out of network. Your deductible does not apply to hospitalizations. It only covers the cost of care you receive while you are there.
You can also use your HSA health savings account to cover healthcare expenses that your health insurance doesn't cover. HSAs can be used to cover healthcare costs that are not covered by your insurance.