Definitions of healthcare terms can sometimes be confusing. The following information will help you to navigate this process.
An exclusive provider organization (EPO) is a health plan that combines features of a HMO and a PPO. This type of plan can store electronic medical records. You will only need the services of providers in your network. You will be charged more if you require care outside the network. 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 tied to your network, unlike a PO. If you go to a provider outside the network, your insurance will not cover the actual cost of services.
The Patient as a Partner Approach is a way of engaging patients in the healthcare process. It acknowledges that the patient's experiential knowledge is just as important as the scientific knowledge that the HCP has. It also encourages patients and others to become involved in their care. For example, a patient may choose to get a second opinion or consult with a doctor over the phone.
Electronic Medical Records (EMR) are computerized systems that store all of your clinical data. They are used to monitor and record your care, as well as copayments and deductibles.
Behavioral Healthcare refers specifically to a range treatment options for substance abuse or mental illness. These include counseling and medication management. Behavioral healthcare can be offered in both hospital emergency rooms and ambulatory care facilities.
Electronic prescribing allows pharmacies and doctors to electronically share patient data. Electronic prescribing uses computerized systems for transferring prescription information from the doctor's office into a pharmacy.
Before they pay you, insurance companies may review your claims. If your claim meets the requirements, the insurer will reimburse. Preauthorization and precertification are required for certain insurance plans.
Similarly, HIPAA, the Health Information Privacy Act, seeks to establish standardized security standards for the exchange of sensitive information. It is enforced by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.
The Affordable Health Care Act (ACA), which requires all health plans to offer coverage, requires four levels. These levels can vary depending on income, dependents, as well the government's assistance.
Your healthcare costs for the calendar year are limited by your annual deductible. For example, if your healthcare costs are high due to an accident or major illness, your deductible can limit how much you can spend on healthcare before your insurance starts. Non-covered services such as visits to hospitals or doctors not in your network are not covered. 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 are tax-advantaged savings accounts that can be used to pay for healthcare services that are not covered by your health plan.