There are many definitions of healthcare that can be confusing. To help you understand the process, we have compiled the following information.
An EPO is an exclusive provider organization, which is a plan that offers both a HMO (prescription only) and a PPO (prescription only). This type of plan can store electronic medical records. This allows you to only see providers within your network. If you need to see a provider outside of your network, you may be charged more. You may also be subject to a higher cost share.
A health maintenance programme (HMP) covers all medical expenses. This includes deductibles, coinsurance, as well as copayments. Unlike a PPO, however, your benefits are not based on your network. If you go to a provider outside the network, your insurance will not cover the actual cost of services.
The Patient-asPartner Approach is a way for patients to be involved in the healthcare process. It acknowledges the value of the patient’s experiences as much as the HCP’s scientific knowledge. Patients are encouraged and supported to take an active part in their care. The patient can, for example, get a second opinion from a doctor or consult with one over the phone.
Electronic Medical Records (EMRs are computerized records that store all of your medical data. These records are used to record and monitor your healthcare, and include a copayment and deductible.
Behavioral healthcare covers a wide range of treatments for substance abuse and mental disorders. These include counseling, medication management, and other options. You can find ambulatory or hospital-based behavioral healthcare.
Electronic prescribing is a way for pharmacies to electronically share patient information. Electronic prescribing utilizes computerized systems that transfer prescription information from a physician to a pharmacist.
Insurers may review your claims prior to paying them. If the claim meets all requirements, the insurer may reimburse you. Preauthorization and precertification are required for certain insurance plans.
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 by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA), requires that all health plans provide coverage at four levels. These levels vary based on your household's income, number of dependents, and the level of assistance that the government provides.
Your healthcare costs for the calendar year are limited by your annual deductible. If you have an accident, or are diagnosed with a major illness, your annual deductible caps the amount of healthcare you can afford before your insurance kicks in. This does not include visits to hospitals or doctors out of network. If you are hospitalized, your maximum deductible is the amount that you pay for care while you are there.
Finally, your HSA (health savings account) allows you to use your money to pay for healthcare costs that your insurance does not cover. HSAs can be used to cover healthcare costs that are not covered by your insurance.