Sometimes, healthcare definitions can be confusing. Luckily, the following information has been compiled to help you navigate the process.
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 stores medical records electronically. This allows you to only see providers within your network. You'll pay more for care outside your network. You might also be charged a higher cost sharing.
A health maintenance policy (HMP), which covers all medical costs, deductibles, coinsurance, and copayments is a type o insurance that provides coverage. However, unlike a PPO your benefits do not depend on your network. When you see a provider outside of the network, your insurance will cover only the costs for services provided.
The Patient as a Partner Approach allows patients to become involved in healthcare. It acknowledges that the patient's experiential knowledge is just as important as the scientific knowledge that the HCP has. It encourages patients to be involved in their own healthcare. One example is that a patient could choose to have a second opinion or talk with a doctor via the telephone.
Electronic Medical Records (EMRs) are computerized systems that store all your clinical data. They are usually used to record and monitor your care, including a deductible and copayments.
Behavioral Healthcare refers specifically to a range treatment options for substance abuse or mental illness. These include counseling and medication control. Both ambulatory and hospital emergency rooms can offer behavioral healthcare.
Electronic prescribing allows pharmacies electronically to share patient information. 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. The insurer will reimburse you if the claim meets certain standards. 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 administered by the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable Care Act (ACA), requires that all health plans provide coverage at four levels. 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 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. 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.
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.