There are many definitions of healthcare that can be confusing. This information is intended to assist you in understanding the process.
An exclusive provider organization (EPO) is a health plan that combines features of a HMO and a PPO. This type of plan stores medical records electronically. As a result, you will only need to see providers in your network. If you need care outside of the network, you will pay more. You could also be subject to a higher price share.
A health maintenance policy (HMP), which covers all medical costs, deductibles, coinsurance, and copayments is a type o insurance that provides coverage. Your benefits are not tied to your network, unlike a PO. Your insurance will only cover the cost of services rendered if you visit a provider that is not part of your network.
The Patient as Partner Approach is a way to involve patients in the healthcare system. It recognizes that the patient's personal experience is just as important than the HCP's scientific information. 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), 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 refers to a variety of treatment options for mental and substance abuse. These include counseling and medication control. In both hospitals emergency rooms and ambulatory healthcare facilities, behavioral healthcare is available.
Electronic prescribing allows pharmacists to electronically share patient records. Electronic prescribing allows prescription information to be transferred electronically from a doctor's practice to a pharmacy via computerized systems.
Insurers may review your claims prior to paying them. The insurer will reimburse you if the claim meets certain standards. Some insurance plans require preauthorization or precertification before you can receive certain procedures.
HIPAA is the Health Information Privacy Act. It establishes standardized security standards to allow 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 Care Act (ACA), requires that all health plans provide coverage at four levels. These levels will vary depending on the income of your household, the number of dependents and the amount of government assistance.
The annual deductible limits your healthcare expenses for the year. Your deductible will limit the amount you can spend on healthcare if you are in an accident or have a serious illness. This does not apply to services that aren't covered, such as visits at hospitals and doctors outside your network. You will only be liable for the actual amount of the care you receive when you are in hospital.
You can also use your HSA funds to pay for any healthcare expenses your plan 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.