There are many definitions of healthcare that can be confusing. The following information will help you to navigate this process.
An EPO (exclusive provider organization) is a combination of features from a HMO or a PPO. This type of plan stores medical records electronically. This allows you to only see providers within your network. You will be charged more if you require care outside the network. You could also be subject to a higher price share.
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. 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 recognizes that patients' experiential knowledge is as important as the HCP's scientific knowledge. It encourages patients to be involved in their own healthcare. The patient can, for example, get a second opinion from a doctor or consult with one over the phone.
Electronic Medical Records (EMR) are computerized systems that store all of your clinical data. They are often used to track and monitor your care.
Behavioral Healthcare refers specifically to a range treatment options for substance abuse or mental illness. These include counseling, medication management, and other options. Behavioral healthcare can also be provided in ambulatory care centers and hospitals.
Electronic prescribing allows pharmacists to electronically share patient records. 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 your claim meets the requirements, the insurer will reimburse. Certain insurance policies require precertification or authorization before you can receive certain services.
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 through the Department of Health and Human Services and 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 annual deductible covers your healthcare costs for the entire 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 apply to services that aren't covered, such as visits at hospitals and doctors outside your 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 account that can be used for healthcare services not covered by your plan.