There are many definitions of healthcare that can be confusing. We have provided the following information to assist you with your understanding of 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 can store electronic medical records. You will only need the services of providers in your network. If you need to see a provider outside of your network, you may be charged more. There may be 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. Unlike a PPO, however, your benefits are not based on your network. Your insurance will only cover services provided if you see a provider not in the network.
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. Patients are encouraged to take part in their own care. A patient might choose to consult with a doctor by phone or get a second opinion.
Electronic Medical Records (EMRs) are computerized systems that store all your clinical data. They are typically used to monitor and record your health care, with a deductible or copayments.
Behavioral healthcare is a term that refers to a range of treatment options for substance and mental abuse. Counseling and medication management are two examples. You can find ambulatory or hospital-based behavioral healthcare.
Electronic prescribing allows pharmacies and doctors to electronically share patient data. Electronic prescribing utilizes computerized systems that transfer prescription information from a physician to a pharmacist.
Your claims may be reviewed by insurance companies before being paid. If the claim meets the required standards, the insurer will reimburse you. Some insurance plans require preauthorization or precertification before you can receive certain procedures.
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 at the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The Affordable care Act (ACA), mandates that health plans must provide basic coverage. 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 include visits to hospitals or doctors out of network. In addition, your deductible applies only to the amount of care received while you are being hospitalized.
Lastly, if you have a health savings account (HSA), you can use your funds to cover any healthcare expenses that your health plan does not cover. HSAs are tax-advantaged savings accounts that can be used to pay for healthcare services that are not covered by your health plan.