Glossary Of Health Coverage And Medical Terms Page 3
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4Plan
Provider
A benefit your employer, union or other group sponsor
A physician (M.D. – Medical Doctor or D.O. – Doctor
provides to you to pay for your health care services.
of Osteopathic Medicine), health care professional or
health care facility licensed, certified or accredited as
Preauthorization
required by state law.
A decision by your health insurer or
plan
that a health
Reconstructive Surgery
care service, treatment plan,
prescription drug
or
durable
medical equipment
is
medically
necessary. Sometimes
Surgery and follow-up treatment needed to correct or
called prior authorization, prior approval or
improve a part of the body because of birth defects,
precertification. Your
health insurance
or plan may
accidents, injuries or medical conditions.
require preauthorization for certain services before you
Rehabilitation Services
receive them, except in an emergency. Preauthorization
isn’t a promise your health insurance or plan will cover
Health care services that help a person keep, get back or
the cost.
improve skills and functioning for daily living that have
been lost or impaired because a person was sick, hurt or
Preferred Provider
disabled. These services may include physical and
A
provider
who has a contract with your health insurer or
occupational therapy, speech-language pathology and
plan
to provide services to you at a discount. Check your
psychiatric rehabilitation services in a variety of inpatient
policy to see if you can see all preferred providers or if
and/or outpatient settings.
your
health insurance
or plan has a “tiered”
network
and
you must pay extra to see some providers. Your health
Skilled Nursing Care
insurance or plan may have preferred providers who are
Services from licensed nurses in your own home or in a
also “participating” providers. Participating providers
nursing home. Skilled care services are from technicians
also contract with your health insurer or plan, but the
and therapists in your own home or in a nursing home.
discount may not be as great, and you may have to pay
more.
Specialist
A physician specialist focuses on a specific area of
Premium
medicine or a group of patients to diagnose, manage,
The amount that must be paid for your
health insurance
prevent or treat certain types of symptoms and
or plan. You and/or your employer usually pay it
conditions. A non-physician specialist is a
provider
who
monthly, quarterly or yearly.
has more training in a specific area of health care.
Prescription Drug Coverage
UCR (Usual, Customary and Reasonable)
Health insurance
or
plan
that helps pay for
prescription
The amount paid for a medical service in a geographic
drugs
and medications.
area based on what
providers
in the area usually charge
for the same or similar medical service. The UCR
Prescription Drugs
amount sometimes is used to determine the
allowed
Drugs and medications that by law require a prescription.
amount.
Primary Care Physician
Urgent Care
A physician (M.D. – Medical Doctor or D.O. – Doctor
Care for an illness, injury or condition serious enough
of Osteopathic Medicine) who directly provides or
that a reasonable person would seek care right away, but
coordinates a range of health care services for a patient.
not so severe as to require
emergency room
care.
Primary Care Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor
of Osteopathic Medicine), nurse practitioner, clinical
nurse specialist or physician assistant, as allowed under
state law, who provides, coordinates or helps a patient
access a range of health care services.
Glossary of Health Coverage and Medical Terms
Page 3 of 4
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