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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Community Plan

Glossary

 

A

Abuse – Harming someone on purpose (this includes yelling, ignoring a person's need and inappropriate touching).

Advance Directive – A decision you make ahead of time about your health care in case you’re ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

Appeal – A formal request for UnitedHealthcare Community Plan to review a decision we made or an action we took.

Authorization – An O.K. or approval for a service.

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B

Benefits – Services, procedures and medications UnitedHealthcare Community Plan will cover for you.

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C

Clinical Case Management – One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan benefits, tailored to your needs.

Complaint – When you call us to say you are unhappy about something, but don't want to take any formal action.

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D

Disenrollment – To stop your membership in UnitedHealthcare Community Plan.

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E

Emergency – A sudden and, at the time, unexpected change in a person's physical or mental condition which, if a procedure or treatment is not performed right away, could be expected to result in 1) the loss of life or limb, 2) significant impairment to a bodily function, or 3) permanent damage to a body part.

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F

Fraud – An untruthful act (example: if someone other than you uses your member ID card and pretends to be you).

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G

Grievance – When a member is unhappy with any part of his/her care. A grievance can be filed by phone or in writing.

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H

Health Information – Facts about your health and care. This information may come from UnitedHealthcare or a provider. It includes information about your physical and mental health, as well as payments for care.

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I

ID card – An identification card that says you are a UnitedHealthcare Community Plan member. You should have this card with you at all times.

Immunization – A shot that protects, or "immunizes", a member from a disease. Children should receive different shots at different ages. These shots are often given during regular doctor visits.

Informed Consent – That you agree to all medical treatments.

In-Network – Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement with UnitedHealthcare Community Plan to provide health care services to members.

Inpatient – When you are admitted to a hospital, or services you get after being admitted to a hospital.

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J

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K

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L

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M

Medically Necessary – A service that (1) prevents, diagnoses or treats a physical or mental illness or injury; strives to ensure age-appropriate growth and development; minimizes the worsening of a disability; or attains, maintains, or regains functional capacity according to accepted standards of practice in the medical community, (2) cannot be omitted without adversely affecting the member’s condition or the quality of medical care rendered, and (3) is furnished in the most appropriate setting.

Member – An eligible person enrolled with UnitedHealthcare Community Plan in the Medicaid or DHCP programs.

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N

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O

Out-of-Network – Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with UnitedHealthcare Community Plan to provide health care services to members.

Outpatient – When you have a procedure done that does not require an overnight hospital stay.

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P

Prescription – A doctor's written instructions for medication or treatment.

Primary Care Provider (PCP) – The doctor who is your physician and takes care of most of your health needs.

Provider or Practitioner – A person or facility that offers health care (doctor, pharmacy, dentist, clinic, hospital, etc.).

Provider Directory – A list of providers who participate with UnitedHealthcare Community Plan to help take care of your health needs.

Prior Authorization – Process your doctor uses to get approval for services that are not normally covered.

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Q

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R

Referral – When you and your PCP agree you need to see another doctor and your PCP sends you to a network specialist.

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S

Self-Referred Services – Services for which you do not need to see your PCP for a referral.

Special Needs Unit (SNU) – A service offered by UnitedHealthcare that can help you understand and use your benefits if you have a disability or other special need.

Specialist – Any doctor who has special training for a specific condition or illness.

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T

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U

Urgent Care – When you need care, treatment or medical advice within 48 hours.

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V

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W

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X

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Y

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Z

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