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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Community Plan M*Plus (MMA)

Glossary



A

Advance Directive - A decision about your health care that you make ahead of time in case you are 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 - You can file an appeal if you are not happy with a decision we made ("denial"). A denial is when we say no to a service you or your doctor asked us to give you. It could also be when we don't give you as much of a service you wanted. For example, you can file an appeal if your doctor wanted a drug we do not allow. You can also file if we didn't approve a hospital stay. If you are not happy but it is not because we said no to what you asked for, you can file a grievance.

ASC/SPU - Ambulatory surgical center / short procedure unit

Authorization - An approval for a service.

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B

Benefits - Services, procedures and medications that UnitedHealthcare will cover for you.

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C

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

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D

Disenrollment- To stop your membership in UnitedHealthcare.

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E

Emergency - When you reasonably believe that your health is in serious danger.

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F

Fraud - An untruthful act – an example is someone other than you using your UnitedHealthcare member ID card and pretending to be you.

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G

Grievance - You can file a grievance when you are not happy. This can be when you are not happy with our plan, or our providers, or anything other than an "action". For example, you may file a grievance if you have a problem making an appointment with a provider or have trouble finding a provider. You can file if you think you are not getting good care. You can also file if a doctor is sending you bills for services you get with our Plan. You can file an appeal If you are not happy with a decision we made (an 'action') (see Appeal).

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H

Home Health Agency - A company contracted by UnitedHealthcare to provide care for you in your home.

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I

ID card- Identification card – a card that says you are a UnitedHealthcare member. You should have this card with you at all times.

Informed Consent - Doctors give you information about a particular treatment or test in order for you to decide whether or not you wish to have the treatment or test

Inpatient - When you are admitted into a hospital for a length of time.

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J

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K

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L

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M

Medical Necessity - Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.

Member - A person who is eligible for UnitedHealthcare.

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N

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O

Outpatient - When you have a procedure done that does not require a hospital stay overnight. . In some cases, you may stay overnight in the hospital but not be admitted as an inpatient.

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P

Provider - Any medical professional that UnitedHealthcare has contracted with to take care of you.

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

Primary Care Provider (PCP) - A doctor you choose to be your family physician. They have their own private practices or work in a clinic.

Prior Authorization - The process for any service that needs an approval from UnitedHealthcare before it can take place.

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Q

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R

Referral - When you and your primary care doctor agree you need to see another doctor, your primary care doctor will send you to a UnitedHealthcare specialist.

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S

Self-Referred Services - Services for which you do not need to see your primary care doctor for a referral.

Specialist - A doctor that has specific, detailed training in one certain medical field.

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T

Treatment - The care that you may receive from doctors and facilities.

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U

Urgent care - When you need care, treatment or medical advice within a 24-hour time period.

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V

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W

WIC - Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.

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X

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Y

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Z

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For more information on Florida Medicaid, download the Florida Medicaid Reference Guide (PDF 268.33 KB)(PDF 268.33 KB) .

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UnitedHealthcare Community Plan M*Plus (MMA)