Abuse - Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.
Adverse Benefit Determination - A decision to deny or limit authorization or payment (in whole or part) for health care services, including new authorizations and previously authorized services; the reduction, suspension, or termination of a previously authorized service; or the failure to provide services in a timely manner; failure to resolve Complaints, Grievances, or Appeals within the time frames specified.
Appeal - An appeal is your request for UnitedHealthcare to review an Adverse Benefit Determination.
Complaint - An expression of dissatisfaction received orally or in writing that is of a less serious or formal nature that is resolved within one (1) business day of receipt.
Coinsurance - A percentage of the cost of a service that you must pay to the provider for that service.
Copayment - Copayments (copays) are a dollar amount that you pay to the doctor at your visit.
Deductible - The annual deductible is the total amount of money you must pay for some services that require copays over the eligibility year. You must pay the annual deductible before UnitedHealthcare will cover services that have copays.
Emergency - A sudden and unexpected change in physical or mental health which, if not treated right away, could result in 1) loss of life or limb, 2) impairment to bodily function, or 3) permanent damage to a body part.
Grievance - Is an expression of dissatisfaction about any matter other than an Adverse Benefit Determination. A grievance can be filed over the phone or in writing, and must be filed directly with your plan.
Health Information - Facts about your health care you can receive from your provider. It includes information about your physical and mental health, as well as payments for health care.
In-Network - Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement to provide health care services to Mississippi members.
Living Will - A document that tells what you want done with your health care. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want, and whether or not to make special efforts to save your life.
Medically Necessary - Services that are required to maintain your health and by not receiving those services, could affect your condition or quality of care.
Member - An eligible person enrolled in the UnitedHealthcare Health Plan.
Out-of-Network - Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with your plan to provide health care services to Mississippi members.
Primary Care Provider (PCP) - The doctor who treats you for all normal health care needs. Your PCP may refer you to a specialist or admit you to a hospital. PCPs are usually family practitioners, internists, pediatricians, and sometimes nurse practitioners and physician’s assistants, and can include Obstetricians and certified nurse midwives for pregnant members.
Prescription - A doctor's written instructions for medication or treatment.
Prior Authorization - Approval for services not normally covered by UnitedHealthcare that your doctor must receive before providing those services.
Provider - A person or facility that provides health care services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.
Specialist - Any doctor who has special training for a specific condition or illness.