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.
Coordinated Care Organization - a company with healthcare providers and services.
Copayment - Copayments (copays) are a dollar amount that you pay to the doctor at your visit. You do not have copayments if you are a member of UnitedHealthcare Community Plan who is enrolled in the MS CAN program.
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. This may come from UnitedHealthcare or a provider. It includes information about your physical and mental health, as well as payments for health care.
Immunization - A shot that protects from a disease. Children should get a variety at specific ages. Shots are often given during regular doctor visits.
In-Network - Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement with UnitedHealthcare 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 through MississippiCAN.
Out-of-Network - Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with UnitedHealthcare 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.
Referral - Process when your primary care provider requests additional care for you from a specialist.
Second Medical Opinion - A review of a medical condition that is done by another doctor.
Specialist - Any doctor who has special training for a specific condition or illness.