New York Glossary
Abuse – Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.
Appeal – A formal request to review an action when you are not satisfied with a decision made by your health plan.
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 coinsurance over the eligibility year. You must pay the annual deductible before UnitedHealthcare will cover services that have coinsurance.
Emergency – A situation where your health, or the health of an unborn baby, could be threatened. Medical help is needed right away.
Grievance – Your statement of dissatisfaction with any part of your care. A grievance can be filed over the phone or in writing, and must be filed directly with your plan.
Immunization – A shot that protects from a disease.
In-Network – Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement to provide health care services to members.
Income Band – Identification of a group of members based on income and poverty level.
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.
Premium – A monthly fee that you pay to stay enrolled in UnitedHealthcare.
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 – The process of reviewing a request for services to make sure it is a necessary service or plan of treatment and providing approval for those services before you receiving them.
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.