Friday, October 31
Grievance
Complaints filed by individuals regarding coverage denial which they believe to be unreasonable.
Thursday, October 30
Premium
Refers to the amount paid for health insurance, usually on a monthly basis.
Wednesday, October 29
Guest Privileges
A component of some insurance plans allowing enrollees to visit out of network doctors if they are temporarily away from home.
Tuesday, October 28
Medicare Part B
Section of Medicare that includes medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health and some home health and ambulance services.
Monday, October 27
Grandfathered Plan
A health insurance plan already in effect before the provisions of the ACA were implemented that is allowed to continue being offered to enrollees under specific circumstances.
Friday, October 24
Underinsured
Individuals who have health insurance but cannot access needed providers or cannot afford the cost sharing requirements.
Thursday, October 23
Direct Access
A provision of some health insurance plans that allows policy holders to see doctors or specialists without a referral from a primary care physician or 'gatekeeper.'
Wednesday, October 22
Staff Model HMO
A form of HMO in which the health care providers are employees of the HMO.
Tuesday, October 21
Small Business Health Options Program (SHOP)
Similar to the individual market exchanges (or marketplaces) the SHOP exchanges allow small businesses to select health plans for their employees (or contribute to employee selected health plans). As with the individual market exchanges, the SHOP exchanges can be run by the federal government or by the individual states.
Monday, October 20
Payment Bundling
A mechanism of provider payment where providers or hospitals receive a single payment for all of the care provided for an episode of illness, rather than per service. Total care provided for an episode of illness may include both acute and post-acute care.