Causing a person harm on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.
Appeal
A formal complaint made where a member is not satisfied with a decision made by UnitedHealthcare Community Plan.
Arizona Health Care Cost Containment System (AHCCCS)
The state agency that manages health care programs and covered health care services provided through contracted health plans.
Arizona Long Term Care System (ALTCS)
An AHCCCS program that delivers long term care to members. Members under ALTCS are elderly, have physical disabilities or developmental disabilities.
B
Behavioral Health Crisis
A situation where, without immediate help, you might hurt yourself or someone else.
Behavioral Health Services
Behavioral health services may include behavior management, group, family and individual therapy and counseling, and emergency/crisis services.
C
Co-payment
A small charge or fee due at the time covered services are provided.
D
Department of Economic Security (DES)
The state agency that determines if a person is eligible for Medicaid.
E
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
A health care program for children up to age 21.
Emergency
A situation where a person's health, or the health of an unborn baby, could be threatened. Medical help is needed right away.
F
Fraud
Lying in order to receive AHCCCS benefits. This including lying about personal information to qualify for AHCCCS benefits. Doctors may commit fraud by lying about services provided and then sending AHCCCS a bill.
G
Grievance
A member's expression of dissatisfaction with any part of their care. A grievance can be filed over the phone or in writing. Grievances must be filed directly with UnitedHealthcare Community Plan, not AHCCCS.
H
Health Information
Facts about a member's health care. This information may be received or created by UnitedHealthcare Community Plan or a provider. It includes information about a member's physical and mental health, as well as payments for health care.
Health Insurance Flexibility and Accountability Act (HIFA)
Offers health care coverage to families with and without children who do not qualify for Medicaid.
Healthcare Power of Attorney
Someone to whom you have given the authority to make health care decisions for you if you cannot make them (usually a close friend, relative or spouse).
High-risk pregnancy
A pregnancy for which the mother or baby may be at higher risk for illness or death.
K
KidsCare
AHCCCS program that provides health care coverage to children under age 19. KidsCare is for children who do not have health insurance and would not qualify for Medicaid.
L
Licensed midwife
A person licensed by the Arizona Department of Health Services to provide maternity care. This does not include certified nurse midwives.
Living Will
A document where you write 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. It can also tell your doctor whether or not to make special efforts to save your life.
M
Mammogram
Screening exam for breast cancer. Recommended for women over the age of 35.
Managed Care
A health plan that works like an HMO. Covered services are provided by providers who contract with the health plan.
Maternity care
Includes medically necessary pregnancy counseling, pregnancy testing, prenatal care, labor and delivery services, as well as care after delivery.
Maternity care coordination
Coordination of the mother's needs to ensure her and her baby receive all the necessary care for a healthy pregnancy and delivery.
Medical Necessity
Health care or products that a prudent, or wise, doctor would give to a patient to prevent, diagnose, or treat an illness, injury, disease or its symptoms in a way that follows generally accepted standards for medicine and is not just for the convenience of the patient, physician or other health care provider.
Member
An eligible person enrolled in AHCCCS who has selected UnitedHealthcare Community Plan as their health plan.
P
Postpartum care
Health care provided to the mother for up to 60 days after delivery.
Practitioner
Refers to a certified nurse practitioner, midwife, or physician assistant.
Preconception counseling
This counseling focuses on finding and managing risk factors before pregnancy. The purpose is to make sure that a woman is healthy before pregnancy.
Prenatal care
Health care provided during the pregnancy.
Prescription
A doctor's written instructions for medication or treatment.
Primary Care Physician (PCP)
The doctor who treats the member directly. The PCP may refer the member to a specialist or admit the member to a hospital. PCPs are usually family practitioners, internists, pediatricians, and sometimes nurse practitioners and physicians assistants, but may also include obstetricians and certified nurse midwives for pregnant members.
Prior Authorization
Process by which your PCP or specialist contacts UnitedHealthcare Community Plan for approval to provide special services such as surgery.
Provider
A person or facility that provides health care services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.
Provider Network
Doctors, specialists, hospitals, pharmacies and other providers who work with UnitedHealthcare Community Plan to provide health care services to UnitedHealthcare Community Plan members.
R
Referral
Process by which your PCP requests additional care for you from a specialist.
Regional Behavioral Health Authority (RBHA)
Place where you go for behavioral health services.
S
Seriously Mentally Ill (SMI)
Any person who, as a result of a serious mental disorder, has emotions or behaviors that prevent them from performing everyday activities.
Service Area
A geographic area, usually one or two adjoining counties, where UnitedHealthcare Community Plan has a contract with AHCCCS to arrange covered health care services to members enrolled with UnitedHealthcare Community Plan.
Sixth Omnibus Budget Reconciliation Act (SOBRA)
An eligibility category for pregnant women and children of certain ages. Eligibility is based on different Federal Poverty Income Levels. If you are pregnant, contact DES to see if you are eligible. Contact your DES Case Worker to help determine if any of your children are eligible.
Special Health Care Needs
Members who have serious and chronic physical, developmental or behavioral conditions who require a special type or amount of care.
Specialist
Any doctor who has special training for a specific condition or illness. UnitedHealthcare Community Plan: The AHCCCS health plan you are enrolled with to help provide the medically necessary health care treatment and services you need.
U
Urgent Care
Care provided to members when their situation is not life threatening, but cannot wait until the next day for treatment.
W
WIC
A community program that provides food, nutrition counseling and access to health services to low income women, infants and children.
