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.
C
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.
D
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.
E
Emergency
A situation where your health, or the health of an unborn baby, could
be threatened. Medical help is needed right away.
G
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.
I
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.
L
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.
M
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.
O
Out-of-Network
Doctors, specialists, hospitals, pharmacies and other providers who
do not have an arrangement with your plan to provide health care services.
P
Premium
A monthly fee that you pay to stay enrolled in UnitedHealthcare.
Prescription
A doctor's written instructions for medication or treatment.
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.
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 receive them.
Provider
A person or facility that provides health care services and treatment
such as a doctor, pharmacy, dentist, clinic or hospital.
R
Referral
Process when your primary care provider requests additional care for
you from a specialist.
S
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.
