Navigating the Health Insurance Landscape by Robert Adziashvili - HTML preview

Navigating the Health Insurance Landscape

Pri mary Care Physi c i an ( PCP) : A do c t o r who pro v i des gen eral medi c al c are an d c o o rdi n at es referral s t o spec i al i st s.

S pec i al i st : A do c t o r who fo c uses o n a spec i fi c area o f medi c i n e o r a spec i fi c medi c al c o n di t i o n .

Preaut ho ri z at i o n : Appro v al fro m t he i n suran c e c o mpan y befo re rec ei v i n g c ert ai n medi c al serv i c es o r t reat men t s.

In -Net wo rk : Heal t hc are pro v i ders o r fac i l i t i es t hat hav e a c o n t rac t wi t h yo ur i n suran c e c o mpan y t o pro v i de serv i c es at a di sc o un t ed rat e.

O ut -o f-Net wo rk : Heal t hc are pro v i ders o r fac i l i t i es t hat do n o t hav e a c o n t rac t wi t h yo ur i n suran c e c o mpan y, resul t i n g i n hi gher o ut -o f-po c k et c o st s fo r yo u.

E xpl an at i o n o f Ben efi t s ( E O B) : A do c umen t t hat expl ai n s t he c o st s c o v ered an d t he amo un t s yo u may o we aft er rec ei v i n g medi c al serv i c es.

Pre E xi st i n g Co n di t i o n : A heal t h c o n di t i o n t hat yo u had befo re gett i n g heal t h i n suran c e c o v erage.

O pen E n ro l l men t Peri o d: A spec i fi ed t i me frame duri n g whi c h i n di v i dual s c an en ro l l i n o r mak e c han ges t o t hei r heal t h i n suran c e c o v erage.

Affo rdabl e Care Ac t ( ACA) : A l aw t hat ai ms t o i mpro v e ac c ess t o heal t h i n suran c e an d heal t hc are serv i c es i n t he U n i t ed S t at es.

Heal t h S av i n gs Ac c o un t ( HS A) : A t ax-adv an t aged sav i n gs ac c o un t t hat c an be used t o pay fo r medi c al expen ses.