MississippiCAN Glossary

A

  • Abuse

    Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.

  • Adverse Benefit Determination

    A decision to deny or limit authorization or payment (in whole or part) for health care services, including new authorizations and previously authorized services; the reduction, suspension, or termination of a previously authorized service; or the failure to provide services in a timely manner; failure to resolve Complaints, Grievances, or Appeals within the time frames specified.

  • Apela

    An appeal is your request for UnitedHealthcare to review an Adverse Benefit Determination.

C

  • Complaint

    An expression of dissatisfaction received orally or in writing that is of a less serious or formal nature that is resolved within one (1) business day of receipt.

  • Coordinated Care Organization

    A company with healthcare providers and services.

  • Copayment

    Copayments (copays) are a dollar amount that you pay to the doctor at your visit. You do not have copayments if you are a member of UnitedHealthcare Community Plan who is enrolled in the MS CAN program.

E

  • Emergency

    A sudden and unexpected change in physical or mental health which, if not treated right away, could result in 1) loss of life or limb, 2) impairment to bodily function, or 3) permanent damage to a body part.

G

  • Daing

    Ang iyong pahayag ng hindi pagkakuntento sa anumang bahagi ng iyong pangangalaga. Ang isang daing ay maaaring maisampa sa pamamagitan ng pagtawag sa telepono o sa pagsulat, at dapat na maisampa nang direkta kasama ang inyong plano.

H

  • Impormasyong Pangkalusugan

    Facts about your health care. This may come from UnitedHealthcare or a provider. It includes information about your physical and mental health, as well as payments for health care.

I

  • Immunization

    A shot that protects from a disease. Children should get a variety at specific ages. Shots are often given during regular doctor visits.

  • Nasa network

    Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement with UnitedHealthcare to provide health care services to Mississippi members.

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.

  • Miyembro

    An eligible person enrolled in the UnitedHealthcare through MississippiCAN.

O

  • Out-of-Network

    Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with UnitedHealthcare to provide health care services to Mississippi members.

P

  • Prescription

    Isang nakasulat na mga tagubilin ng doktor para sa gamot o panggagamot.

  • 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

    Approval for services not normally covered by UnitedHealthcare that your doctor must receive before providing those services.

  • 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

    Sinumang doktor na mayroong espesyal na pagsasanay para sa isang tukoy na kundisyon o sakit.

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