UnitedHealthcare Connected® for MyCare Ohio H2531-001 Glossary

A

  • Abuse

    Harming someone on purpose (this includes yelling, ignoring a person's needs and inappropriate touching).

  • Advance Directive

    Isang pasya sa iyong pangangalagang pangkalusugan na iyong paunang ginawa sa sandaling hindi mo na magagawang magsalita para sa iyong sarili kailanman. This will let your family and your doctors know what decisions you would make if you were able to.

  • Appeal

    An appeal is a dispute made by a member, his or her representative or a provider with the member's permission, challenging an action by the health plan to deny or limit authorization of a service, including the type or level of service or reduce, suspend, or terminate payment for a previously authorized service; or any failure to authorize services in a timely manner or decide a grievance or appeal within the required time frames.

  • Pagpapahintulot

     Isang O.K. o pag-apruba para sa isang serbisyo.

B

  • Mga Benepisyo

    Services, procedures and medications that UnitedHealthcare Community Plan will cover for you.

C

  • Clinical Care Management

    One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan benefits, tailored to your needs.

D

  • Disenrollment

    To stop your membership in UnitedHealthcare Community Plan.

  • DME

    Kabilang sa matibay na medikal na kasangkapan ang mga bagay gaya ng mga wheelchair, walker, diabetic glucose meter, IV pole na kailangang gamitin sa isang partikular na haba ng panahon. It can also be equipment that must be thrown away such as bandages, catheters and needles. DME must be requested by your doctor.

E

  • Emergency

    A sudden and, at the time, unexpected change in a person's physical or mental condition which, if a procedure or treatment is not performed right away, could be expected to result in 1) the loss of life or limb, 2) signifcant impairment to a bodily function, 3) permanent damage to a body part or health of unborn child.

F

  • Panloloko

    Isang hindi tapat na pagkilos (halimbawa: kung ginamit ng ibang tao maliban sa iyo ang iyong ID card ng miyembro at nagpanggap na ikaw).

G

  • Grievance

    A grievance is an expression of dissatisfaction about the health plan, or a practitioner or any matter other than an action taken by the plan. Grievances can include issues with the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect a member's rights.

H

  • Impormasyong Pangkalusugan

    Mga katotohan tungkol sa iyong kalusugan at pangangalaga. This information may come from UnitedHealthcare Community Plan or a provider. May kasama itong impormasyon tungkol sa iyong pisikal na kalusugan at kalusugan ng pag-iisip, gayundin ang mga pagbabayad para sa pangangalaga.

I

  • ID Card

    An identifcation card that says you are a UnitedHealthcare Community Plan member. Dapat na nasa iyo ang card na ito sa lahat ng oras.

  • Immunization

    A medicine (usually a shot) that protects, or "immunizes" a member from a disease. Dapat makatanggap ang mga bata ng iba't ibang bakuna sa iba't ibang edad. Kadalasang ibinibigay ang mga bakunang ito sa mga regular na pagbisita sa doktor.

  • Nasa network

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

  • Informed Consent

    Na naipaliwanag sa iyo ang lahat ng medikal na panggagamot; naunawaan mo at sumang-ayon ka sa mga ito.

  • Inpatient

    Kapag ipinasok ka sa isang ospital sa isang partikular na haba ng panahon.

M

  • Miyembro

    An eligible person enrolled with UnitedHealthcare Community Plan in the Medicaid program.

O

  • ODJFS

    Ohio Department of Job and Family Services

  • Out-of-Network

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

P

  • Prescription

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

  • Primary Care Provider (PCP)

    Isang doktor na iyong pinili upang maging iyong provider ng pangunahing pangangalaga na mayroong sariling pribadong pagsasanay. Your PCP will coordinate all of your health care.

  • Prior Authorization

    Prosesong ginamit ng iyong doktor upang makakuha ng pag-apruba para sa mga serbisyo na kailangang maaprubahan bago maisagawa ang mga ito.

  • Provider Directory

    A list of providers who participate with UnitedHealthcare Community Plan to help take care of your healthcare needs.

  • Provider or Practicioner

    Isang tao o pasilidad na nag-aalok ng pangangalagang pangkalusugan (doktor, botika, dentista, klinika, ospital, atbp.).

R

  • Referral

    When you and your PCP agree you need to see another doctor and your PCP sends you to a network specialist.

S

  • Self-Referred Services

    Services for which you do not need to see your PCP for a referral.

  • Specialist

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

U

  • Urgent Care

    Kapag mayroon kang sakit ngunit hindi isang emergency, at nangangailangan ka ng panggagamot o payong medikal sa loob ng 48-oras na panahon.

W

  • WIC

    Supplemental Food Program for Women, Infants and Children which provides nutrition counseling, nutrition education, and nutritious foods to pregnant and postpartum women, infants and children up to the age of 2. Children deemed nutritionally deficent are covered up to age 5 if they are low income and are determined to be at nutritional risk.

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UnitedHealthcare Connected® for MyCare Ohio H2531-001

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