UnitedHealthcare Community Plan Glosè

Abuse

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

Direktiv Davans

Se yon desizyon ou pran davans sou swen sante w pou si jamè ou pa ta anmezi pou pale pou tèt ou. Sa ap pèmèt fanmi ou ak doktè yo konnen ki desizyon ou ta pran si ou te anmezi pou fè sa.

Apèl

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.

Otorizasyon

An O.K. or approval for a service.

Avantaj yo

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

Jesyon Swen Klinik

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

Anilasyon Enskripsyon

To stop your membership in UnitedHealthcare Community Plan.

DME

Durable Medical Equipment includes things such as wheelchairs, walkers, diabetic glucose meter, IV poles that have to be used for a length of time. It can also be equipment that must be thrown away such as bandages, catheters and needles. DME must be requested by your doctor.

Ijans

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)  significant impairment to a bodily function, 3) permanent damage to a body part or health of unborn child.

Fwòd

Yon zak ki fo (egzanp: si yon moun ki pa oumenm itilize kat ID ou, epi li fè tankou li se oumenm).

Doleyans

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.

Enfòmasyon sou Sante

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

Kat ID

An identifcation card that says you are a UnitedHealthcare Community Plan member. Ou ta dwe gen kat sa a avèk ou toutan.

Immunization

A medicine (usually a shot) that protects, or "immunizes" a member from a disease. Children should receive different shots at different ages. These shots are often given during regular doctor visits.

In-Network

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

Konsantman Reflechi

That all medical treatments have been explained to you; you understand and agree to them.

Pasyan entène

Lè yo admèt ou nan yon lopital pandan yon peryòd tan.

Manm

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

ODJFS

Ohio Department of Job and Family Services

OhioRISE

OhioRISE is a specialized Medicaid health plan for youth with complex behavioral health needs. This program provides behavioral healthcare services to eligible youth. Children and youth who are eligible are under the age of 21 and demonstrate the need for additional behavioral health care as identified through the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) assessment or a recent inpatient admission for mental health or substance use disorder services.

OhioRISE expands access to in-home and community-based services to ensure eligible children and youth and their families have the tools and supports they need to grow and thrive.

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.

Prescription

A doctor's written instructions for medication or treatment.

Founisè swen prensipal (PCP, Primary Care Provider)

A doctor you choose to be your primary care provider who has his/her own private practice. Your PCP will coordinate all of your health care.

Otorizasyon Davans

Process that your doctor uses to get approval for services that need to be approved before they can be done. Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay.

Anyè Founisè

Yon lis founisè ki patisipe nan UnitedHealthcare Community Plan pou ede satisfè bezwen swen sante ou.

Provider or Practitioner

A person or facility that offers health care (doctor, pharmacy, dentist, clinic, hospital, etc.).

Referans

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

Sèvis Oto-Refere

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

Espesyalis

Any doctor who has special training for a specific condition or illness.

Swen Ijan

Yon lòt posiblite pou itilize nan ka ki pa ijans alaplas swen nan depatman dijans nan lopital. Yo itilize yo lè pwoblèm sante yo ijan, men yo pa menase sante oswa lavi.

WIC

Pwogram Manje Siplemantè pou Fanm, Tibebe ak Timoun, ki bay konsèy sou nitrisyon, edikasyon sou nitrisyon, ak manje nourisan pou fanm ansent ak apre akouchman, pou tibebe ak pou timoun jouk rive nan laj 2. Timoun yo konsidere ki gen defisyans nitrisyonèl yo kouvri jouk rive nan laj 5 si yo gen revni fèb epi yo konsidere yo arisk sou plan nitrisyonèl.