When traveling to a foreign country, you’d expect to interact with people who speak a different language. To prepare, you might brush up on words and phrases to get you through your trip without having an awkward encounter with a waiter or cab driver that leaves both sides feeling helpless. You might even download a language translator app and have it ready to go on your smart phone.
However, you take no such precautions when going to the doctor.
It’s my doctor! We speak the same language … right?
When heading to the doctor’s office, you don’t anticipate needing to know a different language to understand what’s being discussed. But I’m not talking about the type of language that you study in grade school and use during a European excursion.
The language I’m talking about is health care terminology.
Understanding the conversation is important.
There are many reasons why it’s important to know what is being communicated between you and your doctors, nurses, and pharmacists. Understanding the language will help you:
- Save money
- Find and receive proper treatment
- Understand what your next steps are after a diagnosis
- Correctly follow directions for taking medications
Your next visit with your doctor doesn’t need to feel like you’re roaming through a foreign country without a translator. Use this glossary of health care terms to keep you from getting lost in the conversation.
Health Care Services
Routine or preventive visits are usually scheduled appointments that include a checkup, screenings, and counseling. They do not include tests or services to monitor or manage a condition or disease once it has been diagnosed. Depending on your plan type, the care provided during these visits is often covered at no out-of-pocket costs.
Different from a routine or preventive visit, a non-routine or sick visit is used to detect or treat a medical diagnosis. The care received during a sick visit is also billed differently than a preventive exam and may result in out-of-pocket costs.
A medical diagnosis is the identification of an illness. Sometimes, medical diagnoses are made when you’re not necessarily looking for them, like at your annual checkup. If this occurs, you may be charged a copay or coinsurance, as this falls outside your normal checkup.
ER, Urgent Care, or PCP?
While you may be familiar with the terms emergency room (ER), urgent care, and primary care physician (PCP), do you know which to visit for a health issue – and when?
Deciding the best course of action can be critical for getting the most effective care for your medical needs. A PCP knows your medical history and can treat you with your unique health needs in mind, while an urgent care facility can be very convenient when your doctor’s office is closed. Of course, the ER is the best option when emergency care is needed.
Making the right choice can also save you money. While you should always go to the ER for serious health emergencies, visiting your PCP is a more cost-effective option under normal circumstances.
Care coordination involves the sharing of information among different health care providers (primary care physicians, your health insurance company, etc.) to ensure that you receive the appropriate health care services.
Health care services that you would receive to learn or improve skills and functioning. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities. Habilitation services are held in a variety of inpatient and/or outpatient settings.
Example: Therapy for a child who isn’t walking or talking at the expected age.
Health care services to help regain skills and functioning. If you’ve been sick, hurt, or disabled and lost skills or functions as a result, you might utilize rehabilitation services. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services.
Services that provide comfort and support in the last stages of a terminal illness. These services can be offered at a person’s home, at a nursing home, or in a hospital.
Outpatient Care/Ambulatory Care
Care in a hospital that doesn’t require an overnight stay. Examples of hospital outpatient services include lab tests, physical therapy, minor surgeries, and X-rays. Outpatient services typically cost less than inpatient services since they do not require a patient to stay at a health care facility for an ongoing amount of time.
Enhanced Primary Care (EPC)
A CDPHP-exclusive program that increases the value and quality of patient care, all while offering a unique payment model that encourages primary care doctors to spend more time with their patients.
Assistance and care for a person with chronic disabilities. Long-term care supports chronic disabilities such as cancer, arthritis, asthma, eating disorders, and diabetes. These services are usually provided in a skilled nursing, intermediate care, personal care, or elder care facility.
Health care services that a licensed medical physician (M.D. – medical doctor or D.O. – doctor of osteopathic medicine) provides or coordinates. The ultimate goal of physician services is to improve or maintain patients’ health.
Admission into a hospital for health care services that usually requires an overnight stay.
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries, or medical conditions.
Skilled Nursing Care
Health care services provided by registered nurses (RNs) and/or specialized therapists (physical, speech, or occupational therapists). Skilled nursing care can support short-term needs such as a broken bone or long-term needs like cancer or asthma.
If you’re in a situation where you need ongoing health care support, a doctor may place you in confinement at a hospital, nursing facility, or other health care program location. Once in stable condition, a doctor would formally discharge you from confinement before you can leave.
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms that meet accepted standards of care.
The facilities, providers, and medical suppliers your health insurance company has contracted with to provide health care services. A network could range from a primary care physician (PCP), to a chiropractor, to a nursing home.
Preferred Providers vs. Non-Preferred Providers
To control costs, your health plan may create what’s called a network of preferred providers, which can include doctors, hospitals, pharmacies, and other health care providers, where you pay less out of pocket. These networks vary by plan type, so it’s always good to check with your health plan before visiting a health care provider in a non-emergency situation
As opposed to a preferred provider, a non-preferred provider doesn’t have an official service contract with your health plan. As a result, you’ll pay more when using a non-preferred provider. Check your insurance policy to see if you can go to all providers who have contracted with your health plan or if your health plan has a “tiered” network where you must pay extra to see select providers.
A specialist is a doctor who focuses on a specific area of health care. Some specialist examples include cardiologists (heart), dermatologists (skin), pulmonologists (lungs), and ophthalmologists (eyes).
Looking for more?
A quick overview to help you navigate paying for health care services can be found on Part 1 of the Health Care Made Easy blog. Plus, prepare for your next doctor’s visit with these resources: