Health Insurance Blog and Resources

You and many others across the United States are self-isolating or under quarantine due to COVID-19. While inconvenient, these measures will help prevent the spread of COVID-19 to keep our hospitals and ICUs from being overwhelmed. Practically speaking, what do you do if you get a UTI, feel unwell, need to follow-up with a doctor, or just need a prescription? If you already have a physician, you may be able to get your needs taken care of by simply making a call to their office. If you have health insurance, you may have other options for receiving non-emergency care. Many health insurers offer a 24-hour nurse hotline with their plans. Some plans also include access to telemedicine, so you can schedule remote appointments with doctors, receive a diagnosis, and be prescribed treatment from your home.  Even without health insurance, you can buy subscriptions to telemedicine services. GoHealth, for example, offers subscriptions to telemedicine services. Rates vary based on the kind of subscription you choose. Here's what you need to know as you evaluate telemedicine services: Telemedicine advantages Telemedicine apps Telemedicine costs Telemedicine and COVID-19 For more background on what telemedicine is, read: "What to Expect from Telemedicine" Telemedicine advantages Convenience is one of the biggest advantages of telemedicine. You don't have to take time to drive to the doctor's office and sit in the waiting room. "Telemedicine is a great option for people who value their health, yet may face barriers reaching an office appointment — childcare, time and cost of traveling to the office, taking time off of work, etc. It’s also a wonderful option for patients who would rather get cozy, grab their cup of coffee, and have their appointments in the comfort of their own home," says Ballehr. Efficiency is another advantage that goes hand-in-hand with convenience. "Telemedicine appointments are altogether more time-efficient. During a telemedicine appointment, more time is spent with the actual physician compared to an in-office visit. This means no time is wasted!" says Lisa Ballehr, DO. Telemedicine also helps overcome barriers like access to specialists and makes it easier to access medical professionals for those in rural areas. And, telemedicine also lowers risk of exposure for medical professionals and patients, which is particularly important during epidemics. For example, hospitals are using telemedicine technology to screen patients before they walk through the doors. Some apps offer screening to help people understand what risk group they're in for COVID-19. Others are working on developing at-home test kits for COVID-19. Even with these advantages, telemedicine does have limitations that in-person visits do not.  Back to Menu Telemedicine apps Telemedicine companies have downloadable apps that you can use from your phone. Check to see if your insurer works with a specific app. Depending on your plan, it may be to your advantage to use the app preferred by your insurance company. You should also check with your doctor to see if they use an app as part of their practice. Some doctors and health care systems will use telemedicine companies to follow-up with patients after they are discharged from the hospital.  To maintain a cohesive care process, check with your provider to see if they use a telemedicine app or system. This can help you maintain consistency with your care and keep your primary care doctor up to date on your health. Your preferences for maximizing your insurance coverage and receiving care from your primary care physician will affect what you look for in an app. "Some apps are intended to connect patients with the app's own providers, which can be a great option for patients who don't have a 'regular' doctor, but others are simply communication mechanisms intended to connect those with existing patient-provider relationships," says Erin Jackson, managing partner of the national health law firm Jackson LLP.  As you're looking at telemedicine apps, make sure that the app you choose is HIPPA-compliant to keep your medical information secure. "Make sure it is 100 percent HIPAA compliant. Anything sent via the internet has to be encrypted in a unique way. Make sure that the one your doctor chooses is HIPAA compliant and that your photos, video, and voice are safe," says Yuna Rapoport, MD MPH, Manhattan Eye director and assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai. Doing thorough research will help you find a good app. If you already have a health care provider, you can ask them for information on the app they use. "If patients have any concerns about their online therapy not being secure or HIPAA compliant, they should ask their therapist directly about how they are storing their records and whether their communication methods are HIPAA compliant," Haley Neidich, LCSW says. Video calls and communication are commonly used in non-medical settings. Ballehr recommends avoiding these services for medical appointments: "If patients are concerned about patient confidentiality, avoid any appointments over Skype, FaceTime, or any similar programs." In addition to security, Jackson identifies other questions to ask when choosing a telemedicine app: "Is it owned by investors or doctors? Are they aggregating the data they receive about patient encounters and monetizing it in some way? Are they HIPAA-compliant?  It's a surprise to many consumers that not all apps are legally compliant, meaning they don't protect your data and facilitate connections to providers in a way that's legally permitted. Find an app that is legit and focused specifically on offering solid, secure patient care," she says. Back to Menu Telemedicine costs You can usually download an app for free. However, you'll be charged for the services you receive. Your telemedicine costs will vary based on how you approach it. Some telemedicine services are available through a subscription. Some subscriptions include a certain amount of visits or charge per visit. Other telemedicine apps do not have a patient subscription fee. However, you'll still pay what your doctor or therapist charges for a visit. If you have health insurance, you may have some coverage for telemedicine services. Check with your insurer to learn more about how telemedicine is covered under your plan. "Patients can reach out to their insurance companies directly to ask about coverage for teletherapy services, and whether coverage is possible under their plan or in their state. They should be sure to ask the frequency and number of total sessions that they are covered for, and clarify which mental health providers are covered," says Neidich. If you're concerned about coverage, it's best to reach out to your insurance company before you receive care. "Patients should definitely check with their insurance company before incurring the charge, as some insurance companies will deny a claim for services that are not covered and not pre-approved," advises Kay Van Wey, board certifed personal injury trial lawyer. Back to Menu Telemedicine and COVID-19 COVID-19 has resulted in increased interest and use of telemedicine. As you explore telemedicine during this time, here are a few things to keep in mind. Telemedicine is feeling a lot of growing pains. Before COVID-19, telemedicine was becoming more and more common. It helped make accessing care in rural areas easier, especially for seeing specialists. It also made it easier to see a doctor for homebound individuals.  However, due to the COVID-19 pandemic and moves to lower exposure risk, telemedicine companies are experiencing unprecedented demand and moving quickly to meet it. More people are looking for telemedicine services to avoid being exposed to whatever germs are at the doctor's office. Medical professionals are also using telemedicine services to screen for COVID-19 patients before they come into the hospital. To accomodate for the rapidly increasing demand, telemedicine app companies are hiring more doctors. However, one tricky aspect of meeting this demand is that doctors are required be licensed in the states where they practice medicine or where their patients live. Rules around telemedicine are changing because of COVID-19.  Some new, temporary rules are requiring expanded coverage for telemedicine services by insurers. Federal rules have changed to permit telemedicine coverage by Medicare. This shift is an important protection for elderly, who are at a higher risk for this virus. However, even this positive step doesn't benefit all equally.  For example, community health centers are exempt from this change. This omission affects 81,000 seniors in Pennsylvania. Whether or not Medicaid covers telemedicine is being decided by each state. Check your state laws to see if your state has additional changes to require insurers to cover telemedicine during the COVID-19 pandemic. Your insurer should also have this information. However, as the situation with COVID-19 changes daily, your insurer's representatives may not always be aware of the most recent changes. "Many insurance companies are now offering telehealth parity — this means that if a service would've been covered for an in-office visit, it's required to be covered at the same rate for occurring via telehealth. If your doctor's office is asking you to pay upfront in full for a telehealth visit and won't file it with your insurance like they would a normal in-office visit, that should raise a red flag that your doctor isn't up on recent changes that the government and insurers have enacted with the COVID-19 pandemic," says Jackson.  Since insurer choices and state laws can vary, check with your insurer to see how it's covering telemedicine services during this crisis. You should also be aware of any legal changes that have been made to accomodate self-isolation practices. "If you get a denial from your health insurance company for a telemedicine visit during this COVID-19 public health  emergency, you should report them to your state Board of Insurance.  During this public health crisis, 'we’re all in this together' must mean that health insurers and HMOs make it easy and affordable for patients to see their healthcare providers virtually and not have to break social distancing rules in order to receive routine medical care," says Van Wey. As you navigate telemedicine during the crisis, don't overlook security and privacy protections. "It's also crucial to mention that providers should be careful to comply with their privacy and security obligations. HIPAA has been loosened in some respects, but there's really no reason for a typical provider to offer care via a medium that falls below HIPAA's standards. Aside from creating potential liability for your practice, it puts your patients' privacy at risk," reminds Jackson.

How you use telemedicine and the kind of doctor you're seeing will affect what you should expect from an appointment. For example, there may not be much difference between a telemedicine therapy session and an in-person one.  However, there are more differences between an in-person visit with a primary care physician and a telemedicine one. "Depending on where you get seen, you may still interact with a nurse at the beginning of the appointment before getting transferred to the physician. However, in some private practices, you will go straight to the physician so there is no waiting room time or time spent answering questions from a nurse. This allows the patient more time with the actual provider.  If any additional work-ups are needed, at-home test kits could be provided, or the patient could be sent to a local lab if any of the tests can’t be done at home," says Lisa Ballehr, DO. Here's what you can expect from telemedicine: You can get simple diagnoses and medical advice. You can use telemedicine for therapy. You should prepare for appointments. Telemedicine does not replace the emergency room. You can get simple diagnoses and medical advice. Telemedicine is used by a surprising number of medical specialties including oncologists, OBGYNs, opthamologists, and dermatologists. Through telemedicine services, you can receive simple diagnoses and get medical advice. One concern many have regarding telemedicine is its care quality. A 2020 study by healthinsurance.com found that 64.65 percent of people did not think telemedicine was as good as an in-person visit. While telemedicine does have limitations, you can be confident in the care you receive from it. "The standard of care for doctors seeing patients virtually is the same as if they were seen in person, so for example, if a doctor made an erroneous diagnosis or prescribed a medication that was contraindicated, they could be held legally responsible," says Kay Van Wey, board certifed personal injury trial lawyer. While doctors still deliver a high standard of care and are liable for mistakes, keep in mind that the nature of telemedicine includes some limitations. Amy Baxter, MD, PainCareLabs founder and CEO, offers a few examples: "The biggest difficulty with telemedicine diagnoses in physical therapy is assessing strength. When you find out what's weak, you can extrapolate how someone is moving that results in pain. In general, therapy telemedicine makes more sense than diagnostic telemedicine. There are some telemedicine diagnoses that result in an overprescription of antibiotics or pain medications. When people pay for a diagnosis, they expect something in return. When a practitioner has laid hands on you, you feel as if you've received something and believe them. When you've paid for them to look at you, you expect something in return — a prescription.  In medical school, we were taught never to go on visual examination of an ear infection, but always to puff air and see if in fact the eardrum moved (red but fine) or didn't (fluid behind it). Telemedicine will never insufflate an ear."  Keep these limitations in mind, though the doctor you speak with should let you know if an in-person visit is necessary. "Sometimes a doctor can reach a diagnosis without a physical examination. Certainly for established patients physicians can refill most routine prescriptions for chronic medical conditions, seasonal allergies, etc. However, in the case of a new onset, acute condition, it will be incumbent upon the physician to explain the limits of the exam and either require you to come to the office or go to the ER depending upon the circumstances," says Van Wey. Back to List You can use telemedicine for therapy. Mental health doctors and physical therapists use telemedicine. Therapists and psychiatric doctors hold appointments over video chat or through telemedicine services. If you see a therapist regularly, ask what options they offer for remote appointments. Check with your insurer to see if they have their own telemedicine services to see if they have a preferred telemedicine resource. You can also look at telemedicine subscriptions. "While some states and insurers will provide some coverage for teletherapy sessions, a large portion of individuals are paying out of pocket. Many therapists in private practice have their own fee, and online therapy apps like BetterHelp and TalkSpace provide access to a mental health professional at a lower rate. Payments are typically made weekly and are either per session or monthly for a prescription package with one of the apps," says Haley Neidich, LCSW. If you're using telemedicine for physical therapy, you may get additional technology that will improve your experience. "Some of the new PT platforms using virtual reality and accelerometers for sensors will be able to make sure that a patient is doing the exercises correctly," says Baxter. You'll also want to talk to your physical therapist about exercises to do before and after your appointment. "Before a tele-physical therapy event patients need to warm up stiff muscles. Afterwards, they may need to reduce pain with mechanical or electrical stimulation, ice, or both," advises Baxter. You'll need equipment like a high-frequency vibration unit for mechanical stimulation or a TENS unit for electrical stimulation. Back to List You should prepare for appointments. Even though telemedicine is highly convenient, you should still prepare for appointments.  "Don't treat it like a casual phone call or meeting — treat it like a true doctors appointment. Show up on time (hopefully your doctor will too), bring a list of questions, and come prepared," advises Yuna Rapoport, MD MPH, Manhattan Eye director and assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai. Being prepared will help you get the most out of your telemedicine visit and have answers to your questions. Another aspect of preparing for a telemedicine visit is making sure your tech is working well. "Try to find a place that is quiet and that is well lit so your provider can hear and see you clearly. Be sure that your device is plugged in or charged fully before your appointment to avoid any technical issues," recommends Ballehr. Back to List Telemedicine doesn't replace the emergency room. While telemedicine is a great option for non-emergency care, it won't help you in an emergency situation. If you have a medical question or don't feel well, then scheduling an appointment via telemedicine is great. In fact, many people make unnecessary visits to the ER. UnitedHealth Group found that two thirds of ER visits by privately insured people were avoidable. So, if your typical point of contact with doctors is in the ER, you can re-evaluate how you reach out to medical professionals. Using telemedicine or calling your doctor's office for non-emergency situations can also save you from expensive ER bills. However, if you need immediate medical attention, don't spend time on telemedicine — get yourself to the ER or call 911. If you think you have COVID-19, mention it in your call so that first responders and hospitals can follow their protocols for receiving COVID-19 patients. Telemedicine is a convenient way to receive medical advice, simple diagnoses, and therapy. As you explore telemedicine, be sure to understand the costs and carefully consider apps to ensure that they are HIPPA-compliant. For more information on these topics, read "Telemedicine: What You Need to Know."

Guest Post by Jan Dubauskas Many of us are experiencing major life adjustments as we social distance and shelter in place while we wait for the coronavirus to pass. Grocery stores are no longer stocked with our favorite foods, and restaurants are closed for all but take-out. We’re working from home while homeschooling our kids, and these changes can be overwhelming, especially if someone in the family needs medical treatment. Fortunately, telemedicine makes it easy and affordable to receive medical treatment while social distancing. In recent days, the Trump administration has promoted telemedicine as an excellent way to receive regular healthcare while maintaining a safe distance. Also, the FDA has just provided guidance to expand the availability and capabilities of remote healthcare devices. Before telemedicine, when we were sick and needed treatment right away, we had to either go to the emergency room or call the doctor’s office and hope for an opening the next day. Now, thanks to continued advancements in connectivity, we have access to a telemedicine provider at all times. And many doctor’s offices have ventured into the world of telehealth so their patients can work directly with their regular physicians. What is telemedicine? First, let’s define telemedicine. Telemedicine is the telephonic delivery of healthcare services where a healthcare provider is connected over the telephone or video with a patient who needs treatment. The appointment, diagnosis and treatment plan are all discussed during the telephone appointment.   Just like an in-office appointment, the doctor and patient discuss the symptoms, and any treatment already received. Once the physician has made the diagnosis, she communicates her decision and, if a prescription is required, can submit the order directly to the pharmacy of the patient’s choice.     What conditions does telemedicine treat? Patients are often surprised to learn the number of conditions that can be treated by telemedicine. It can be a quick and effective way to handle routine illnesses like a cold or flu, sinus or bacterial infections, conjunctivitis (pink eye), yeast infections, bladder infections and more. Telehealth professionals can treat patients for allergies, skin infections, rashes, moles, acid reflux, arthritis and more. In addition, mental health conditions such as depression, grief, anxiety, and stress are more frequently being treated through telehealth providers. Telemedicine doesn’t cover emergency situations like heart attack, stroke, accidents or injuries. For emergency situations, patients should review their health insurance network options and consider whether to visit an urgent care facility or the emergency room. How much does telemedicine cost? Although each telemedicine provider program is a little bit different, typically there is a monthly fee that starts around $19.99 per month for an individual and more for a family. There is usually a cost for each telephone appointment of $20 or $40. Telemedicine is not insurance, so any costs from the telemedicine would not apply toward a deductible or be discounted by a health insurance network.   If the patient’s telemedicine appointment is with his regular doctor, the visit typically costs the same or less than a regular office visit. Can I submit my telemedicine bill to my insurance company? Yes, appointments that are given by a patient’s regular doctor can be submitted to insurance. Recently, the Trump administration relaxed the rules for Medicare allowing doctor visits by telephone that can be submitted to Medicare for payment. Unfortunately, standalone telemedicine and telehealth provider services are not typically covered by insurance. Look closely at your insurance policy to decide if it covers telemedicine or telehealth and feel free to call their customer service number to find out more. Can online doctors use FaceTime?   While most telemedicine is conducted telephonically, video visits are becoming more popular, too. Some telehealth providers are video-capable, and can conduct the appointment from Skype, FaceTime and other online video applications.   Certain uses for video appointments may be particularly helpful. For example, physical therapists are providing appointments via telemedicine, and their live-action video can demonstrate real-time physical therapy techniques. Does my doctor use telemedicine? The best way to know if a doctor uses telemedicine is to call their office and ask. Another way to find out which doctors are in the telemedicine network is to contact the telemedicine provider and either look up the doctors online or call in and ask.   If a doctor does not offer telemedicine services through her practice, a telehealth product can be purchased online. Also, many employer health insurance plans provide a telemedicine solution, so it is important to check your plan to determine if telemedicine is already included. If not, there are many affordable options available. Extraordinary challenges call for extraordinary solutions. Unexpectedly, coronavirus is teaching us to embrace newer technology, products, and ideas, like having a doctor’s visit over the phone, instead of in-person.  Jan Dubauskas is a healthcare expert, enthusiastic insurance pro and mom serving as Vice President and Senior Counsel of HealthInsurance.com.

Guest Post by Nicole T. Rochester, MD National Doctors' Day is celebrated annually on March 30th to honor and celebrate physicians and their contributions to patients, communities, and society at large. While the holiday was signed into law by President George Bush in 1990, the concept originated in the 1930s with Eudora Brown Almond, the wife of a prominent Georgia physician. The date commemorates the first time an anesthetic was used in surgery (March 30, 1842). As an experienced pediatrician who completed residency training 20 years ago, I have been the beneficiary of numerous Doctors' Day celebrations, and I am grateful. I appreciate the pastries, herbal tea (because I never developed a taste for coffee), chair massages, branded gifts (blankets, umbrellas, travel mugs, etc.), invited speakers, and extravagant lunches. But I hope you'll understand and will not be too offended when I say that these acts of kindness fall terribly short of what is truly needed to address the crisis facing today's physicians. In the latest Mayo Clinic survey, 43.9 percent of physician respondents reported burnout, characterized by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. What used to be medicine’s “dirty little secret” is now discussed widely in mainstream social and traditional media. These open discussions have led to some controversy over the use of the word “burnout,” as some feel the term is a form of victim-blaming. Many feel that the term moral injury, defined as the betrayal of what is right by someone who holds legitimate authority in a high stakes situation, is a better descriptor for what physicians currently experience while practicing medicine in an environment that threatens their autonomy and well-being. Semantics aside, suffice it to say that doctors are hurting. The statistics regarding physician suicide are also sobering. An estimated 300–400 physicians die by suicide every year, a rate that is higher than any other profession. As I write this article in mid-February, an Illinois pediatrician’s suicide has been in the national headlines for the last few days. Sadly, questions surrounding his vaccination practices seem to have overshadowed the tragedy of his death and the magnitude of this growing epidemic.  It’s not often that individuals get an opportunity to see their profession from the inside, Undercover Boss style. Unfortunately, the only way to do this in the healthcare field is to either become a patient or a family caregiver. For almost three years, I had the honor of being a caregiver to my late father and it was like watching sausage being made. I witnessed disjointed communication, medication errors, and near misses. I am convinced that my medical knowledge, professional influence, and ability to strongly advocate for my dad saved his life on more than one occasion. It would have been easy to blame the physicians and label them as careless or incompetent, but I knew better. What I knew in my heart was that they were just as broken as the systems in which they worked. In their desperate attempts to survive, they had become disconnected. It’s what happens when computer screens create physical barriers between doctors and patients, when administrators and insurance companies rob physicians of their decision-making authority, and when your love for medicine is no longer strong enough to mask the bitter taste of reality. The overwhelming majority of us became doctors because we wanted to help people. It sounds cliché, but it’s true. The problem is that patients have been reduced to checkboxes, physicians spend their days racing from one exam room to the next, and meaningful patient encounters are interrupted by misaligned administrative tasks. In this environment, it’s easy to forget why you chose this noble path. I believe that the disruption of human connection is the thread that continues to unravel the practice of medicine as we know it.  When an unknown homeless man slowly walks past your car window begging for change, the decision to stare blindly ahead while waiting for the traffic light to change is not a particularly difficult one. But if you engage in a conversation with that homeless gentleman while volunteering at a local shelter, and learn that he lost everything when his wife succumbed to cancer, you’ll roll down your window the next time your paths cross.  Similarly, when we refer to patients as room numbers or by the names of their chronic diseases, this anonymity separates us from their suffering. But if we take a few moments to learn something substantive about our patients, it creates a connection that facilitates healing on both sides of the stethoscope. I call this a 90 second encounter. I believe that if doctors use the first 1.5 minutes of every patient visit to engage in dialogue that creates genuine human connection, the results would be transformative.  To my amazing physician colleagues who are making a difference in clinical and non-clinical arenas, I salute you. Happy Doctors’ Day! To the hospital, health system, and practice administrators, I’d like to issue a friendly challenge. Cancel next year’s bulk order of customized reusable water bottles. Invest that money in system changes that foster opportunities for doctors to connect with their patients. We don’t need another luncheon. What we need is innovation, servant leadership, and compassion. March 30, 2021 will be here before you know it, and we’re counting on you. Photo by Jackie Hicks   Nicole T. Rochester, MD is a board-certified pediatrician, independent health advocate, TEDx and keynote speaker, and the CEO of Your GPS Doc, LLC, an innovative company that helps aging individuals, those with chronic illnesses, and their family caregivers navigate the healthcare system. Dr. Rochester was inspired to start her company after caring for her late father and witnessing the complicated healthcare system from the other side of the stethoscope. She is the author of Healthcare Navigation 101: A Guide for College-Bound Students (and Parents!). Dr. Rochester is committed to educating and empowering individuals and believes that patients and family caregivers belong at the center of every medical team. She has been featured on WJLA/ABC7 and in numerous digital publications, including KevinMD, Authority Magazine, Modern Healthcare, Reader’s Digest, and Best Company.

The health insurance industry is permeated with acronyms. These simple three-letter abbreviations may leave you wanting to say four-letter words. A health insurance insider may casually say such nonsense as, "You can use your HSA to pay part of the OOP expenses on your HDHP plan." This stream of three-letter abbreviations sounds like gibberish and might as well be written in hieroglyphics (I'd like to sign up for the flax-owl-lasso plan, please). If you don't speak "health insurance," you may often feel in the dark. Even worse, you may not fully understand your plan or coverage. Below you will find some common acronyms to help you navigate this foreign tongue. Consider this your Rosetta Stone. Acronyms for Types of Health Insurance Plans PPO: Preferred Provider Organization Preferred Provider Organization plans allow customers to receive care from doctors and hospitals both inside and outside of their network. This type of plan usually provides customers with a list of in-network facilities and physicians who have agreed to a discounted rate. Customers can choose from a list of doctors within their network. Visits to providers outside of the network require additional costs. PPOs are the most prevalent type of health insurance plan enrolling 48% of covered workers. HDHP: High-Deductible Health Plans High-Deductible Health Plans (also known by another acronym: CDHP, or Consumer Driven Health Plan) have significantly higher deductibles than other plans. These plans usually cover free preventative services; however, any other costs are first covered by the customer. Once the deductible is met, the insurance company will cover additional charges. Though customers pay for services until they meet their deductible, they receive negotiated rates when going to in-network providers. Visiting out-of-network providers leads to extremely high costs. HDHP plans are become increasing popular, with 29% of covered workers enrolled in 2016. In addition, these plans may include a (HSA) Health Savings Account. Customers may use this savings account to pay for medical expenses. They may put aside pre-tax money for health expenses. Sometimes employers will also contribute to this account. HMO: Health Maintenance Organization Health Maintenance Organization plans allow members to choose from a list of in-network primary care physicians. They do not cover services outside of their network (except in an emergency). Typically customers will need a referral to see a specialist. These plans typically have lower premiums than PPOs. Approximately 15% of health plans are HMOs. POS: Point of Service Point of Service plans are similar to HMOs with a notable exception: customers must choose a primary care physician within the plan's network. However, customers may visit doctors out of their network, but they will pay most of the cost. However, if customers are referred to an out-of-network specialist by their primary care physician, their insurance will typical pay more of the cost than with no referral. EPO: Exclusive Provider Organization Exclusive Provider Organization plans only cover visits to providers within the plan's network (except in an emergency). Customers do not need a referral to see an in-network specialist with this type of plan. Out-of-network services are not covered. Other Acronyms PCP: Primary Care Physician A primary care physician is your main doctor, often a general practitioner. This doctor typically performs preventative exams and assists with general medical needs. HSA: Health Savings Account Health Savings Accounts often accompany HDHPs (see above). You may put pre-tax earnings into this account and use it for qualified medical expenses. ACA: Affordable Care Act The Affordable Care Act is the 2010 health care reform law. You can read more about the law here. CS: Cost Sharing Cost sharing refers to deductibles, co-payments, and other similar payments. It is the share of costs the customer must pay for covered benefits. OOP: Out of Pocket Out of pocket refers to the amount that customers pay, up to a certain maximum, in a year. Once the out-of-pocket maximum is reached the insurance covers all other expenses. Deductibles, co-payments, etc. contribute to this amount. It does not include premiums. EOB: Explanation of Benefits An explanation of benefits is a document that describes services received. It helps customers understand their coverage and the amount owed for a given service. OV: Office Visit An office visit is when a patient goes to the doctor for a specific medial problem, rather than a general check-up. CHIP: Children's Health Insurance Program The Children's Health Insurance Program provides inexpensive insurance for children in low income households who do not qualify for Medicaid. Read more information about CHIP here. QHP: Qualified Health Plan Qualified Health Plans meet the requirements described in the Affordable Care Act with specified price limits and covered benefits. In addition to this list, there are a plethora of other health insurance acronyms. Take time to learn this complex language so you can understand your insurance coverage and benefits. When choosing a health insurance company, you need the most helpful and accurate information. Check out our top rated companies and find the one that best meets your needs here.