UnitedHealthcare Connected® (Medicare-Medicaid Plan) Glossary

Abuse

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

Advance Directive

A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

Appeal

A formal request to review an action when you are not satisfied with a decision made by your health plan.

Authorization

An O.K. or approval for a service.

Benefits

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

Clinical Care Management

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

Disenrollment

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.

Emergency

A situation where your health, or the health of an unborn baby, could be threatened. Medical help is needed right away.

Fraud

An untruthful act (example: if someone other than you uses your member ID card and pretends to be you).

Grievance

Your statement of dissatisfaction with any part of your care. A grievance can be filed over the phone or in writing, and must be filed directly with your plan.

Health Information

Facts about your health care you can receive from your provider. It includes information about your physical and mental health, as well as payments for health care.

ID Card

An identifcation card that says you are a UnitedHealthcare Community Plan member. You should have this card with you at all times.

Immunization

A shot that protects from a disease.

In-Network

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

Informed Consent

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

Inpatient

A patient who is admitted for an overnight or longer stay at a health care facility and is receiving covered services.

Medicaid

A program that offers health care services to persons who have limited income, are pregnant, and/or persons with disabilities.

Medically Needy Program

The Medically Needy Program provides Medicaid benefits to children younger than age 19, and pregnant women whose families make too much money for regular Medicaid. This means that the pregnant woman or child may qualify for the Medically Needy Program if they have high medical bills and they do not have enough monthly income to pay these bills. The pregnant woman or child can qualify for this program on a month-to-month basis. Some of these bills may include:

• Doctor's visits
• Prescriptions
• Past medical bills
• Medical insurance charges

NOTE: The Medically Needy Program is not for people who qualify for any other Medicaid program.

Medicare

A federal health insurance program for people who are 65 or older, people with disabilities, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.

Member

An eligible person enrolled in our plan.

Out-of-Network

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

Prescription

A doctor's written instructions for medication or treatment.

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

The process of reviewing a request for services to make sure it is a necessary service or plan of treatment and providing approval for those services before you receive them.

Provider Directory

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

Provider or Practitioner

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

Referral

Process when your primary care provider requests additional care for you from a specialist.

Self-Referred Services

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

Specialist

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

SSI

Supplemental Security Income.

Urgent Care

When you are sick but it is not an emergency, and you need treatment or medical advice within a 48-hour time period.

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 deficient are covered up to age 5 if they are low income and are determined to be at nutritional risk.