Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.
Appeal
A request for a review of an action taken by the health plan.
C
Care Management
The process that assists enrollees to access necessary covered services that are identified in the care plan. It also provides referral and coordination of other services to support your care plan.
Care plan (or plan of care)
A written description in the care management record of your health care goals and the amount, duration and scope of the covered services to be provided to you in order to achieve your goals.
G
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.
H
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.
Home Care
This includes the following services which are of a preventive, therapeutic rehabilitative, health guidance and/or supportive nature: nursing services, home health aide services, nutritional services, social work services, physical therapy, occupational therapy and speech/language pathology.
I
In-Network
Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement to provide health care services to members.
L
Living Will
A document that tells what you want done with your health care. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want, and whether or not to make special efforts to save your life.
M
Medically Necessary
Services that are required to maintain your health and by not receiving those services, could affect your condition or quality of care.
Member
An eligible person enrolled in the UnitedHealthcare Health Plan.
O
Out-of-Network
Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with your plan to provide health care services.
P
Personal Care
This term means some or total assistance with activities such as personal hygiene, dressing and feeding, and nutritional and environmental support function tasks. Personal care must be medically necessary, ordered by your physician and provided by a qualified person in accordance with your plan of care.
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
A person or facility that provides health care services and treatment such as a home health care agency, physical therapist, dentist, or Adult Day Health Care program.
S
Surplus Amounts
The amount of medical expenses the Department of Health determines a "medically needy" individual must incur in any period in order to be eligible for medical assistance. Surplus amounts are also referred to as spenddown.
