Basic Benefits
amount the member pays out of their own pocket before benefits kick in
what is Deductible
This helps with scheduling reoccurring appointments
What is Transportation Vendor Services
What is Request from a doctor meaning approval from Humana before certain medical services, test, treatments, or devices are covered
Preauthorization
platform used by the Care Management team to manage our members' care
GuidingCare
fixed dollar amount paid by members for specific services such as an office visit
what is copay
This covers a limited number of outpatient prescriptions medications under certain conditions. This usually covers drugs not typically self administered
What is Medicare Part B
What is a type of authorization that allows a member to be referred to a specialist
Referral
is the shortened way we refer to a system called Clinical Guidance eXchange
CGX 2.0
percentage of costs a member pays after satisfying their annual deductible
what is coinsurance
Dental Coverage in IL, MI, and SC is a separate plan administered by which vendor?
What is DentaQuest
Preapproval - New members enrolled in a Medicare Advantage (MA only) plan are allowed to continue care with an out-of-network doctor for a certain time frame
what is Transition of care
helps Humana understand a member's medical needs, which assists with providing specialized care and, or disease management programs that target those needs
The Health Assessment (HA)
a special program that allows states to provide services that are not typically covered under the standard Medicaid program
what is waivers
A legal concept that gives private insurance companies the right to recover money paid out on accident-related claims when another party is determined financial responsibility
what is subrogation