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UnitedHealthcare Indiana PathWays for Aging - Glossary
An advance directive puts your choices for health care into writing. This is helpful in case you are not able to communicate your wishes.
A request for a fair hearing concerning a proposed agency action, a completed agency action, or failure of the agency to make a timely determination.
A formal request for benefits made to the agency in writing and signed by the applicant or someone acting on behalf of the applicant. Application may be received by mail, phone, fax, in person, or electronically.
A member’s main point of contact at UnitedHealthcare Community Plan. This person can answer all questions that a member has about how to work with the health plan, get needed services, and plan goals. Completes check-ins and asks questions about the member’s lifestyle and health. Listens to the member and sets goals. Talks with friends, family members, providers, and others when the member approves.
The emergent and acute onset of a symptom or symptoms, including severe pain, that would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s health in serious jeopardy.
Emergency rooms (ERs) are for major injuries or sudden sicknesses that may be life-threatening and need medical care right away. In an emergency, you should call 911 or go to an ER immediately.
The willful intent to obtain ineligible benefits or payments.
A grievance is another word for complaint. You may report a grievance by sending a letter or by contacting Member Services.
A hearing is when you ask your health program to review your case after your plan denied your appeal.
A patient who is admitted for an overnight or longer stay at a health care facility and is receiving covered services.
The Indiana Family and Social Services Administration (FSSA) offers Medicaid services to eligible Hoosiers through the Indiana Health Coverage Programs (IHCP). Your health plan partners with the IHCP to provide your Medicaid services. For information on Indiana’s Medicaid programs visit in.gov/PathWays/.
An eligible person enrolled in the UnitedHealthcare Community Plan.
A type of addictive drug that acts on the nervous system to relieve pain.
A nonhospitalized patient receiving covered services away from a hospital, such as in a physician's office or the patient’s own home, or in a hospital outpatient or hospital emergency department or surgical center.
Preferred Drug List (PDL)
A list of approved prescription drugs approved by the Indiana Family Social Services Administration.
Primary Medical Provider (PMP)
Your personal health care provider. Your primary medical provider (PMP) can be a family or general doctor, nurse practitioner, internist, or other provider approved by the State of Indiana. To receive benefits, your PMP must provide or coordinate your care. If you need to see a specialist, your PMP will usually refer you.
A health care professional (such as a doctor, nurse, internist, etc.) or facility (such as a hospital, clinic, etc.).
Periodic review of your family’s income and eligibility. During redetermination, also known as renewal, you must submit proof of current income and residency to verify your eligibility.
A need that is best addressed by resources out in the community. Your Member Services Advocate can help you access services that will address your social needs.
A provider of specialized health care, such as a cardiologist (heart doctor) or a podiatrist (foot doctor).
Urgent Care Centers
You can use these centers when it's not a life-threatening situation, but you are sick or need medical care right away and your PCP is not available. Urgent care centers are usually open in the evenings and on weekends.
Virtual visits connect you with a live doctor through a smart phone or computer for non-emergent visits.