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Healthy Louisiana Plan Glossary

Glossary

A

  • Appeal

    A step you can take to ask Medicaid to change its mind when it decides it will not pay for care you need.

B

  • Behavioral Health Services

    Health care for emotional, psychological, substance use and psychiatric problems. It is part of your health plan.

C

  • Care Coordination

    Your primary care provider works with you and other providers to make sure that all your providers know about your health problems.

  • Continuity of Care

    If your primary care provider sends you to a specialist, your primary care provider will stay involved and keep up with all your medical/dental treatments.

  • Copayment

    Money you have to pay out of your pocket before you can see a health provider.

D

  • Durable Medical Equipment

    Equipment ordered by your physician that helps you at home. This includes wheelchairs, hospital beds, canes, crutches, walkers, kidney machines, ventilators, oxygen, monitors, pressure mattresses, lifts, nebulizers, etc.

E

  • Emergency Dental Condition

    A health problem that needs immediate dental attention. An example includes a dental problem that can cause you serious harm.

  • Emergency Medical Condition

    A health problem that needs immediate medical/dental attention. An example includes a health problem that can cause you (or your unborn child, if you are pregnant) serious harm.

  • Emergency Medical Transportation

    Ambulance.

  • Emergency Room Care

    Care for an emergency medical or dental condition that is too serious to be treated in a clinic or urgent care center.

  • Emergency Services

    Inpatient and outpatient medical or dental care by a healthcare provider to screen, evaluate, and/or stabilize your emergency medical or dental condition.

  • Excluded Services

    Care that is not paid for by Medicaid.

G

  • Grievance

    A report that you can make if you are not happy with the quality of care you got or if you think a provider or someone at the clinic was rude or denied you access to the care you needed.

H

  • Habilitation Services and Devices

    Health care services that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech & language pathology, and other services for people with disabilities.

  • Health Insurance

    A plan that helps you pay for health care visits, procedures, hospital stays and preventive care. It will pay for the high cost expenses and routine screenings that it says are covered.

  • Health Plan

    A group of doctors, hospitals and other providers who work together to help you get the health care services you need. They may provide physical health services, like doctor, hospital and emergency room visits; x-rays and prescriptions, and non-emergency medical transportation.

    They may also provide mental health or substance use disorder services, like psychotherapy or crisis intervention.

  • Health Risk Assessment

    A form you fill out to tell about your health and health behavior. Health providers use the information to figure out whether you are at risk of getting certain diseases or medical or dental conditions.

  • Home Health Care

    A wide range of health care given in your home to treat an illness or injury.

    Examples include care for a wound, patient education, checking your blood pressure and breathing, checking on you after you get out of the hospital.

  • Hospice Services

    Hospice is to keep you comfortable and as free as possible from pain and symptoms when you have a terminal illness. Hospice helps you have a good quality of life for time remaining. Most hospice care happens at home or it can be given in hospital or special facility.

    Hospice is for patients likely to die within six months if their disease runs its normal course.

  • Hospital Outpatient Care

    Care given at a hospital that your doctor does not expect will need an over night stay. In some cases you may stay overnight without being registered as an in-patient.

    Examples include same-day surgery and blood transfusions.

  • Hospitalization

    When you are checked into a hospital for care.

M

  • Medically Necessary

    Medical or dental care or supplies your provider says are needed to prevent, diagnose or treat your illness, injury, or disease. To be medically necessary, the care or supplies must be clinically appropriate and meet accepted standards of medicine. Medicaid does NOT pay for treatments that are experimental, non-FDA approved, investigational, or cosmetic.

N

  • Network or Provider Network

    The group of providers linked to your health plan who provide primary and acute health care.

  • Non-participating Provider

    A physician that is not part of your provider network.

P

  • Participating Provider

    A provider who works for your health plan or is linked to your health plan.

  • Physician Services

    Care provided by a physician.

  • Plan

    See Health Plan.

  • Preauthorization

    Getting permission for specific health or dental services before you receive them so that Medicaid will pay for the care.

  • Premium

    The amount of money you must pay for your health care plan.

  • Prescription Drug Coverage

    The medicines your plan will pay for that your provider prescribes that have to be filled by a pharmacy.

  • Prescription Drugs

    These are medicines your provider prescribes that have to be filled by a pharmacy.

  • Primary Care Physician

    The doctor who is responsible for your health care. This doctor may also refer you to a specialist, or admit you to a hospital.

  • Primary Care Provider

    A physician, nurse practitioner, or physician assistant who manages your health care needs. This includes preventive care and care when you are sick. The primary care provider may treat you, refer you to a specialist, or admit you to a hospital.

  • Primary Dental Provider

    The dentist who is responsible for your dental care. This dentist may also refer you to a specialist.

  • Provider

    An individual, clinic, hospital or other caregiver approved by Medicaid to provide health care.

R

  • Rehabilitation Services and Devices

    Care and items that help restore your health and functions.

    Examples include cardiac rehab (for your heart), pulmonary rehab (to help you breathe better) and physical or speech therapy. These include exercise, education and counseling. These are usually provided in a hospital outpatient setting but can be offered in a skilled nursing facility.

S

  • Skilled Nursing Care

    A high level of nursing care. Nurses help to manage, observe, and evaluate your care.

  • Specialist

    A health professional who is educated and trained to have in-depth knowledge of how to care for certain medical or dental problems. Physician specialist examples include cardiologist (heart doctor), pulmonologist (lung doctor), nephrologist (kidney doctor) and surgeon.

U

  • Urgent Care

    Medical care to treat an illness or injury that needs quick attention but that is not a medical emergency. Examples include stomach pain, dizziness that will not go away, or a suspected broken bone. Urgent care requires face-to-face medical attention within 24 hours of noticing the urgent problem.

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Healthy Louisiana Plan


Disclaimer information

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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Special Needs plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Benefits, features and/or devices may vary by plan/area.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only. Access to this service is subject to terms of use.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2026.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.