Insurance can be full of unfamiliar and sometime confusing language. In order to better help you understand the benefits of being a member of Volusia Health Networks, we’ve provided this glossary of common insurance terms.
- PPO: A PPO (Preferred Provider Organization) is an affiliation of physicians, hospitals and other healthcare providers, who form a network to assist self-insured businesses in tailoring health plans to meet the unique needs of their employees.
- EPO: An EPO (Exclusive Provider Organization) works the same way as a PPO – however, with a greater discount on healthcare services.
- Network: A term used to describe the entire group of hospitals, physicians and other medical professionals who have contracted with the PPO to provide services at a discounted rate.
- Participating Provider: Another name for a physician, hospital or other medical professional/facility who has contracted with Volusia Health Network to provide services at a discounted rate.
- Explanation of Benefits: An “EOB” is a form sent to you and the provider after each claim submission which will identify billed charges, amount covered by the plans and any amount owed by the member.
- Urgent Care Center: A facility with on-site physicians, x-ray and lab equipment. The center is designed to treat patients with minor medical emergencies but not life threatening illnesses/emergencies.
- Utilization Review: A process that includes, but is not limited to, pre-certification of outpatient procedures and inpatient hospitalization as well as review of necessity/appropriateness of medical treatment.