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Health Care Terms

Affiliated Provider/Practice
Providers/practices contracted with Security Health Plan to provide covered healthcare services to our members.

Allergists
Diagnose and treat allergic conditions.

Ambulatory Surgery Center
A facility where outpatient surgery is performed and recovery is expected to be a few hours.

Ancillary Providers
Provide assistive services such as durable medical equipment, respiratory equipment, home health and skilled nursing. These services are typically coordinated through your personal or specialty provider.

Anesthesiologists
Administer anesthesia to achieve temporary, partial or complete loss of sensation to patient undergoing surgery.

AODA (Alcohol and Other Drug Abuse)
Diagnosis and treatment of disease and behavioral disorders caused by the abuse of alcohol and other drugs.

Cardiologists
Diagnose and treat diseases of the heart.

Chiropractors (D.C.)
Treat patients by manipulating the body joints, especially the spine.

Dermatologists
Diagnose and treat diseases and disorders of the skin.

Emergency Medical Condition
A medical condition with acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine, to reasonably conclude that a lack of immediate medical attention will likely result in the following :

• serious jeopardy to the participant’s health or, with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn child
• serious impairment to the participant’s bodily functions
• serious dysfunction of one or more of the participant’s body organs or parts

Some examples of emergencies are:

• prolonged or repeated seizures
• severe pain
• suspected heart attack
• suspected stroke
• trouble breathing
• unconsciousness

All care to treat an emergency medical condition in or out of the service area is covered by Security Health Plan, subject to copayments, coinsurance, deductibles, and other provisions of your policy.

Endocrinologists
Diagnose and treat diseases and disorders of the endocrine glands ( thyroid, pituitary, pancreas, ovaries and testes ) including diabetes.

Family Practice Providers
Provide preventive care, diagnose and treat various medical conditions for people of all ages.

Gastroenterologists
Diagnose and treat diseases and disorders of the stomach and intestines.

General Surgeons
Perform operative procedures for corrections of deformities, repair of injuries, and diagnosis and cure of certain diseases.

Geriatic Specialists
Diagnose and treat medical conditions of elderly people.

Home Health Agencies
Provide part-time, intermittent skilled home care. There are limited benefits available for these services under most Security Health Plan policies or programs. If they are covered, a written home care plan must be submitted by your physician and approved by Security Health Plan.

Infectious Disease Specialists
Diagnose and treat complicated infections.

Internal Medicine Providers
Provide preventive care, diagnose and treat medical conditions of adult men and women.

Nephrologists
Diagnose and treat diseases and disorders of the kidneys.

Neurologists
Diagnose and treat diseases and disorders of the nervous system.

Obstetrician/Gynecologists
Manage female medical conditions, especially those related to reproduction. This may include preventive care, care during pregnancy, and childbirth.

Oncologists
Diagnose and treat tumors and cancer.

Opthalmologists
Examine, diagnose and treat diseases and disorders of the eye.

Oral Surgery
Surgery to treat disorders of the gums, teeth and mouth.

Orthopedics/Orthopedic Surgeons
Examine, diagnose, and treat diseases and disorders of the skeletal structure and muscles.

Osteopathic (D.O.) Physicians
Diagnose, treat and repair diseases, injuries and disorders of the entire body for people of all ages.

Otolaryngologists (Ear, Nose and Throat - ENT)
Diagnose and treat diseases and disorders of the ear, nose and throat.

Out-of-Area Coverage
Coverage for services provided outside the Security Health Plan service area. Providers located outside the service area are not affiliated providers. Generally, only emergency services and urgent care services are covered outside of the service area, when you cannot safely postpone the care until you return to the service area.

If emergency or urgent care services are provided outside the coverage area by a non-affiliated provider, Security Health Plan must be notified at 1-800-472-2363 by the next business day, or as soon as reasonably possible to ensure appropriate claim payment.

Coverage for any other care is only available if the care is obtained from affiliated providers unless the member receives prior written authorization from Security Health Plan. Benefits are also subject to copayments, coinsurance, deductibles and other provisions of your policy.

Pediatricians
Provide preventive care, diagnose and treat diseases of children and adolescents.

Physical Medicine and Rehabilitation (Physiatry)
Therapeutic use of physical medicine and equipment in the treatment of injuries and diseases including physical therapy and rehabilitation techniques.

Plastic and Reconstructive Surgeons
Repair, restore or reuse external physical conditions or trauma effects.

Prior Authorization
Before obtaining health care from a non-affiliated provider, you must obtain approval from Security Health Plan or coverage will not be available. Claims from non-affiliated providers will be denied if prior authorization was not obtained.

Psychiatrists/Psychologists
Diagnose and treat emotional or mental disorders.

Podiatrists (D.P.M.)
Diagnose and treat diseases and injuries of the foot.

Pulmonary Medicine Providers
Diagnose and treat disorders of the lungs.

Radiology
The use of x-ray equipment to prevent, diagnose and treat diseases and injuries.

Rheumatologists
Diagnose and treat diseases and disorders of the joints and associated structures, such as arthritis and degenerative joint disease.

Sports Medicine Specialists
Diagnose and treat sports related injuries.

24-hour Nurse Line
Healthcare information from registered nurses 24 hours a day.

Urgent Care Services
Urgent care is care that you need sooner than a routine doctor’s visit. Urgent care is not emergency care. When you are in the Security Health Plan service area, benefits are payable for urgent care services only when provided by an affiliated provider. If you need urgent care outside the Security Health Plan service area and cannot safely postpone the care until you return to the service area, benefits are payable for services received at the nearest appropriate medical facility. Urgent care does not include care that can be safely postponed until you can return to the service area, including follow-up care.

Some examples of urgent care are:

• bruises or sprains
• minor burns
• minor cuts
• most broken bones
• non-severe bleeding
• most drug reactions

Urologists
Diagnose and treat diseases and disorders or the urinary system.

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