Do you ever find yourself coming out of an appointment with your doctor feeling confused?
If so, you’re not alone.
Our A-Z glossary aims to simplify and explain the most commonly used US healthcare and insurance coverage terms to help you make sense of some jargon so you can walk in and out of appointments feeling informed and confident.
Please note that this article was written with a US audience in mind. If you’re living outside of the United States, these terms will probably vary. On that note, check out our article on patient advocacy for tips on how to simplify communication between you and your doctor.
Reduce stress and improve recall
Many people may experience feelings of uncertainty, stress, and confusion when they attend doctor appointments, making it hard to receive and retain the important information being shared – especially when it’s spoken rather than written down.
Specifically, stress can cause attentional narrowing, a state where the brain can focus only on headline statements and struggles to remember secondary or more detailed information.
Doctors and nurses are committed to the health and well-being of their patients, but because of the pressure and strain on the healthcare system, they may be unable to spend as much time as they’d like or need with every individual.
That’s why it’s essential to prepare for your appointments by getting to know some of the healthcare terms you’re likely to hear.
A-Z of Healthcare Terms
Let’s demystify some medical jargon so you can focus on feeling cool, calm, and confident in your next appointment with your doctor.
Activities of Daily Living (ADLs)
Activities performed as part of a person’s daily routine of self-care, such as eating, bathing, dressing, and toileting.
A benefit is a service your health plan covers. If you’re insured, you may also have mental health benefits, which means your health plan covers part or all of the cost of mental health related treatments.
Chronic disease management
A care approach to prevent or minimize the effects of a long-term illness that includes screenings, check-ups, monitoring and coordinating treatment, and patient education.
The amount you pay for medical services before your health insurance company or plan starts to pay. The deductible usually resets at the beginning of the calendar year or when you enroll in a new plan.
Electronic Health Record (EHR)
Your Electronic Health Record (EHR) or Electronic Medical Record (EMR) is a digital report of your medical history. Your doctor or healthcare provider adds to your record every time you have an appointment. It’s always good to keep in mind that you’re legally entitled to get a copy of your medical records from your healthcare provider in the format you request, either paper or electronic.
A drug formulary, also called a drug list, details the prescription drugs your health plan helps pay for. Different plans have different formularies.
A complaint or statement of dissatisfaction with any part of your care. A grievance could be filed over the phone or in writing.
A legal document that lets you choose someone you trust to make decisions about your medical care on your behalf if you find you are unable to make them yourself.
Infusion Drug Care
Infusion drug treatments are often used for chronic conditions like asthma, immune deficiencies, or rheumatoid arthritis. Infusions are liquid drugs that are put directly into your bloodstream through a needle. These drugs are often covered under your health plan’s “medical” benefit, not the “drug” benefit.
Job-based Health Plan
Coverage that is offered to an employee, and often their family, by an employer.
As part of some self-care routines, kegel exercises can help people with problems with urine leakage or bowel control to strengthen muscles under the bladder and large intestine.
Assistance and care plan for people with chronic conditions. The goal of long-term care is to help people live as independently as possible. It is focused on providing the best care that enables an individual to live a meaningful, independent life.
Your health plan may ask for proof that a claim is medically necessary. This means they need your healthcare provider to show that you need their medical services.
At times, providing proof of medical necessity may feel like a burden or even offensive, especially when it stands between you and getting medical care. Remember to seek support from friends, loved ones, and trusted medical professionals to help navigate these challenges if you need.
The group of doctors, hospitals, and other health care providers that insurance companies contract with to provide covered services at discounted rates. You will generally pay more for services received from out-of-network providers.
A person who receives healthcare services without being admitted to a hospital. Outpatient care could include surgery without an overnight stay or doctor’s appointments.
Primary Care Physician (PCP)
Also known as a Primary Care Provider, this is the doctor you choose to be your primary source for non-emergency medical care. Your PCP often coordinates your medical care, including hospital admissions and specialist referrals. ]
As such, having a PCP who you trust and can communicate with well is an important element of receiving the healthcare you deserve. If your current PCP is not meeting your needs, consider changing to a different doctor covered by your insurance. Your friends, family, and loved ones may have recommendations that can help.
Qualifying Life Event (QLE)
Something that happened in your life that means you need to change your health plan, like getting married, divorced, or starting or leaving a job.
Routine care is usually the care you get from your Primary Care Provider (PCP) and the care you get from other doctors they refer you to. Routine care is in response to a non-urgent condition and can include things like regular physical examinations and monitoring an already known condition.
Healthcare from specialists. Specialists are providers who are not your Primary Care Provider (PCP), like cardiologists and therapists.
Therapeutic alternatives are drugs that may have chemically different contents to those initially prescribed by your doctor but may have a similar effect for treating your condition.
Usual, Customary, and Reasonable (UCR)
This is the amount a health plan will pay a healthcare provider for a particular service. UCR is based on how much that service usually costs, which may vary across cities or states.
These are additional to your health plan and bought separately. For example, you can get coverage for cancer, accidental injury, or hospital care.
This is important if you get your health plan through your job. A waiting period is the time between when you start your job and the date you are covered by your employer’s health plan.
Sex-linked genetic disorders in which the abnormal gene or genes are located on the X chromosome. Almost all affected people are males.
The most important person when it comes to your health. Healthcare professionals are here to help, but ultimately, no one knows your body better than you do.
The way we all started out. A fertilized egg cell measuring less than a millimeter in diameter.
At Sidekick Health, we’re committed to helping you live well. Our Sidekick programs feature educational content on a number of lifestyle areas as well as tips and tricks to help you create long-lasting healthy habits to improve your overall quality of life.
Explore our library to find more helpful healthcare articles designed to help you feel your best and take back control of your health.