Allergist/Immunologist
A physician who has completed specialty training in pediatrics or internal medicine, and has elected at least two additional years of training in the diagnosis and treatment of allergic and immunologic diseases.
Capitation
A method of reimbursement in which a physician is paid a fixed amount of money per each member enrolled in a health care plan.
Co-Payment
A fixed amount paid by the patient at the time services are rendered. Typical co-payments are for office visits, prescriptions or hospitalizations.
Deductible
The portion of health care which must be paid by the patient before insurance coverage applies.
Direct Access
Patients may consult the specialists of their choice for a specific medical problem without being required to obtain prior approval of the gatekeeper.
Fee-for-Service
Traditional health care payment system under which providers receive a fee for each service rendered.
Formulary
Prescription medications that have been approved by a particular health care plan for its enrollees.
Gatekeeper
The primary care physician or other provider whom a patient must see for all initial medical visits. For referrals to all specialists or diagnostic, therapeutic or hospital services, the patient must see the gatekeeper first.
Health Care Payers
Insurance companies, hospitals, some physician groups, and employers who are responsible for paying the cost of health care for enrollees.
Managed Care
A health care insurance plan designed to provide high quality care at low cost. This care includes a detailed plan with a set of rules to be followed by the patient.
Point of Service
Allows patients to see their personal doctors who may not be a part of the insurance network. The doctor may be compensated at a lower rate and the patient may be charged a portion of the cost.
Pre-existing Condition
An illness, disease or condition that an individual has at the time of enrollment in a health care plan.
Primary Care Provider (PCP)
A generalist physician such as a pediatrician, internist or family physician.
