Glossary of Terms
Part of MedCart’s mission is educating the patients we serve. Here are some terms that are helpful to know.
This means taking your medication exactly as your doctor prescribed. The information will be on your prescription packaging.
This term is used to describe submitting a claim to your insurance company. Sometimes the words “process” or “run” are used instead.
The fee you pay when you fill a prescription or receive medical care. The fee will vary depending on your insurance coverage and the service you are receiving.
The amount you pay each year before your plan begins reimbursing you for medical costs.
The supply and delivery of medicine, especially prescriptions.
Any document sent by electronic mail using a computer system.
This is a list of drugs approved by a health plan or pharmacy benefits manager.
When referring to medication, funding means assistance with copayments.
A medication that is given by injection (not by mouth).
LETTER OF MEDICAL NECESSITY
Written or certified by a medical doctor, this letter explains why a patient needs a specific drug and why a different drug can’t be substituted.
This describes medication only available through specialty pharmacies. These are usually medications prescribed to treat chronic and complex conditions.
This federal program is administered by each state to provide health care for qualified low-income people. Details and eligibility vary by state.
A federal insurance program that provides health care coverage to people ages 65 and older. Some people with disabilities are also eligible for Medicare.
This refers to the portion of Medicare that covers “inpatient services.” These include services from a hospital, hospice or skilled nursing facility.
This portion of Medicare covers “outpatient services.” This includes physician services, home health care, durable medical equipment such as insulin pumps and clinical laboratory services.
This is Medicare’s prescription drug coverage program.
This is packaging that provides single doses of medication labeled with instructions on taking it, to help patients take their medication in the right amount, at the right time.
The date when a patient will need a prescription order filled or refilled by to avoid running out of medication.
A medication taken by mouth, in pill or liquid form.
This describes the annual dollar limit on the portion of covered medical expenses you must pay during the year. When the out-of-pocket limit is met, you will not have to pay any additional deductibles or coinsurance that year.
This means the insurance company has paid their share of the cost of a medication. You may still owe a copayment.
This is a third party that finances or reimburses the cost of your health services. This could refer to your insurance company or a health plan sponsor, such as your employer or union.
The doctor who writes a prescription for a particular medication.
A doctor’s order for medicine or other medical treatment.
Some insurance companies may require you to get approval in advance, before you fill a prescription, in order to reimbursed for all or part of the cost by the insurer.
PROTECTED HEALTH INFORMATION (PHI)
Health information that relates to a person’s physical and/or mental health, health care received or its payment. This information is considered protected if it can be used to identify an individual.
When your insurance company refuses to pay for a medication. There are many reasons why your claim for reimbursement could be rejected, including exceeding plan limitations or trying to refill a prescription too soon.
Many medications cause side effects. Always tell your doctor and pharmacist about any side effects. Don’t stop taking your medication without your doctor’s permission even if the side effects are unpleasant.
A pharmacy that provides medications not found at a typical commercial pharmacy. Specialty pharmacies often serve patients with complex conditions such as cancer, Crohn’s disease, HIV, bleeding disorders and rheumatoid arthritis.
The day treatment is to begin.
This is the process of trying drugs that may be effective in treating a condition, but are less expensive, before “stepping up” to medication that costs more.
- Who We Serve