At Credence, we believe when you’re informed, you feel empowered to take control of your healthcare—and healthcare doesn’t have to feel complex. That’s why we’re simplifying some common healthcare terms to help you navigate your care.
Network
A network is a group of doctors, hospitals and healthcare providers that accept a certain healthcare plan.
In-network
Services provided by a physician or other healthcare provider that have a contractual agreement with the insurance company; in-network services are often covered more comprehensively.
Out-of-network
Services provided by a physician or other healthcare provider that does not have a contractual agreement with your insurance company; services by out-of-network providers may not be covered by your benefits plan or may be covered less comprehensively.
Benefits
Benefits are healthcare items or services covered by a healthcare plan. Your healthcare plan may sometimes be referred to as a “benefit package.”
PPO
A Preferred Provider Organization (PPO) is a healthcare plan that supplies services at a higher level of benefits when members use contracted healthcare providers (in-network); these plans offer more flexibility to choose the doctors, hospitals and other healthcare providers you use to get care.
HMO
A Health Maintenance Organization (HMO) is an organization—and benefit plan option—that provides healthcare coverage to its members through a network of doctors, hospitals and other healthcare providers. Generally, members with HMO plans require referrals from their PCP for specialist care, and the network may be limited to a specific geographical area.
Provider
A provider is a licensed healthcare facility, program, agency, doctor or health professional that delivers healthcare services.
PCP
A Primary Care Physician (PCP) is the physician you choose to be your primary source for medical care; your PCP coordinates all your medical care, including hospital admissions and referrals to specialists.
Claim statement
A claim statement is one of the most frequent communications that you’ll receive from your healthcare plan. Whether you receive a hard copy in the mail or a digital version online, this important document clearly summarizes any recent healthcare services you received, and it may provide an overview of your benefits usage to date.
CPT codes
Current Procedural Terminology (CPT) codes were created by the American Medical Association to construct a universal language for standardizing how healthcare describes medical procedures; providers use these codes to simplify billing for services, which you will see on your Claim Statement.
Referral
A referral is a written or electronic authorization from a member’s PCP to receive care from a different contracted doctor, specialist or facility prior to your visit.
