Members

Understanding Your Care

At Health Choice Utah, it is important to us that we provide you and your family with healthcare that meets your needs and is explained in a way that you understand. We partner with providers who share our commitment.

Without clear communication and understanding about your healthcare, important facts about your health and well-being may not be revealed and you may not receive the correct diagnosis, treatment or prescription.

The Partnership for Clear Health Communication: AskMe3.org provides many communication tips for physicians and patients.

Patients are advised to ask three questions when visiting their healthcare provider, pharmacist or when preparing for a medical test or procedure:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Asking these three questions can help you:

  • Take care of your health.
  • Prepare for medical tests.
  • Take medicines the right way.

If you still do not understand, let your doctor, nurse or pharmacist know you need further explanation of what you need to do. Try not to be nervous to ask your health provider questions. Your medical team wants you to let them know that you need help. They want you to know all about your condition, why a certain treatment is important for your health and the steps to take to prevent future illness or keep your condition in control.

When you prepare to see your healthcare provider, make sure you let your doctor, nurse, technician etc. know of any lifestyle changes such as a change in diet, exercise, medications etc. It is important that you communicate with them as well as they communicate with you.

In addition, Health Choice recognizes the diverse backgrounds and cultural differences of our members such as age, income, literacy skills, employment status, education level or racial or ethnic group. We are committed to offering services and contracting with healthcare providers, hospitals, pharmacies and ancillary services that are sensitive to the needs of our members. Also, Health Choice representatives are trained to be culturally aware and sensitive to member’s needs.

Translation and Interpreter Services

If there is a doctor that is close to your home and speaks your language, we will assign that doctor as your primary care provider (PCP). You may always call to change your PCP if you would rather have another doctor that has an office in your area.

If you need translation or interpreter services, please call our Member Services Department at 1-877-358-8797 at least four (4) business days prior to your routine appointments to arrange translation services in time for your doctor or any other medical appointments. You may also call us if you need any of our printed information in another language or a different format. There is no cost for translation services. Please call Member Services for instructions on obtaining culturally competent materials and/or services, including translated member materials.

If you are deaf and need the help of a signer call Member Services at 1-877-358-8797 and we will get one for you.
If you are hard of hearing, you can call Utah Relay Services at 711 or 1-800-346-4128. This is a telephone relay service or TTY/TDD that is a free public service.


Abbreviations

Below are some commonly used abbreviations in healthcare and what they mean:

CHEC: Child Health Evaluation and Care Program
CHIP: Child Health Insurance Program
CHSCN: Children with Special Healthcare Needs
DWS: Utah Department of Workforce Services
EOB: Explanation of Benefits
HIPAA: Health Insurance Portability and Accountability Act
HPR: Health Program Representative
LHD: Local Health Department
MIHP: Maternal and Infant Health Program
PCP: Primary Care Physician/Provider
PITU: Paiute Tribe of Utah Behavioral Care Department
QMB: Qualified Medicare Beneficiary
SPMI: Seriously and Persistently Mentally Ill
TOB: Total OB Package
TPL: Third Party Liability (Primary Insurance)
UDOH: Utah Department of Health
UTA: Utah Transit Authority
UTEIP: Utah Early Intervention Program
VMH: Valley Mental Health
WIC: Women, Infants and Children (nutritional program)

Glossary of Terms

Below are some commonly used terms and what they mean:

Appeal – A formal complaint made where a member is not satisfied with a decision made by Health Choice Utah.
Behavioral Health Crisis – A situation where, without immediate help, you might hurt yourself or someone else.
Behavioral Health Services – Behavioral health services may include behavior management, group, family and individual therapy and counseling, and emergency/crisis services.
Child Health Evaluation and Care Program (CHEC) – A healthcare program for children up through age 20.
Co-payment – A small charge or fee due at the time covered services are provided.
Emergency – A situation where a person’s health, or the health of an unborn baby, could be threatened. Medical help is needed right away.
Explanation of Benefits (EOB) – The Explanation of Benefits (EOB) may look like a bill, but it is not. The EOB explains to the member the services that the health plan will pay for, how much was paid and if there is any balance that the member may still owe to the provider. If the claim was denied, the EOB will also provide an explanation.
Grievance – A member’s expression of dissatisfaction with any part of their care. A grievance can be filed over the phone or in writing.
Healthcare Power of Attorney – Someone to whom you have given the authority to make healthcare decisions for you if you cannot make them (usually a close friend, relative or spouse).
High-risk pregnancy – A pregnancy for which the mother or baby may be at higher risk for illness or death.
Living Will – A document where you write what you want done with your healthcare. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want. It can also tell your doctor whether or not to make special efforts to save your life.
Mammogram – Screening exam for breast cancer. Recommended for women over the age of 35.
Managed Care – A health plan that works like an HMO. Covered services are provided by providers who contract with the health plan.
Maternity care – Includes medically necessary pregnancy counseling, pregnancy testing, prenatal care, labor and delivery services, as well as care after delivery.
Maternity care coordination – Coordination of the mother’s needs to ensure she and her baby receive all the necessary care for a healthy pregnancy and delivery.
Medical Necessity – This term refers to the need for healthcare services or products that a doctor would give to a patient to prevent, diagnose, or treat an illness, injury, disease or its symptoms in a way that follows generally accepted standards for medicine and is not just for the convenience of the patient, physician or other healthcare provider.
Member – An eligible person enrolled in Health Choice Utah.
Personal Health Information (PHI) – PHI includes information about a member’s healthcare, such as physical and mental health, as well as payments for healthcare.
Postpartum care – Healthcare provided to the mother for up to 60 days after delivery.
Practitioner – Generally, refers to a certified nurse practitioner, midwife, or physician assistant.
Prenatal care – Healthcare provided during the pregnancy.
Prescription – A doctor’s written instructions for medication or treatment.
Primary Care Physician (PCP) – The doctor who treats the member directly. PCPs are usually family practitioners, internists or pediatricians.
Prior Authorization – Some medical procedures, surgeries, equipment and services require your primary care physician or specialist to contact Health Choice Utah prior to determining if this service is appropriate for your care.
Provider – A person or facility that provides healthcare services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.
Referral – Your primary care physician (PCP) may be required to you or your family member a referral for certain specialists or procedures. The referral can take the form of a document that you must bring to the specialist or facility that your PCP has referred you to. The referral tells the specialist or facility that you have seen the PCP for your condition and that additional healthcare services may be recommended. The referral also tells Health Choice Utah that your PCP has referred you to a specialist or facility in the Health Choice Utah network.
Seriously and Persistently Mentally Ill (SPMI) – Any person who, as a result of a serious mental disorder, has emotions or behaviors that prevent them from performing everyday activities.
Special Healthcare Needs – Patients who have serious and chronic physical, developmental or behavioral conditions who require a special type or amount of care.
Specialist – Any doctor who has special training for a specific condition or illness.
Urgent Care – Care provided to patients when their condition is not life threatening, but cannot wait until the next business day for treatment.
Women, Infants and Children (WIC) – A community program that provides food, nutrition counseling and access to health services to low income women, infants and children.