Understanding Your Care

At Health Choice Utah, we are committed to providing you the care you need right in your community.

It is important to visit a provider you trust and share any facts about your health with them. Let your provider know if there has been any change to:

  • Your diet
  • Your exercise routine
  • Medications

AskMe3.org suggests three questions to ask when visiting your provider or pharmacist:

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

These questions will help you prepare for your appointments and take care of your health. If you have trouble understanding your care plan, ask your provider to explain it again.

Translation and Interpreter Services

Health Choice Utah offers care in your language.

Call Member Services to help you with the following:

  • Finding a primary care provider close to home that speaks your language
  • Needing an interpreter or translator for your appointments*
  • Printed material in another language or format
  • Services for the hard of hearing or deaf

*Please call Member Services 4 business days prior to your appointment to set up this service.

Numbers to know:

Member Services: 877-358-8797 (Available Monday – Friday from 8 AM – 6 PM)
Relay Utah: 1-800-346-4128
TTY/TDD: 711


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  You or your provider contacts Heath Choice Utah to review an Adverse Benefit Determination to see if the right decision was made to deny a request for service.
Co-Payment – A fixed amount you pay for a covered health care service after you’ve paid your deductible. Co-payments can vary for different services. Also called a co-pay.
Durable Medical Equipment (DME) – Medical equipment that your doctor prescribes for use in your home. Example of DMEs are blood sugar monitors, blood sugar test strips, crutches, hospital beds, CPAP machines, walkers, and more.
Emergency Medical Condition – An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
Emergency Medical Transportation – Ambulance services for an emergency medical condition.
Emergency Room Care – Emergency services you get in an emergency room.
Emergency Services – Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Excluded Services – Health care services that your health insurance or plan doesn’t pay for or cover.
Grievance – A complaint about the way your health care services were handled by your provider or Health Choice Utah.
Habilitation Services and Devices – Services that help you learn, keep, or improve skills needed for daily living. Examples include physical and occupational therapy, speech-language pathology, and more.
Health Insurance – A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.
Home Health Care – Health care services a person receives at home.
Hospice Services – Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Hospitalization – Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care.
Hospital Outpatient Care – Care in a hospital that usually doesn’t require an overnight stay.
Medically Necessary – Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
Network – The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Non-Participating Provider – A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-participating provider.
Physician Services – Health care services a licensed medical physician (M.D. or D.O.) provides or coordinates.
Plan – A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
Preauthorization – A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Health Choice Utah refers to this as Prior Authorization.
Participating Provider – A provider who has a contract with your health insurer or plan to provide services to you at a discount.
Premium – The amount you pay for your health insurance every month.
Prescription Drug Coverage – Health insurance or plan that helps pay for prescription drugs and medications.
Prescription Drugs – Drugs and medications that, by law, require a prescription.
Primary Care Physician – A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.
Primary Care Provider – A physician (M.D. or D.O.), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.
Provider – A health care professional that is allowed under state law to provide health care services to patients.
Rehabilitation Services and Devices – Health care services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled. These services can include physical therapy, occupational therapy, speech-language pathology, and more.
Skilled Nursing Care – Services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home.
Specialist – A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.
Urgent Care – Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe it requires emergency room care.

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