Hypoplastic Left Heart Syndrome (HLHS) Information Page
Anesthesiologist - a physician specially trained in the administration of anesthesia for surgical, obstetrical and other procedures, as well as the management of pain problems. Some can be pain management specialists.
Cardio-Thoracic Surgeon - a physician specializing in surgical procedures involving the heart, lungs, esophagus, chest wall and mediastinum. Required to complete additional residency training after their general surgery residency.
Cardiologist - a physician specially trained in the diagnosis and treatment of abnormalities of the heart and blood vessels, including high blood pressure, chest pain and arrhythmias.
Neonatologist - a pediatrician specializing in the first 29 days of an infant's life.
Obstetrician - a physician specializing in the care and treatment of women during pregnancy, childbirth and the period immediately following.
Pediatrician - a physician specializing in the development of children and in the prevention, diagnosis and treatment of children's diseases.
Perinatalogist - a physician specially trained in maternal-fetal medicine dealing with the fetus and infant during the perinatal period (from the 20th to 29th week of pregnancy to the first to fourth week after birth). Consulted in cases of high-risk pregnancy.
Transplant Surgeon - a physician specializing in the removal and transplantation of organs and tissues.
Coinsurance - The portion of covered health care costs for which the covered person has a financial responsibility, usually a fixed percentage. Coinsurance usually applies after the insured meets his/her deductible.
Copayment - a cost-sharing arrangement in which an insured pays a specified charge for a specified service, such as $10 for an office visit. The insured is usually responsible for payment at the time the service is rendered. This charge may be in addition to certain coinsurance and deductible payments.
Covered Person- an individual who meets eligibility requirements and for whom premium payments are paid for specified benefits of the contractual agreement.
Deductible - the amount of eligible expenses a covered person must pay each year from his/her own pocket before the plan will make payment for eligible benefits.
Deductible Carry Over Credit - charges applied to the deductible for services during the last 3 months of a calendar year which may be used to satisfy the following year's deductible.
Dependent - a covered person who relies on another person for support or obtains health coverage through a spouse, parent or grandparent who is the covered person under a plan.
Effective Date - the date insurance coverage begins.
Eligible Dependent - a dependent of a covered person (spouse, child, or other dependent) who meets all requirements specified in the contract to qualify for coverage and for who premium payment is made.
Eligible Expenses - the lower of the reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan.
Explanation of Benefits (EOB) - the statement send to an insured by their health insurance company listing services provided, amount billed, eligible expenses and payment made by the health insurance company.
Out-of-Pocket Maximum - the total payments that must be paid by a covered person (i.e., deductibles and coinsurance) as defined by the contract. Once this limit is reached, covered health services are paid at 100% for health services received during the rest of that calendar year.
Participating Provider - a medical provider who has been contracted to render medical services or supplies to insureds at a pre-negotiated fee. Providers include hospitals, physicians, and other medical facilities.
Preferred Provider Organization (PPO) - a health care delivery arrangement which offers insureds access to participating providers at reduced costs. PPOs provide insureds incentives, such as lower deductibles and copayments, to use providers in the network. Network providers agree to negotiated fees in exchange for their preferred provider status.
Provider - a physician, hospital, health professional and other entity or institutional health care provider that provides a health care service.
Primary Care Physician (PCP) - a physician that is responsible for providing, prescribing, authorizing and coordinating all medical care and treatment.