Health Insurance Glossary A

Accredited (Accreditation)

A "seal of approval" for health care facilities. Being accredited means that a facility has met certain quality standards. These standards are set by private, nationally recognized groups that check on the quality of care at health care facilities.

Accumulation Period

Timeframe within a policy period in which deductible and out-of-pocket amounts are calculated. For most health insurance policies, the accumulation period is a calendar year.

Administrative Services Only (ASO)

An arrangement in which an employer hires a third party to deliver employee benefit administrative services to the employer. These services typically include health claims processing and billing. The employer bears the risk for health care expenses under an ASO plan.

After Care

The care or follow-up treatment needed by a patient who has recently undergone surgery, been involved in an accident or has experienced an illness requiring hospitalization.

Agent of Record

The insurance agent recognized by a client to represent the client's interests in doing business with an insurance company.

Ambulatory Care

All types of health services that do not require an overnight hospital stay.

Ancillary Services

Services, other than those provided by a physician or hospital, which are related to a patient’s care, such as laboratory work, x-rays and anesthesia.

Appeal

Request made to a payer to reconsider a decision, such as a claim denial or denied prior authorization request. Most appeals must be submitted in writing within a specified period.

Assignment of Benefits

When an insured person assign benefits, they sign a document allowing the hospital or doctor to collect health insurance benefits directly from the health insurance company. Otherwise, the insured person pays for the treatment and is later reimbursed by the health insurance company.

Adhesions

When your body heals, it forms scar tissue, which can occur if the tissues in your abdomen or pelvis are injured. Adhesions are bands of scar tissue that develop between various organs or tissues, causing them to adhere to each other.

Attachment

A policy modification which changes, restricts or clarifies coverage.

Abdominal hernia

Your abdominal wall consists of sturdy sheets of muscles and tendons running from your ribs to your groin. Weakness in this wall can lead to an abdominal hernia, where contents push through the weakened area. Symptoms of a hernia include pain or a noticeable bulge in the abdomen or groin, particularly when coughing or straining. Sometimes, symptoms may not be immediately apparent. Treatment for an abdominal hernia often involves surgery, depending on its type and likelihood of complications. If you experience sudden severe pain or tenderness in the hernia, especially if it cannot be pushed back in, seek medical attention promptly as this may indicate a trapped hernia, necessitating urgent surgery.

Achilles tendinopathy

The Achilles tendon, the thickest and strongest in the body, connects your calf muscle to the heel bone, facilitating movement of the foot during activities like walking, running, climbing, or jumping. When afflicted with Achilles tendinopathy, the tendon sustains damage and loses its optimal function due to repetitive stress and injury over time. This damage can result in pain and difficulty performing usual activities. While Achilles tendinopathy is sometimes referred to as Achilles tendonitis, implying inflammation of the tendon, this term isn't always accurate since inflammation may not always be present in tendon injuries.

Achilles tendon rupture

Tendons, resilient and supple, serve to link muscles to various body parts, typically bones. Among these, the Achilles tendon stands out as the body's strongest, facilitating heel elevation crucial for walking, running, and jumping. Achilles tendon ruptures, or tears, often occur when the foot is abruptly forced upward or when forceful push-off actions, such as jumping, are executed. While Achilles tendon injuries can happen at any age, they are most prevalent among individuals aged 30 to 50 who engage in occasional sports activities.

Acne

Acne is a common skin condition that can manifest on various areas including the face, back, shoulders, and chest. It presents in different forms: - Blackheads - Whiteheads - Inflamed red bumps (papules) or yellowish bumps (pustules) - Deep, fluid-filled spots known as cysts Most prevalent among teenagers and young adults, with approximately 9 in 10 individuals aged 12 to 24 experiencing it at some point, acne affects around 650 million people worldwide. While less common in adulthood, it can still occur, and even newborns may develop acne in their first six months. Typically, acne tends to clear up as one transitions into adulthood. It's important to note that acne is not contagious, so it cannot be transmitted from one person to another.

Alcoholism

For many, alcohol is a casual part of social life, enjoyed without significant repercussions. National guidelines exist to promote safe and responsible drinking habits. However, some individuals find it challenging to manage their alcohol consumption, leading to its prominence in their lives. This may result in personal and interpersonal issues, affecting mental and physical well-being. If you suspect alcohol may be problematic for you, know that you're not alone. General practitioners regularly encounter patients grappling with alcohol-related concerns, with estimates suggesting that as many as one in ten individuals may experience alcohol dependency at some stage in their lives.

Alzheimer’s disease

Alzheimer's disease progressively impairs cognitive function and memory, altering personality and behavior. Communication and self-management become increasingly challenging as the condition advances. As individuals age, Alzheimer's prevalence rises, especially beyond 60 years old. Approximately 1 in every 100 people develop Alzheimer's by age 60, escalating to around 40 in every 100 by age 85. While more women receive diagnoses, this trend may be attributed to women's longer lifespan rather than a gender-specific susceptibility.

Anaemia

Anemia occurs when the body lacks an adequate number of red blood cells or hemoglobin to meet its requirements. Hemoglobin, found in red blood cells, is responsible for transporting oxygen to tissues and organs. Symptoms of anemia may include fatigue, weakness, or shortness of breath.

Anal cancer

Anal cancer is relatively uncommon, with approximately 1,000 diagnoses annually in the UK. However, there has been a notable increase in cases in recent years, particularly among women.

Anal fissure

An anal fissure refers to a tiny tear or ulcer in the skin located inside the anus, resulting in intense pain and occasional bleeding during bowel movements. While anal fissures typically resolve on their own, especially with basic self-care practices, treatment options are available if they persist.

Anal fistula

An anal fistula may arise following an infection of the glands surrounding the anus, leading to the formation of an abscess, which is a pocket of pus between the skin and the anus. When the pus drains away, it can create a small tunnel known as a fistula. About a third of individuals with an anal abscess eventually develop a fistula. Additionally, long-term bowel conditions like Crohn's disease can contribute to their development. Typically, a fistula manifests as a tunnel connecting the skin to the anal canal. In more complex cases, multiple tracts may form from the same tunnel or pass through the anal sphincter muscles, complicating treatment. Surgery is the primary treatment for anal fistulas since they rarely heal on their own. Without intervention, they can lead to recurrent abscesses.

Angina

Angina typically signals the presence of coronary heart disease. In this condition, fatty deposits known as plaques accumulate in the blood vessel walls, a process called atherosclerosis, leading to narrowing of the vessels. Consequently, the flow of blood and oxygen to the heart muscle is hindered. Angina symptoms often become noticeable during periods of increased cardiac demand, such as during physical exertion or emotional stress. It serves as a warning sign for potential serious health issues, including the risk of a heart attack, which can be life-threatening. However, managing angina symptoms is achievable through treatment and adopting healthy lifestyle modifications.

Angiogram

During an angiogram procedure, a thin tube known as a catheter is carefully inserted into an artery, typically in your wrist or groin, and guided towards your heart. Your doctor then administers a specialised dye, called contrast, through the catheter, which illuminates your heart and coronary arteries on an X-ray. These arteries are responsible for supplying blood to your heart. By visualising the arteries, an angiogram can pinpoint any areas of narrowing or blockage, providing insight into the location and severity of the obstruction.

Angioplasty

Angioplasty is a medical procedure designed to widen narrowed or obstructed arteries, enhancing blood flow. It can be performed on the arteries in your legs to address peripheral arterial disease, thereby improving circulation to your lower limbs. When conducted below the groin, specifically in the legs, it's referred to as femoral angioplasty.

Ankylosing spondylitis

Ankylosing spondylitis is a form of arthritis characterised by its impact on the joints of the spine, leading to persistent pain and stiffness, particularly in the lower back. While it's a chronic condition, symptoms can be alleviated through physiotherapy, exercise, and medications, often resulting in improved comfort and mobility.

Anterior cruciate ligament (ACL)

The anterior cruciate ligament (ACL) is a crucial ligament located within the knee joint, connecting the thigh bone (femur) to the front of the shin bone (tibia). Injuries to the ACL commonly occur during sports activities that require sudden changes in direction or abrupt stops, such as football, netball, or skiing.

Anterior cruciate ligament (ACL) reconstruction

Anterior cruciate ligament (ACL) reconstruction is a surgical procedure aimed at replacing a damaged ACL, one of the key ligaments in the knee joint. This surgery is typically recommended for individuals with ACL injuries to restore proper function and stability to the knee.

Antibiotics

Antibiotics are medications prescribed to treat or prevent bacterial infections. Proper usage of antibiotics, taking them only when necessary and as directed, is essential to prevent the development of antibiotic resistance, which can render these medications less effective over time.

Antidepressants

Antidepressants are medications primarily prescribed to alleviate symptoms of depression. There are various types of antidepressants available, and your doctor will determine the most suitable option based on your individual needs and situation. It may take several weeks before you notice any improvement in your symptoms after starting an antidepressant regimen. While all antidepressants carry the potential for side effects, many individuals find that these effects are mild and diminish over time.

Antihistamines

Antihistamines are medications typically utilised to alleviate symptoms associated with allergic reactions, such as those experienced during hay fever. They can also be taken for conditions like insect bites and stings, as well as to mitigate symptoms of travel sickness.

Anxiety

Anxiety is characterised by feelings of fear, unease, or worry regarding potential future events. When anxiety persists over an extended period and becomes severe, it can significantly disrupt daily functioning and impact both mental and physical well-being.

Aortic aneurysm surgery

Aortic aneurysm surgery is a procedure aimed at repairing a dilated artery, specifically the aorta, to decrease the risk of rupture. In cases where the aortic aneurysm has already ruptured, emergency surgery is necessary to address the issue.

Asthma

Asthma is a prevalent, chronic condition impacting the airways within the lungs. Its symptoms can vary among individuals but commonly include wheezing, coughing, tightness in the chest, and shortness of breath. Management of asthma involves the use of medications and avoidance of triggers to effectively control the condition.

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is characterised by differences in how the brain functions compared to neurotypical individuals. It can impact behaviour and social interaction patterns. While living with ASD presents challenges, seeking support can assist in effectively managing any associated difficulties.

Coronary angioplasty

Coronary angioplasty is a medical procedure performed to widen narrowed or obstructed arteries in the heart, facilitating smoother blood flow and ensuring adequate oxygen supply to the heart muscle. It is commonly utilised to alleviate angina symptoms or as an urgent intervention in the event of a heart attack.