Members

Understanding Your Care

At Steward 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 You or your provider contacts Steward 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 Steward 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. Steward 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.