Glossary of Health Coverage and Medical Terms

Listed below is a summary of some commonly used terms you may find in working with your insurance coverage and medical providers such as doctors, dentists, and medical specialists. 

Balance Billing

This will occur when a provider (doctor or medical/dental service) bills you for the difference between the amount they charge and the allowed amount (the amount the doctor agrees to accept as payment in full if they are under contract with an insurance company). For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. Balance billing should not occur if the provider is under contact (and most are) with the insurance carrier.

Please ask the provider if they accept your insurance coverage by showing the office your Member ID card prior to services being rendered.

Co-payment

A fixed amount (for example, $15) you pay for a covered health care service.  It is usually charged at the time of service.  The amount can vary by the type of covered health care service.

Deductible

The initial amount that you must pay each plan year (generally September 1 through August 31) for covered benefits before the insurance plan contributes towards the cost of the services. Please note that the University of Pittsburgh student insurance plans do not have a deductible for in-network services.

Dependent

A spouse or an unmarried child under 26 years of age.

Disability Resources and Services (DRS)

DRS provides equal opportunities and support services for academically qualified students with disabilities to ensure they are integrated as fully as possible into the University experience. Their services include providing assistive technology, specialized exam accommodations, interpreters and real-time captioning, assistance with transportation and specialized housing accommodations. DRS is located on the first floor of the William Pitt Union and can be contacted at 412-648-7890.

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 receive in an emergency room.  Emergency rooms are situated in a hospital setting.

Emergency Services

Evaluation and treatment of an emergency medical condition that may prevent this acute situation from getting worse.

Excluded Services

There is a list of health care services that your insurance plan does not cover. They may be found in the Certificate of Coverage on this web site.  Any excluded services received are the responsibility of the member.

Health Insurance

A contract that requires your health insurer (e.g. UPMC Health Plan, Aetna, United Health Care, Highmark) to pay some or all of your health care costs in exchange for a premium.

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.

Outpatient Care

Care in a hospital or other outpatient facility that usually does not require an overnight stay.

In-Network Services

Services performed by participating providers who have a contract or agreement with UPMC Health Plan or other insurance plan to provide specific services for a specific cost.

International Student Organizations and Programs

International student organizations and programs are housed on the sixth floor of the William Pitt Union in the Office of Cross-Cultural and Leadership Development (CCLD). Through this office, international students attend culture shock and adjustment workshops, social events, and information and educational programs. New international students participate in the LINKS program to aid in their adjustment to Pitt through CCLD. CCLD also serves as the advisor for numerous international student organizations.

Mail-Order Prescription Drugs

Medications that can be ordered in a 3-month or 90-day supply for a reduced out-of-pocket cost.  Please note that if you have coverage through UPMC Health Plan, you may obtain a 90-day supply at Student Health Services (SHS) and Falk Pharmacy.

Medically Necessary

Health care services or supplies needed to prevent, 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 that has not contracted with UPMC Health Plan to provide services at a reduced fee

Out-of-Network Services

Health care services received outside of the designated PPO network by non-participating providers. Benefits are paid at a lower level after the annual deductible is met. Members may also have to pay the difference between the provider’s charge and the UPMC Health Plan payment

Participating Provider

A provider that has contracted with UPMC Health Plan or other insurance carrier to provide medical services to covered persons. The provider may be a hospital or other facility, a physician, or a pharmacy that has contractually accepted the terms and conditions as set forth by UPMC Health Plan or any other contracted insurance carrier.

Physician Services

Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.

Plan

A benefit your employer, union or other group sponsor provides to you to pay for your health care services.

Preferred Provider Organization (PPO)

An arrangement between a group of doctors or providers and another entity, such as an employer or other group. This arrangement makes it possible for price discounts on services in exchange for a higher volume of patients.  Please make sure your physicians and other health care service providers or facilities participate with your insurance coverage.  Most providers and facilities in Western PA contract with UPMC Health Plan but it is always a good idea to confirm the arrangement. 

Premium

The amount that must be paid for your health insurance or plan. Student Health Insurance is usually paid monthly.

Prescription Drug Coverage

Most health insurance plans usually pay towards the cost of prescription medication.  Your cost share is typically a co-payment (a flat dollar amount) or a percentage of the total costs (e.g. 20%).

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. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), 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 physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law.

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.

Specialty Prescription Drugs

Specialty medications are used to treat complex clinical conditions and are limited to a 30-day supply. Most specialty medications must be obtained through our designated specialty provider, which provides convenient and expedited delivery through the mail.

Student Health Services

(SHS) is a primary care facility that features a health care clinic and pharmacy staffed by medical doctors, nurses, nurse practitioners, a pharmacist, and other health care professionals. Each student pays a student health fee each semester that gives them access to SHS, which also provides a comprehensive array of educational programs and preventative medicine, including women’s health services. SHS is located in the Medical Arts Building at 3708 Fifth Avenue (beside Rita’s) and their number is 412-383-1800.  Students at the regional campuses should check their campus directory for the telephone number and location.

University Counseling Center

Provides comprehensive and confidential personal and academic counseling to Pitt students free of charge. Staffed by psychologists, counselors, social workers, psychiatrists, and pre-doctoral interns, the counseling center provides personal and group counseling for a variety of conditions including ADHD/ADD, depression, drug and alcohol support, anxiety, grief, sexual abuse, and more. The counseling center has day and evening hours by appointment and is located on third floor of the William Pitt Union. Please call 412-648-7930 for more information.

Urgent Care (i.e. UPMC Urgent Care & MedExpress)

Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. At an urgent care center you may be seen by a physician or a nurse practitioner, but a physician is generally always on site. An urgent care clinic may treat injuries or illnesses that need more immediate care but are not serious enough to go to an emergency room. These include all of the convenience clinic treatments plus a broader range of treatments and tests such as x-rays, setting broken bones, and stitches. Highfield Urgent Care is subject to deductible and co-insurance.

Convenient Care Clinics (i.e. MinuteClinic)

At a convenience care clinic (such as one found in a drug store), you may be seen by a Certified Nurse Practitioner or Physician Assistant. A convenience care clinic may treat things such as: minor infections, ear and sinus infections, skin conditions (e.g., poison ivy), and minor injuries such as a splinters or sprains.

Additional Dental Medicine Terminology

Dental Anesthesiology

Provides nitrous oxide, oral sedation, intravenous (IV) sedation and/or general anesthesia.

Dental Hygiene

Provides dental prophylaxis (teeth cleaning) and preventive services, such as application of topical fluoride treatments and sealants; educates and counsels patients about proper oral hygiene techniques, nutrition, and tobacco cessation.

Emergency Care

Provides emergency dental care (pain, bleeding, swelling, infection).

Endodontics (Root Canal)

 Provides treatment of tooth infections of the pulp caused by decay or injury.

Implantology

Provides replacement of missing teeth using dental implants and implant-supported or implant-retained prostheses.

New Patient Screening

Includes examinations and assessments of oral health needs, including medical factors.

Oral and Maxillofacial Surgery

Provides diagnosis and surgical and adjunctive treatment of diseases, injuries, defects, and aesthetic problems involving the teeth and other structures associated with the oral and maxillofacial regions.

Orthodontics and Dentofacial Orthopedics

Provides diagnosis and specialized treatment of oral and facial malformations, including braces.

Pediatric Dentistry (all patients less than 18 years of age)

Provides preventive and comprehensive dental treatment for children and adolescents.

Periodontics

Provides services ranging from prophylaxis (teeth cleaning) to the treatment of periodontal disease (gum disease) including scaling and root planing (deep cleaning), as well as specialized treatment such as periodontal surgery, bone grafts, soft tissue grafts, implants, and managing of temporomandibular joint (TMJ) disorders.

Prosthodontics

Provides services ranging from single unit crowns to multiple units of crowns (bridges), removable complete dentures, and removable partial dentures to replace missing teeth.

Radiology

Provides imaging services that include radiographs of teeth and supporting structures (intra-oral); 3D imaging of selected areas for certain diagnostic tasks such as study of potential implant sites, temporomandibular joints, etc.; appropriate referrals for advanced imaging at UPMC hospitals or other such imaging centers in select cases, upon request from the care provider; radiographs are read by radiology faculty and written reports are provided, when specifically requested.

Restorative Dentistry

Provides restorations (fillings), such as silver amalgam, gold, composites (white fillings), and porcelain inlays, onlays, and veneers.