PMB Glossary Terms S
Appro-Rx helps improve the way pharmacy benefits management is done every day to help lower prescription costs. However, we understand that the world of PBMs can be confusing. Below we have answered your most frequently asked questions to give you a better understanding of your needs!
The voluntary option or mandatory requirement to visit another physician or surgeon for an opinion regarding a diagnosis, course of treatment or having specific types of elective surgery performed.
The geographic area the HMO or PPO is licensed to operate, where applicable, or when licensing is not required, the geographical area where an adequate network is established to provide the services covered under the benefit plan.
Skilled Nursing Facility (SNF)
An institution or a distinct part of an institution that is licensed or approved under state or local law, and which is primarily engaged in providing skilled nursing care and related services as a Skilled Nursing Facility, extended care facility, or nursing care facility approved by the Joint Commission on Accreditation of Health Care Organizations or the Bureau of Hospitals of the American Osteopathic Association, or as otherwise determined by the health plan to meet the reasonable standards applied by any of the aforesaid authorities
A Physician who provides medical care in any generally accepted medical or surgical specialty or subspecialty.
Treatment for the correction of a speech impairment that resulted from birth, or from disease, injury, or prior medical treatment.
The employee covered under an employer's group agreement or group insurance policy. The subscriber can enroll eligible dependents as determined by the contract holder under family coverage.