Glossary

P

Pain Management — 

A specialty focusing on medical care that alleviates or reduces pain.

Palliative Medicine — 

A multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain and the physical and mental stress of a serious illness — whatever the diagnosis.

Participating Hospital Affiliation — 

The network hospital(s) at which the doctor has active or courtesy medical staff privileges. This information is collected before a doctor joins Horizon BCBSNJ’s network(s) and it is verified at least every 36 months upon re-credentialing or as new information is received from the doctor. If hospital care is needed, doctors may direct members to one of these hospitals.

Participating Provider — 

A doctor, other medical services professional or organization (hospital, lab facility, etc.) that contracts with Horizon BCBSNJ to provide in-network services to its members. A participating provider may also be referred to as an in-network provider.

Patient-Centered Medical Home (PCMH) — 

A model that aims to produce high-quality patient care and an improved experience by supporting patients through a care team of health professionals. The care team is accountable for addressing patients’ wellness and preventive services and providing for the patients chronic and acute care needs.

Pediatric Dentist — 

Pediatric dentists specialize in dealing with the oral health care of children, from infancy through the teenage years.

Pediatric-Neurodevelopmental Disabilities — 

A pediatrician who treats children having developmental delays or learning disorders, including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions.

Pediatrics — 

A specialty focusing on maintaining health and providing medical care for children from birth to late teens.

Periodontist — 

Periodontists are dentists who specialize in the care and prevention of gum-related diseases, guided bone regeneration, and dental implants.

Pharmacy -- Vaccine Administration — 

A health care professional who administers vaccines.

Physical Medicine / Physical Therapy — 

The branch of medicine concerned with treatment by physical means, such as such as manipulation, heat, electricity, or radiation, rather than by medication or surgery to: relieve pain; develop or restore normal function; and prevent disability following illness, injury, or loss of limb.

Physician’s Assistant — 

A medical practitioner who works under the supervision of a licensed doctor (an M.D.) or osteopathic doctor (a D.O.).

Plastic Surgery — 

A specialty focusing on corrective operations to the face, head and body to restore function as well as appearance.

Podiatry — 

A specialty focusing on the diagnosis and treatment of disorders and injury of the feet.

Positron Emission Tomography (PET) — 

PET uses small amounts of radioactive materials called radiotracers, a special camera and a computer to help evaluate your organ and tissue functions.

Positron Emission Tomography–Computed Tomography (PET-CT) — 

Also known as PET-CT or PET/CT, a nuclear medicine technique which combines, in a single gantry, a positron emission tomography (PET) scanner and an X-ray computed tomography (CT) scanner, to acquire sequential images from both devices in the same session, which are combined into a single superposed (co-registered) image.

PRECIOUS ADDITIONS® — 

This voluntary Horizon BCBSBJ program provides members with valuable health information and resources during early pregnancy, when prenatal care is most important.

Preferred Provider Organization (PPO) Plan — 

A network-based health plan where a member does not need to choose a Primary Care Physician (PCP). A member may choose to receive care either from participating health care providers or non-participating providers. If a member receives care from a participating provider, the health plan generally covers the member at a higher level of benefits.

Premium Subsidy Amount (Premium Tax Credit) — 

A premium assistance tax credit will be provided monthly to lower the amount of premium the individual or family must pay for their coverage.

Premium Subsidy Effective Date — 

The date the premium subsidy became effective for the member.

Premium Subsidy Termination — 

The date the premium subsidy terminated for the member.

Preventive Care — 

Medical and dental services aimed at early detection and intervention. Preventive care includes, but is not limited to, routine physical exams, screening tests, immunizations, etc. Preventive care does not include treatment of an injury or illness.

Primary Care Physician (PCP) — 

An in-network doctor or other health care professional who: (a) is licensed or otherwise authorized to provide health care services in the state or jurisdiction in which the services are furnished; and (b) supervises, coordinates and maintains continuity of care for covered persons. PCPs include: nurse practitioners/clinical nurse specialists; physician assistants; and certified nurse midwives who meet specific New Jersey requirements.

Private Duty Nursing — 

Medical and nursing care provided in the home.

Proctology — 

A branch of medicine dealing with the structure and diseases of the anus, rectum, and sigmoid colon.

Prosthodontist — 

Prosthodontists are dentists who specialize in the restoration and replacement of broken teeth with crowns, bridges, or removable prosthetics (dentures).

Provider Discounts — 

The amount of money contracting health care providers deduct from their usual charges pursuant to contracts between themselves and a health insurer such as Horizon BCBSNJ.

Psychiatric Nurse — 

A nurse who applies the nursing process to assess, diagnose and treat individuals or families with psychiatric disorders and identify risk factors for such disorders.

Psychiatrist — 

A doctor who specializes in the prevention, diagnosis and treatment of mental illness. Psychiatrists must receive additional training and serve a supervised residency in their specialty.

Psychologist — 

A professional specializing in diagnosis and treatment of diseases of the brain, emotional disturbance and behavior problems. Psychologists cannot prescribe medication for their patients.

Pulmonary Disease — 

A specialty focusing on the diagnosis and treatment of disorders of the lungs and airway.

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