Glossary

S

Service Area — 

The geographical area covered by a network of health care providers. Horizon BCBSNJ service area is the state of New Jersey and certain bordering areas.

Skilled Nursing Facility — 

Facility that provides rehabilitation, and various medical and nursing procedures at a non-acute level. Horizon BCBSNJ will recognize it if it carries out the stated purpose under all relevant state and local laws, and it is either:
  1. a. accredited for its stated purpose by either the Joint Commission; or
  2. b. approved for its stated purpose by Medicare. In some places, a skilled nursing facility may be called an “extended care center” or “skilled nursing center.”

Sleep Medicine — 

A specialty that focuses on disturbance of sleep and unusual sleep patterns or behaviors.

Social Worker — 

A professional who uses community resources, individual casework or group work to promote the adaptive capabilities of individuals in relation to their social and economic environment.

Specialty — 

A branch of medicine or surgery in which a practitioner specializes; the field or practice of a specialist. This information is collected before a practitioner joins our network(s) and it is verified at least every 36 months upon re-credentialing or as new information is received from the practitioner.

Specialty Pharmacy — 

A provider of specialty pharmaceuticals.

Speech Therapy — 

A specialty focusing on the diagnosis and treatment of speech disorders that is performed by a qualified speech therapist and is described in either of the following:
  1. Speech therapy to restore speech after a loss or impairment of a demonstrated, previous ability to speak.
  2. Speech therapy to develop or improve speech to correct a defect that both (i) existed at birth; and (ii) impaired or would have impaired the ability to speak.
  3. Regardless of anything in a. or b. above to the contrary, speech therapy needed to treat speech impairment of the covered person diagnosed with a Developmental Disability.

For the purpose of Horizon BCBSNJ’s Managed Care Program, Speech Therapy shall be deemed to include feeding therapy, when medically necessary and appropriate, designed to facilitate normal feeding patterns.

Sports Medicine — 

A sports medicine doctor has knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise, physiology, bio-mechanics, nutrition, psychology, physical rehabilitation, epidemiology, injuries and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine.

Status Change — 

A lifestyle event that may cause a person to change his/her health benefits coverage. Examples include, but are not limited to, the birth of a child, divorce or marriage.

Stereotactic Breast Biopsy — 

Uses mammography — a specific type of breast imaging that uses low-dose X-rays — to help locate a breast abnormality and remove a tissue sample for examination under a microscope.

Subacute Facility — 

Facility that provides rehabilitation and various medical and nursing procedures at a non-acute level.

Substance Abuse Provider - Inpatient — 

An inpatient facility that provides treatment for substance abuse related disorders.

Substance Abuse Provider - Outpatient — 

An outpatient facility that provides treatment for substance abuse related disorders.

Summary Plan Description (SPD) — 

A summary of plan eligibility, benefits and other information provided by employer groups to anyone participating in an Employee Retirement Income Security Act (ERISA) plan. Administrators of plans subject to ERISA are required by law to provide SPDs to plan participants.

Surgery — 

A specialty covering a wide variety of surgical procedures. These surgical procedures consist of: (a) The performance of generally accepted operative and cutting procedures, including: surgical diagnostic procedures; specialized instrumentations; endoscopic exams, and other invasive procedures; (b) The correction of fractures and dislocations; (c) Pre-operative and post-operative care; or (d) Any of the procedures designated by C.P.T. codes as surgery.

Surgical Critical Care — 

A specialty of surgery and a primary component of general surgery related to the care of patients with acute, life-threatening or potentially life-threatening surgical conditions.

Surgical Oncologist — 

A surgeon that applies surgery to oncology; it focuses on the surgical management of tumors, especially cancerous tumors.

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