Glossary

 
D
Date of Service

The date on which a service was rendered.

Day Treatment Center

An outpatient psychiatric facility which is licensed to provide outpatient care and treatment of mental or nervous disorders or substance abuse under the supervision of physicians.

Deductible

A portion of eligible expenses that an individual or family must pay during a calendar year before EmblemHealth will begin to pay benefits for covered services.

Delegation

The process by which the organization permits another entity to perform functions and assume responsibilities covered under these standards on behalf of the organization, while the organization retains final authority to provide oversight to the delegate.

Denial of Benefits

A rejection of an entire claim or part of a claim.

Dental Care

The treatment of the oral cavity.

Dependent

An individual other than the subscriber who is eligible to receive health care services under the subscriber's Certificate of Insurance. Generally, dependents are limited to the subscriber's spouse and eligible children.

Diagnostic Tests

Tests and procedures ordered by a physician to determine if the patient has a certain condition or disease based upon specific signs or symptoms demonstrated by the patient. Such diagnostic tools include radiology, ultrasound, nuclear medicine, laboratory, or pathology services.

Direct Payment
Individual subscribers who are billed and pay premiums directly to the insurer or managed care organization.
Discharge Date

Date the patient left the hospital.

Disease Management

A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition.

Domestic Partners

Domestic partners are two people, both of whom are eighteen years of age or older, neither of whom is married or related by blood in a manner that would bar her or his marriage in New York State, who have a close and committed personal relationship, who live together and have been living together on a continuous basis. A domestic partner may be eligible to receive health care services as dependent under your Certificate of Insurance. Not all groups provide coverage for domestic partners. Therefore, please review the amendments or riders to your Certificate in order to determine if coverage for a domestic partner is available.

Drug Formulary

A list of preferred pharmaceutical products that health plans, working with pharmacists and physicians, have developed to encourage greater efficiency in the dispensing of prescription drugs without sacrificing quality.

Durable Medical Equipment (DME)

Medical equipment, goods, implements, prosthetics, etc., that are prescribed for patient care, usually in an outpatient setting. Examples of such equipment include hospital beds, wheelchairs, and walkers.