Ngaba ufuna ukunyamekela kumgqirha ongaphandle komntla, kwikliniki okanye esibhedlele? Unakho ukuhlawula okungaphezulu kunokuba ungathanda ukuba uhlala kwi-network. Enyanisweni, nge- HMO kunye ne- EPO , i-inshorensi yakho yezempilo ayinakho ukuhlawula nayiphi na into yokunakekelwa kwe-out-of-network . Nokuba i-inshorensi yakho yezempilo iyisicwangciso se- PPO okanye i-POS egalela ekunakekeleni kwakho ukunakekelwa kwe-intanethi, inxalenye yakho yowayilwayo iya kuba mkhulu kunokuba isetyenziselwe ukuhlawula ukunakekelwa kwenethiwekhi.
Nangona kunjalo, phantsi kweemeko ezithile, isicwangciso sakho sezempilo siya kuhlawula ukunyamekelwa kwenkonzo ngaphandle kwenethiwekhi kwisantya esifanayo esihlawulela ukunakekelwa kwenethiwekhi, ukugcina imali eninzi. Umele ukwazi ukuba nini kwaye njani ukubuza.
Xa iSicwangciso seMpilo sakho siza kuhlawula amaxabiso angaphakathi kwiNethiwekhi yokuNakekela iNethiwekhi
Intshuwalense yezempilo ilawulwa yimithetho kaRhulumente. Urhulumente ngamnye uhluke kubamelwane bawo, ngoko ke oku kulandelayo zikhokelo eziqhelekileyo ezisebenza kwiindawo ezininzi zelizwe. Nangona kunjalo, ukuba imithetho yakho yelizwe iyahluka, isicwangciso sakho sezempilo sinokulandela imigaqo eyahlukileyo.
Izicwangciso zezempilo zinokuqwalasela ukuhlawula ukunyamekela ukuba uphume kwe-network njengokungathi ufumene kumboneleli wenethiwekhi kwiimeko ezilandelayo:
- Kwakuyimeko engxamisekileyo kwaye waya kwigumbi eliphuthumayo elisondeleyo elikwazi ukunyanga imeko yakho. Kule meko, isicwangciso sakho sempilo sinokuthi siphumelele "kwimeko engxamisekileyo" njengendlebe, ukukhwehlela, okanye isiqhelo esinye sokuhlanza. Kodwa, kunokwenzeka ukuba ikhusele ngokukhawuleza ukunyamekela kwezinto ezifana nokuhlaselwa kwintliziyo, ukubetha, okanye ukusongela ubomi kunye nokulimala kwamalungu.
- Akukho banikezeli-inethiwekhi apho ukhona. Oku kusenokuthi uphuma edolobheni xa ugula kwaye ufumanisa inethwekhi yesicwangciso sakho sempilo ayifihla isixeko ovakatyelayo. Kwakhona kunokuthetha ukuba ungaphakathi kwintsimi yakho yesicwangciso sempilo, kodwa inethwekhi yezempilo yakho ayibandakanyi uhlobo lwenzululwazi oluyifunayo, okanye ingcali kuphela ye-network inokuthi i-200 miles. Kuzo zombini iimeko, isicwangciso sakho sempilo siya kuba nako ukunakekelwa ngononophelo lwentlalo kwi-in-rate rate xa udibana nesicwangciso sezempilo ngaphambi kokuba unakekele.
- Uphakathi komjikelezo okhuselekileyo wonyango (cinga i-chemotherapy okanye ukufakelwa komzimba) xa umboneleli wakho ngokukhawuleza ephuma ekubeni in-network ukuya ngaphandle kwe-network. Oku kwenzeka ngenxa yokuba umnikezeli wakho wehlisiwe, okanye ukhetha ukushiya, umnatha. Kusenokwenzeka nokuba kwenzeka ngenxa yokuba u-inshorensi yempilo yakho ishintshile. Ngokomzekelo, mhlawumbi unomsebenzi osuselwe kumsebenzi kwaye umqeshi wakho akasanikeli isicwangciso obenakho iminyaka kangangokuba waphoqeleka ukuba utshintshe kwisicwangciso esitsha. Kwezinye iimeko, isicwangciso sakho sezempilo esikuyo siyakukuvumela ukuba ugqibe umjikelezo wakho wonyango kunye nomnikezeli-ngaphandle wenethiwekhi ngeli xesha unxibelele ukhathalelo kwinqanaba le-in-network.
- Inhlekelele yendalo yenza kube nzima ukuba ufumane ukunakekelwa kwenethiwekhi . Ukuba ummandla wakho uvele ujikeleze umkhukula, inqhwithi, inyikima, okanye umlilo ochaphazeleke kakhulu kwiindawo ezisenkundleni, isicwangciso sakho sempilo sinokukulungela ukunyamekela ukunakekelwa kwakho kwe-intanethi kwii-network rates kuba Amaziko angenakukukhathalela.
- Kukho imeko ebanzi yokwenza ukunakekelwa kwenethiwekhi kunzima okanye oko kunokunokwenza ukunakekelwa kwenethiwekhi kuncinci kunokunyamekela kwenethiwekhi. Ezi zizodwa, iimeko ezizimeleyo ezimele ziqwalaselwe kumntu ngamnye. Uya kuba ucela isicwangciso sakho sezempilo ukuba wenze ukhetho olukhethekileyo, nje kuwe, kunye neli qhe le nkathalo. Nazi ezinye zeemifanekiso:
- Ufunda ukuba ugqirha we-in-network unesilinganiselo sokusuleleka kwe-post-op ephindwe kathathu ngaphezu kogqirha ongaphandle kweso sixeko. Akunabanye oogqirha be-network. Kufuneka utyunjiswe, kwaye unamayeza (okanye unokugula) okwenza kube nzima kuwe ukulwa nezifo. Kule meko, ucela isicwangciso sempilo ukuba wenze ikhefu ngokusekelwe kwengozi yakho yokufumana isifo, ubunzima bakho ukulwa nesifo, kunye nezinga eliphezulu lokusuleleka kwi-network-provider. Uya kufuneka uqinisekise isicwangciso sakho sezempilo kuya kuba nexabiso elininzi kubo ukuba bahlawule ukunyamekela kwakho ngaphandle kwenethiwekhi kwizinga le-intanethi kunokuhlawulela unyango olubi kunye nemiphumo emva kwe-post-op sulelo.
- Usandul 'uqhawulo lomtshato. Umyeni wakho wangaphambili nguye kuphela inethiwekhi ye-neurosurgeon ngaphakathi kwimizila engama-300-mile, kwaye une-tumor yengqondo efuna ukuhlinzwa. Awufuni nje ukuba umyeni wakho wangaphambili enze utyando, nawe awufuni ukuba abe nokufikelela kwiirekhodi zakho zonyango. Buza isicwangciso sakho sezempilo ukuba wenze ukhetho olukhethekileyo kwaye ugubungele i-neurosurgeon ngaphandle kwe-network njengokungathi inethiwekhi.
Indlela Yokufumana Isicwangciso Sempilo Yakho Ukukhupha I-Out-Of-Network Care kwii-Intanethi zamaRhafu
Okokuqala, kufuneka ucele isicwangciso sakho sezempilo ukwenza oku, isicwangciso sezempilo asiyi kuzinikela ngokuzithandela. Ngaphandle kokunakekelwa kwenkxalabo yongxamiseko, ezininzi izicwangciso zempilo aziyi kuba nomdla ngokubhekiselele ekunakekeleni ukunakekelwa kwenethiwekhi kwizinga le-in-network. Kuthetha ukuba isicwangciso sezempilo siya kuhlawula ngaphezulu kwenkathalo yakho okanye kufuneka uchithe ixesha lomsebenzi kunye namandla ukuze uxoxisane namazinga athatyathweyo kunyango kunye nomnikezeli wangaphandle. Nangona kunjalo, oku akuthethi ukuba isicwangciso sezempilo asiyi kuhlawula iirhafu zenethiwekhi. Uza kufuneka nje wenze ingxabano ekholisayo malunga nokuba ufuna ntoni ukunakekelwa ngaphandle kwenethiwekhi kwaye kutheni ukusebenzisa umnikezeli-inethiwekhi akuyi kusebenza.
Uza kuba nethuba elingcono lokuphumelela xa uceba kwangaphambili. Ukuba oku kungakhathaliseki ukuba unonophelo lwangxamisekileyo, jonga isicwangciso sakho sezempilo ngesicelo sakho kakuhle phambi kokuba uceba ukufumana unonophelo lwangaphandle. Le nkqubo ingathatha iiveki. Yenza umsebenzi wesikolo ukwenzela ukuba unokomeleza ingxabano yakho kunye neenyaniso, kungekhona nje imibono. Cela uncedo lwe-in-network yakho yonyango ukuncedisa ukuba ubhale ileta kwisicwangciso sakho sezempilo okanye uthethe nomlawuli wakho wezocwangciso zezempilo malunga nokuba kutheni isicelo sakho sifanele sihlonishwe. Intetho yeemali, ngoko ukuba unokubonisa indlela ukusebenzisa umsebenzisi-ntanethi ungasindisa ngayo inkampani yakho yenkampani yinshorensi yemali ngexesha elide, eliya kukunceda ibango lakho.
Xa udibanisa nesicwangciso sakho sezempilo, gcina uqeqesho oluhloniphekileyo. Yiba nesigxina, kodwa ungabi nambi. Ukuba unomxholo wefowuni, fumana igama kunye nesihloko somntu othetha naye. Bhala yonke into. Emva kwengxoxo yefowuni, cinga ukubhala ileta okanye i-imeyli ngokufingqa incoko yefowuni nokuyithumela kumntu othethile naye, okanye kumphathi wayo, njengesikhumbuzo seenkcukacha zengxoxo. Fumana izivumelwano ngokubhaliweyo.
Xa kuthethathethwano nge-out-of-network coverings in rates-network, kukho ubuncinane izinto ezimbini zokuxoxisana: ukwabelana ngeendleko kunye nemirhumo efanelekileyo neyesiko .
- Iingxoxo zokwabelana ngeendleko: Xa ufumana ukhathalelo lwangaphandle kweenethiwekhi ngePPO okanye iplani ye-POS, unakho ukuxhomekeka okuphezulu kunonophelo lwentlalo ngaphandle kokunakekelwa kwenethiwekhi. Imali oye wahlawulwa ngaphambili kwi-in-network deductible ayinakubalwa malunga ne-out-of-network deductible, ngoko unokuqala yonke indawo kwi-zero. Ukongezelela, i- coinsurance ye-care-of-network ukunakekelwa ngokuqhelekileyo iphezulu kunokuba inonophelo lwenethiwekhi. Uxoxisane ngokunyamekela ukuba uhlawulwe ngokusebenzisa i-in-deductible rate rate kunye ne-in-network coinsurance rate, njengoko nje usebenzisa i-in-network provider.
- Inkokhelo engqiqo kunye neyesiko lokuhlawula imali: Xa usebenzisa umnikezeli-ngaphandle wenethiwekhi, usemngciphekweni wokubhaliswa kwemali ekhokhwayo engakhokelela ekuhlawuleleni ipesenteji enkulu kakhulu yebhiliki kunokuba uqikelele. Abaqinisekisi bezeMpilo baya kujonga i-bill ye-out-of-network, bathi, i-$ 15,000 kwaye uthethe into ekusebenzeni kwayo "Le ntlawulo iphezulu kakhulu kule nkonzo. Umthetho osilwayo awunangqiqo. Inkokhelo eqhelekileyo kunye nesiko le nkonzo i-$ 10,000, ngoko ke siya kuhlawula isabelo sethu se-$ 10,000. "Ngelishwa, unokubambelela ukuhlawula imali engama-5,000 yemali ngaphezu kokubelana ngeendleko zakho. Funda kabanzi malunga nale "kwi- balance balance-What It's & How It Works ."
Xa uxoxisana nokunyamekela kwenethiwekhi kwinqanaba le-in-network, qiniseka ukulungisa ulwahlulo phakathi kweentlawulo zakho zokunikezela ngeenkonzo kunye nokuba isicwangciso sakho sezempilo sicinga ukuba sinengqiqo. Oku kungabandakanya isicwangciso sakho sezempilo senza isivumelwano kunye nomnikezeli wakho ongaphandle-wenethiwekhi kwisiganeko esisodwa sokunyamekela kwisantya esithile sithethathethwano. Qinisekisa ukuba isivumelwano se-"akukho bhalansi yokubhatala" isigatya ukuze ungabambeleli naziphi na iindleko ngaphandle kwe-deductible, copay kunye ne-coinsurance.