Uye wangena kwinqanaba lokungena ngemvume kwinshuwalense yezempilo . Uhlawule ama- premium akho. Ngoku qiniseka ukuba ungenzi enye yale mpazamo ye-inshorensi yempilo xa usebenzisa yakho inshorensi yempilo.
1) AwuyiCwangciso soTshintsho lwakho kunye noQoqosho
I-inshorensi yezempilo ayinakulungile ukuba awukwazi ukuyisebenzisa ngenxa yokuba awukwazi ukuhlawula imali yakho, i- coinsurance okanye i-copays.
Masijongene nayo, kungekhona wonke umntu unemali engamawaka angamawaka ambalwa nje alala phantsi. Kodwa, iinqununu ziyinyaniso yobomi kwiindidi ezithile ze-inshorensi yezempilo.
Kufuneka wenze isicwangciso sokujongana ne-deductible yakho, i-coinsurance kunye ne-copays okanye unokuzifumanisa ngokuqinisekileyo ngokuqinisekileyo kodwa unako ukufumana unyango lwempilo oyidingayo kuba awukwazi ukufumana isabelo sakho seendleko.
2) Ngenjongo yokungena kwi-Out-Of-Network
Uninzi lwezicwangciso zempilo e-United States zinomnatha weenkonzo zokunakekelwa kwempilo ezikhethiweyo. Ukuba usebenzisa umboneleli kwinethiwekhi yakho yesicwangciso sezempilo, i-copays yakho, i-coinsurance, kunye ne-deductible iyancinci kunokuba ungasebenzisa umnikezeli we-out-of-network. I-HMO nee-EPO aziyi kuhlawula nayiphi na into enonophelo oyenayo kumboneleli-ngaphandle-wenethiwekhi, ngelixa i-PPOs kunye ne-POS izicwangciso ziza kuhlawula encinci, kodwa kungabi nanjengokuba ungasebenzisa umnini-nethiwekhi.
Ukuba uyazi ukuba ngubani-inethiwekhi kwaye ongekho, unamathele kubanikezeli benethiwekhi kunye nokuphepha ukunakekelwa kwe-intanethi yexabiso eliphezulu.
Nangona kunjalo, oku akukona kube lula njengoko kuzwakala. Izicwangciso zezeMpilo zihlula amanethiwekhi abo. Izivumelwano phakathi kwezicwangciso zezempilo kunye nabanikezeli benethiwekhi zabo ziyaphelelwa yisikhathi kwaye zingenakuvuselelwa.
Ugqirha wakho oyintloko usenokuba neentlonipho zokwazisa ukuba uyayeka ukuthatha inxaxheba kwisicwangciso sakho senethiwekhi (okanye angenako), kodwa i-your mammogram, i-lab yokuhlolwa kwegazi, kunye ne-pharmacy ayinakukwazi ukukunika.
Ngaphambi kokuba ufumane nayiphi na unonophelo olungengxamisekileyo, khangela ukuba umniki-nkonzo usekho kwinethiwekhi kunye nesicwangciso sakho sezempilo.
3) Akunakuthetha iNtengiso kwiNkonzo yokuThumela ngaphandle
Unelungelo lokunyamekela ngaphandle kwenethiwekhi ukuba ukhetha, kodwa uya kuhlawulwa ngaphezulu. Nangona kunjalo, kwezinye iimeko, unokukhetha ukuhlawula ngaphezulu ngenxa yokuba uziva ukuba imali eyongezelelweyo iyakufanelekela ukuba unakekelwe ngumntu othile.
Ukuba ukhetha ukufumana unonophelo lwangaphandle-wenethiwekhi, xubusha intengo yolo lonyango ngaphambi kokuba usenamandla okuxoxisana. Umnikezeli wakho ongaphandle-wenethiwekhi uyaqonda ukuba ukuba akayi kuxoxisana, unokulahlekelwa yoshishino lakho. Kwakhona, nangona ungaphandle kwe-network yakho, mhlawumbi unxibelelwano lwesinye isicwangciso sezempilo, ngoko unikela umntu isaphulelo. Unako ukwandisa loo phulelo kuwe.
Xa uxoxisana neendleko zokunyamekela kwangaphambili, unokunciphisa umngcipheko wezezimali kwaye ugweme ukuhlawula imali kunye nezinye iimangalisa zemali ezimbi.
4) Ukungathobeli Ukugunyazwa Xa Kufuneka
Ingaba isicwangciso sakho sempilo sidinga ukuba ufumane imvume phambi kokuba ufumane iimvavanyo, iinkqubo okanye unyango? Uninzi lwePPO kunye nee-EPO zenza. Ukuba isicwangciso sakho sempilo sifuna oku kwaye awufumani imvume yokuphambi kokuqala, unako ukuphazamiseka ngemali enzima.
Umzekelo, ukuba isicwangciso sakho sezempilo sinesidingo sokuqala sokugunyazwa kwi-MRI esicatshulwayo kwaye ufumana i-MRI scan ngaphandle kokuyifumana kuqala, isicwangciso sakho sezempilo sinokungafuni ukuhlawula ukukhangela. Oku kuyinyaniso nokuba ngaba unokubonisa ukuba unyanzelekile ukukhangela. Cinga nje ngolu hlobo lobugcisa. Awuzange ulandele imigaqo uze uphume kuzo zonke iipopu ngendlela echanekileyo, ngoko uhlawulwa ngokuhlawula i-bill.
Ukuze ugweme oku, ukuba isicwangciso sakho sezempilo sidinga ukugunyazwa kwangaphambili, musa ukucinga nje ugqirha wakho uya kufumana imvume phambi kwakho. Unako; kodwa, ukuba akayithandi, le bhakane iyayeka nawe, kungekhona nayo.
Uya kuba ngulowo unamathele ukuhlawula ityala. Ukuba awuqinisekanga ukuba uvavanyo, inkqubo, okanye unyango kufuna ukugunyazwa kwangaphambili, biza isicwangciso sakho sempilo uze ucele.
5) Awukulandelelwanga ngokusebenzisa iMicrosoft Treatment Plans
Ukuba unayo i- HMO, i-PPO, i-EPO, okanye iplani ye- POS , enye yezicwangciso zakho izicwangciso zempilo yakho esetyenziswayo ukulawula iindleko zayo zicwangciso zonyango. Izicwangciso zonyango lwe-Tiered zisebenza ngale ndlela: ukuba kukho iindlela ezintathu zokunyanga ingxaki yakho yezokwelapha, icebo liza kufuna ukuba usebenzise unyango wokuqala unyango olubi. Ukuba uzama ukhetho oluncinci lwexabiso olubizayo kwaye alusebenzi, ngoko icebo liya kuvuma ukuhlawula ukhetho lwonyango oluncinci olubizayo. Isicwangciso siza kuvuma ukuhlawula ixabiso elininzi kwiindlela ezintathu zokwenza unyango emva kokuba uzame kwaye wahluleka ukhetho oluninzi oluphantsi.
Unokukrokra ukuba ukhetho enye kunye ezimbini aziyi kusebenzela kuwe, kwaye ufuna ukuyeqa ukunene kwizinto ezintathu. Nangona kunjalo, ngaphandle kokuba kukho izizathu zonyango ukuba kutheni ukhetho olulodwa kunye nobabini luya kuba yingozi kwimeko ethile ethile (umzekelo, unyanzelekile kwisicatshulwa esisinye), isicwangciso sakho sezempilo siya kukwenzela ukuhlawula ikhetho ezintathu uze uzame kwaye ayiphumelelanga bobabini ukhetho oluncinci lwezonyango.
Kutheni iinkampani ze-inshorensi zempilo zenza oku? Ngenxa yokuba abaninzi abantu baya kuphelisa kwaye babeke inketho enye okanye ukhetho olubini nangona lungasebenzi kunye nokulindele. Bagula kwaye banxungule ukubuyela kumgqirha basoloko bekhalaza ngale ngxaki efanayo, ngoko bahlala kwiziphumo ezingezantsi ngenxa yokuba bangena ngaphakathi. Ekugqibeleni, oku kusindisa iinkampani zomshuwalense yezempilo.
Ukuba oku kwenzeka kuwe, umsebenzi wakho ukubuyela emva kwaye usebenze ngendlela ephakamileyo ukuya kwinqanaba elithile uze ufike kwindlela yokwenza unyango olusebenza ngokwenene umzimba wakho kunye nendlela ophila ngayo.
6) Ukungafanisi ukuthengwa phakathi kwabaxhasi be-In-Network xa uza kuhlawulwa i-Coinsurance
Ngaba kufuneka uhlawule ipesenti ezingama-20, iipesenti ezingama-30, okanye i-40% ye-coinsurance yeenkonzo zonyango? Ngaba ufuna inkonzo eninzi? Emva koko kufuneka uzithenge ngeenxa zonke, nakwiindawo zokunikezela ngenethiwekhi .
Iinkampani ze-inshorensi zempilo zixubusha amaxabiso ahlawulelwayo kunye nabanikezeli bee-network, kodwa isaphulelo asiyinto efanayo kubo bonke ababoneleli. Ngamanye amaxesha isicwangciso sakho sempilo sixoxisana nesaphulelo esikhulu; Ngamanye amaxesha uxoxisana nesaphulelo esibi.
Ekubeni i-coinsurance yakho ipesenteji yentengo ehlaziyiweyo, qiniseka ukuba uyihlawula kwizinga eliphantsi kakhulu lokuncishiswa, kungekhona kwizinga eliphezulu kuba awuzange uthenge ngeenxa zonke phakathi kwabanikezeli benethiwekhi.
Nantsi indlela esebenza ngayo. Masithi isicwangciso sakho sempilo sixoxisana nesilinganiso esaphungulwayo sama-R10 000 ekusebenziseni i-ankle yakho noDkt Jones. Ubuncwane bakho beepesenti ezingama-30, ngoko uhlawula i-$ 3,000 ngaphandle kwepokothini lakho ukuba uDkt Jones wenza utyando.
Ekunene kwedolophu, uDkt. Brown naye unxibelelwano kunye nesicwangciso sakho sempilo kodwa akayiyo intetho. Isicwangciso sakho sempilo sikwazi ukumvumela ukuba avumelane nesilinganiso esiphuculwayo samaRandi ayi-8,000 kwi-optical operation. Uya kufuneka uhlawule i-30% ye-coinsurance ukuba usebenzise uDkt Brown, kodwa uya kusindisa imali kuba uhlawula iipesenti ezingama-30 zeerhafu ezingama-8,000 ngaphezu kweepesenti ezingama-30 zikaDkt Jones. Ungalondoloza i-$ 600 ngokusebenzisa uDkt Brown kunokuba uDkt Jones nangona bobabini oogqirha be-inethiwekhi kunye nesicwangciso sakho sezempilo.
7) Akunakubheno kwiNkundla yokuTyala
Kukho amaxesha apho wenze konke ngokufanelekileyo kodwa isicwangciso sakho sezempilo sisaphila inzuzo yomshuwalense wezempilo. Ukuba oku kwenzeka kuwe, thatha umoya ophefumlelweyo uze ubhekisise ngokukwenzekileyo. Ngaba ulandele yonke imithetho yezempilo yakho? Ingaba unonophelo oluxhamlekileyo lwenkqubo yakho yezempilo? Ngaba ufuna ngokwenene ukunakekelwa? Ukuba uphendula ewe kuyo yonke le mibuzo, ngoko kufuneka ubhenele isimangalo sakho sesicwangciso sezempilo.
Nangona kunokuziva ngathi uDavid ulwa nekampani yomshuwalense yeGoliath ene-slingshot kuphela, khumbula ukuba uDavid walinqoba loo nto. Ipesenti enkulu yokukhanyela iyanqatshwa kwisibheno. Cela uncedo lugqirha wakho, fumana amadada akho ngokulandelelana, uze uhambe kunye ne-slingshot yakho.