Amathuba kwi-Ofisi yezoLonyango kwiSigaba ngasinye kwiNqununu yeNgeniso
Ukulawula umjikelo wenkcitho ngokufanelekileyo akukho msebenzi olula kwaye ufuna ukuba uqaphele rhoqo. Isigaba ngasinye somjikelezo weengeniso - ukususela kwithuba isigulane esilungiselelwe ukuqeshwa de kube ixesha elihlawulwayo livela kwinkampani yomshuwalense - ibaluleke kakhulu ekunyuseni imali yokubuyisela i-inshorensi.
Kubalulekile ukuba uzinzo lwezemali zesibhedlele okanye iofisi yezobugqirha ukuba ibe nenkqubo ekhoyo kwisigaba ngasinye somjikelezo wemali.
Ngeke kuphela ufumane iintlawulo ngexesha elifanelekileyo kodwa kuya kunciphisa umthwalo kubasebenzi bentlawulo, gcina phantsi iindleko zolawulo, kwaye kubaluleke kakhulu ukugcina ubudlelwane obuhle nezigulane zakho.
1. Ukuqinisekiswa kweInshurensi
Umjikelo wembuyekezo kufuneka uqale ngaphambi kokufika kwesigulane. Ngokukhawuleza ukuba kuqeshwe, i-inshorensi yengcaciso yomshuwalense kufuneka iqinisekiswe. Ngenxa yokuba iinkcukacha ze-inshorensi zingatshintsha nanini na, nangona izigulane eziqhelekileyo, kubalulekile ukuba umboneleli uqinisekise ukufaneleka kwamalungu ngalinye kwiinkonzo ngezikhathi zonke. Iinzuzo zokufumana uqinisekiso lwe-inshorensi ngaphambi kokufika kwesigulane ziquka:
- Ukunciphisa ukungabikho kwamangalo ngenxa yeengxaki zesigulane esingavumelekanga
- Ukufumana ukugunyazwa kwangaphambili
- Qinisekisa ukubhaliswa ngokukhawuleza kunye / okanye ukunika amandla ukubhalisa kwangaphambili
- Qinisekisa ukuba zeziphi iinkonzo zonyango ezixutywe / ezingenakutyhulwa
- Fumana ulwazi malunga nokuhlawula i-co-patient, coinsurance, kunye ne-deductible
2. Amaqoqo angaphambili
Indlela ekhawulezayo yokunyusa ukuhamba kwemali kunye nokuphucula amaxabiso okuqokelela ukuqokelela uxanduva lwezonyango phambi. Izigulane azithobekanga ukuhlawula okanye zinzima ukufikelela xa iinkonzo zenziwe. Esikhundleni sokulinda kude kube yinqanaba leqokelelo lomjikelo wenkcitho, ababoneleli kufuneka baxhamle ngokuxoxa ngemicimbi yezemali nokuqokelela iintlawulo zegulane kwangoko kwinkqubo.
Yazise izigulane ngaphambi kokuba zifikelele ukuba zeziphi iimbopheleleko ezixhomekeke kuzo kwaye zibenza bazi ukuba intlawulo iyadingeka ngaphambi kokuba iinkonzo zenziwe.
Kwakhona, ukululekwa ngemali kunokunceda ukufumana ukufaneleka kwesigulane kunceda uncedo loluntu, ukunyamekela ngothando okanye izicwangciso zokuhlawula, okukunokuba nzima ukuyenza xa isigulane sele sefumene unyango. Le nkqubo iya kunceda ngokunciphisa umthwalo womsebenzi wokuhlawula kunye nokuphucula imizamo yokuqokelela.
3. UkuCwangcisa Amabango ahlambulukileyo
Ukuhambisa ibango elihlambulukileyo kukuphela kwendlela yokuqinisekisa ukuhlawulwa okuchanekileyo okokuqala . Ukuhlawula ngokuchanekileyo ngexesha lokuqala kukuthintela ukulibaziseka ekusebenzeni kwebango kwaye, kwezinye iimeko, ukubuyiswa okuphezulu. Ibango elihlambulukileyo lugqityiwe ngokuchanekileyo ngokuhambelana neenkampani zomshuwalense kunye nezikhokelo zokuhlawula ngurhulumente.
Umngeni omkhulu kubanikezeli baqaphela kwaye bahambelana nemithetho ethile ephathekayo enxulumene nekhowudi. Nangona imiba yokubhalisa akuyiyo yodwa yeso sizathu sokukhanyela i-inshorensi, ngamanye amaxesha angayinakwa ngenxa yokuhlawula okuncinane ngokuchasene nezinye izinto ezichasayo ezingenakho ukubuyisela imali njengengcaciso engafanelekanga yesigulane. Kubaluleke ngokwenene ukuba abasebenzi bekhowudi kunye nabahlawulayo bahlala bekwaziswa ngokumalunga nezikhokelo zokukhokha kwabo bonke abathwali.
Khumbula ukuqinisekisa ukuba ulwazi lomguli luchanekile ukukhusela ukuphika.
4. Ukuphatha ngokukhawuleza ukulahlwa
Uninzi lwababathwali bomshuwalense kufuneka bhatale ibango okanye banikele ngokubhaliweyo ngokubhaliweyo zingadlulanga iintsuku ezingama-30 emva kokufumana. Ibango elingazange lilandwe zingaphantsi kweentsuku ezingama-30 lixhomekeke kwizigwebo zenzalo, nangona kunjalo, inzala ehlawulwayo ayikho kwinjongo yakho. Injongo yakho kukuhlawulwa ngokukhawuleza. Ukuthatha indlela echanekileyo yokusingatha ukuchasana kunokuphucula iintsuku ze-AR ngokubanzi.
- Yenza ukuba abasebenzi bakho bentlawulo balandele kumabango kwiintsuku ezili-10 zoshishino zamabango e-elektroniki zihlawulwe kwaye iintsuku ezili-15 zoshishino zamaphepha eebill ukuqinisekisa ukuba ibango lifunyenwe kwaye lifumene ukuba ibango liye lacutswa.
- Ukuba ibango liphikisiwe, ibango lommeli linokukuxelela phezu kwefowuni kunokuba ulinde ukukhanyela ukuza kwi-imeyile. Isenzo sokulungisa esingahle senziwe singenziwa.
- Ukuba ibango alizange lifunyenwe nonke, uyazi ngokukhawuleza ukuze ubuyiselwe ibango.
5. Ukuhlaziywa kweNtlawulo
Isinyathelo sokugqibela ekulawuleni umjikelo weengeniso kukuhlaziya iintlawulo zokuchaneka. Qinisekisa ukuba ufumana i-reimbursement epheleleyo ngekontrakthi yakho yomshuwalense. Ngamanye amaxesha inkokhelo ephantsi ingenziwa ngenxa yephutha lokubhala okanye mhlawumbi impazamo yokuhlawulwa eyenziwa ngumphathi womshuwalense. Naluphina ukungahambelani kufuneka kulungiswe ngokukhawuleza ukuze bakwazi ukulungiswa ngexesha elifanelekileyo.