Ukuhlawula i-balance balance can surprise you with biills bills a hundred, a thousand, okanye even thousands of dollars ngaphezu kokulindelwe.
Ukuba ugqirha okanye isibhedlele sikulindele ukuba uhlawule ibhalansi esele kwilwayo-mali emva kokuba uyihlawule imali echithwayo , u- coinsurance , okanye ikhoyayment kunye nenkampani yakho yomshuwalense ihlawule oko kukunyanzele ukuhlawula, ngoko uhlawule imali.
Ngamanye amaxesha ukuhlawula ibhalansi kusemthethweni, kwaye ngamanye amaxesha akukho mthethweni. Indlela oyisingatha ngayo iya kuxhomekeka kuyo nokuba ingaba ibhajethi yebhanti yomthetho.
Ukuba Unokulinganisela Ukugqitywa ngokungekho mthethweni
Ungayikhokheli inxalenye ebhaliweyo-ebhokisiwe kwilwayo yezobisi xa uhlawule-uhlawulwe ngokungekho mthethweni. Kwezinye iimeko, ukuhlawula ibhalansi engekho mthethweni kunzima, kwanobugebengu, izigwebo. Unokhetho oluninzi malunga nendlela ongayiphendula ngayo xa unokukrokrela ukuba ubhalisele imali engekho mthethweni:
- Thetha nomboneleli wezempilo kwaye uxoxe ngale meko. Ngale ndlela, ngokuqinisekileyo unikezela umniki wakho inzuzo yokungathandabuzeki, esondela kumbandela nje ngokuba iyiphutha lokukhokha elula. Chaza ukuba kutheni uvakalelwa ukuba imali yokubhatala imali ibinqatshelwe kulo mzekelo, kwaye ubuze umboneleli ukuba alungise iphutha lokukhokha.
- Ukuba ingxoxo yakho kunye nomboneleli ingayilungisisi ingxaki, khalaza kwinkampani yakho yomshuwalense, i-Medicare, okanye iMedicaid, nokuba yeyiphi na inika inkxaso yakho. Tshela inkampani yomshuwalense ukuba uhlawule imali, ucele ukuba ungenelele egameni lakho. Ukuba unayo i-Medicare okanye iMedicaid, qha ga mshelana neZiko leMedare neeNkonzo zeMedicaid.
- Ukongeza, unakho ukukhalaza kwigunya elilawulayo lomboneleli wezempilo. Kwimeko yamagqirha, oku kwenzeka ukuba iBhodi yezoMpilo yeBhodi. Fumana iinkcukacha zoqhagamshelwano kwiBhodi nganye yezoMlapha apha. Fumana ulwazi malunga negunya lolawulo kwiibhedlele zikarhulumente ngamnye kwi-Coalition ye-Empowered Patient Coalition. Ukuba unomuzwa wokuthi awuphathatyathwa ngokufanelekileyo ngubharensi wakho wezempilo, khalaza kwiSebe le-Intshumo.
Ukuba Uyazi Ngaphambi Kokuya Kuza Kulinganisa Ngokusemthethweni
Okokuqala, zama ukukhusela imali yokuhlawula ngokuhlala kwi-network kunye nokuqinisekisa ukuba inkampani yakho yomshuwalense ihlanganisa iinkonzo ozifumanayo. Ukuba unemizila ye-x-ray, i-MRIs, i-CT, okanye i-PET, qinisekisa ukuba zombini indawo yokucinga kunye ne-radiologist oza kufunda ukukhangela kwakho inethiwekhi. Ukuba uceba ukwenza utyando, cela ukuba ngaba i-anesthesiologists in-network.
Ukuba uyazi kwangaphambili ukuba uya kusebenzisa umnikezeli-ngaphandle wenethiwekhi okanye umboneleli ongenamkeli isabelo seMedare, unokhetho oluthile. Nangona kunjalo, akukho nanye kubo kulula kwaye bonke bafuna ukuthetha.
Cela ukuqikelelwa kweendleko zomboneleli. Emva koko, cela umqinisekisi wakho ukuba bakujonga njani ukuhlawulwa okufanelekileyo kunye nesiko kule nkonzo. Ukufumana impendulo kule nto kunokuba nzima, kodwa kuqhubeke.
Emva kokuba uqikelele oko umniki wakho uya kuhlawula kwaye yintoni inkampani yakho ye-inshorensi eya kuhlawula ngayo, uya kukwazi ukuba kude kangakanani na manani kwaye yintoni umngcipheko wezezimali. Ngolu lwazi, unokunciphisa isithuba. Kukho iindlela ezimbini kuphela zokwenza oku: fumana umboneleli wakho ukuba akhokhe ngaphantsi okanye ufumane umshwalense wakho ukuhlawula ngaphezulu.
Buza umniki-mboli ukuba uya kwamkela inkampani yakho yomshuwalense isingqinisiso kunye nesithethe esiqhelekileyo njengentlawulo epheleleyo.
Ukuba kunjalo, funda isivumelwano ngokubhaliweyo, kubandakanywa nesigatshana-sokuhlawula ibhalansi.
Ukuba umboneleli wakho akayi kwamkela isantya esicacileyo kunye nesiko njengentlawulo ngokupheleleyo, qala ukusebenza kwi-insurer yakho. Buza i-insurer yakho ukwandisa inani ababiza ngalo elifanelekileyo kunye nesiko kulolu hlobo oluthile. Yenza ingxoxo ekholisayo ngokubonisa isizathu sokuba ityala lakho lilukhuni, kunzima, okanye ixesha elidlulileyo ukunyanga ngaphezu kohlobo oluqhelekileyo.
Enye inketho ukucela umgcini wakho womshuwalense ukuba athethe inkontileka yekontra eyodwa kunye nomnikezeli wakho ongaphandle kwesevisi kule nkonzo ethile.
Ngamanye amaxesha bayavumelana nesikontraka esisinye-mali kwisixa-mali sakho somshurensi uhlala ehlawula abathengi be-network. Ngamanye amaxesha baya kuvuma kwiikhontrakthi yecala elilodwa kwinqanaba lokunciphisa ugqirha wakho wamkela kwiinkampani ze-inshorensi esele e-network. Okanye, ngamanye amaxesha bayavumelana kwiikhontrakthi yecala-nye yepesenti yeendleko ezihlawuliswayo zomboneleli. Naliphi na isivumelwano, qinisekisa ukuba kuqukwa isahlulo sokubhalisa.
Ukuba zonke ezi zikhethiweyo zihluleka, unokucela umgcini wakho womshuwalense ukuba agubungele ukunyamekela kwe-intanethi usebenzisa i-intanethi yexabiso le-intanethi. Ngoxa le nto ingayi kuthintela ukuhlawula imali, ubuncinci wakho uya kubahlawula ipesenti yebhilikhi ukususela ekubambeni kwakho uxanduva lwe-intanethi kuncinci kunonophelo lwangaphandle.
Ukuba ulandela le nketho, yiba nengxabano ekholisayo yokuba kutheni umgcini-mpahla kufuneka aphathe oku njengenethiwekhi. Umzekelo, akukho baqhubi beendawo ezinxibelelwano kwi-intanethi yakho, okanye iirhafu zokuxilongwa kwabagqirha be-in-network ziphakamileyo kakhulu kunezo zonyango ongaphandle.
Ukuba Awuyikukufumanisa Inkinga Kuze Emva kokuba Ufumene Unyango
Ukuthetha emva kwe-inyaniso xa ufumene ibhajethi yebhanti yomthetho kunzima kakhulu, kodwa unokhetho.
Unokuthi uxoxisane nesahlulo sokuhlawula imali kunye nomboneleli wakho. Khumbula, umniki wakho ufuna ukuhlawulwa kwaye angathanda ukufumana imali yakhe ngokukhawuleza kwaye ngaphandle kokuhlawula inxalenye yayo kwi-arhente yokuqokelela. Oku kuthetha ukuba umniki-mboleko angavuma ukunciphisa inani elipheleleyo elihlawulwe kwizinga lokunciphisa elifumanayo kwiinkampani zomshuwalense, kunye nenkundla, ukuba uyavuma ukuhlawula isabelo sakho ngokukhawuleza. Okanye, umboneleli wakho angamkela inxalenye yemali eseleyo njengentlawulo ngokupheleleyo xa uvuma ukuhlawula ngokukhawuleza. Abanye baya kukuvumela ukuba ufake isicwangciso sokuhlawula.
Unokuxoxa nge-insurer yakho. Ukuba i-inshurensi yakho sele ihlawule umyinge we-out-of-network kwintlawulo efanelekileyo neyesiko, uya kuba nobunzima bokufaka isikhalazo esisesikweni kuba umgcini-mali awuzange enqabe ibango lakho . Yayihlawula ibango lakho, kodwa kwinqanaba le-out-of-network. Kunoko, cela ukuba kuphindwe kwakhona. Ufuna inkampani yakho yomshuwalense ukuba iphinde icinge ngesigqibo sokukhupha oku njengononophelo lwentlalo , kwaye kunoko uyigubungele njengononophelo lwenethiwekhi. Uya kuba nenhlanhla eninzi ngale ndlela ukuba unesizathu esinyanzekayo sezokwelapha okanye isizathu sokukhetha umniki-ntanethi.
Ukuba uvakalelwa kukuba uphathwe kakubi yinkampani yakho yomshuwalense, landela inkqubo yesicwangciso sakho sokusombulula isikhalazo sangaphakathi. Unokufumana ulwazi malunga nenkqubo yesisombululo sakho somshuwalense kwizinzuzo zakho kwincwadi okanye kwiSebe lakho lobutyebi. Ukuba oku kungayisombululi ingxaki, unokhalaza kwiSebe le-Intshumo. Fumana ulwazi loqhagamshelwano kwiSebe lakho le-Inshorensi ngokuchofoza ummandla wakho kule mephu.
Ukuba isicwangciso sakho sempilo sixhaswa ngemali-mali, oku kuthetha ukuba umqeshi wakho ungumbutho ohlawula iindleko zonyango nangona inkampani yomshuwalense inokulawula isicwangciso, isicwangciso sakho sempilo asiyi kuwela phantsi kwegunya leSebe le-inshurensi. Izicwangciso ezizixhaswa ngemali zihlala phantsi kolawulo lweSebe loLawulo lweeNkonzo zabasebenzi. Fumana ulwazi oluninzi kwiphepha lewebhu le-EBSA loncedo lwabathengi okanye ngokubiza umcebisi nge-EBSA kwi-1-866-444-3272.