Kukho Mhlawumbi kubekho amaxesha apho uMboneleli weNethiwekhi engekho ngaphandle kuyimfuneko
Umnikezeli ongaphandle kwe-network ungenayo isivumelwano kunye nenkampani yakho ye-inshorensi yokubuyiselwa kwintlawulo edibeneyo. Ezinye izicwangciso zempilo, njenge- HMOs , azibuyiseli nabanikezeli benethiwekhi ngaphandle kwabo bonke, oko kuthetha ukuba njengesigulane, uya kuba nexanduva lemali epheleleyo ehlawulwe ngugqirha wakho. Ezinye izicwangciso zezempilo zibonelela ngeenkonzo zokubonelela ngeenkonzo zangaphandle, kodwa umthwalo wakho wezigulane uya kuba mkhulu kunokuba wawukubona umboneleli we-intanethi.
Izizathu zokukhetha ukuNakekelwa kweMpilo yeNethiwekhi
Nangona okokuqala kunokuhlawula imali eninzi, kunokubakho amaxesha apho unokufumanisa kuyimfuneko, okanye kucebise ukuba usebenzise umnikezeli-ngaphandle wenethiwekhi.
Ngamanye amaxesha awunanto yokhetho, okanye kunengqiqo ukukhetha umboneleli wezempilo ongeyena wenethiwekhi. Ngezantsi uluhlu lweemeko apho unokwazi ukubhenela kwi-in-network coverage, okanye ingafumaneka ngokuzenzekelayo:
Uxinzelelo: Kwiimeko eziphuthumayo, kufuneka ufune uncedo olusondeleyo olukhoyo. Umthetho woNonophelo ongenakunqwenelekayo ufuna abaqinisekisi ukuba baxhomekeke ngononophelo lwengxamiseko njengokuba kusekho kwinethiwekhi, kungakhathaliseki ukuba unyango olungxamisekileyo lufumaneka kwi-in-network okanye ngaphandle kwe-network. Nangona kunjalo, igumbi eliphuthumayo le-network kunye namagqirha banokukuthumelela ibhajethi yebhalansi , kwaye imali yokuhlawula imali ayigciniwe yi-ACA (nangona ezinye iindawo zithintele ). Ukuba akuyiyo imeko engxamisekileyo, ukutyelela kwakho akuyi kuqhutyelwa njengonyango lwenethiwekhi; kufuneka uhambe kumboneleli okhuselekileyo endaweni yoko.
Unonophelo oluthile: Ukuba unesifo esingavumelekanga esingazibandakanyi nongcali kwisicwangciso sakho, ukunakekelwa kwe-out-of-network kungabalulekile.
Abanikezeli bokutshintsha baya kuphazamisa impilo yakho: Ukuba uphakathi kwonyango malunga nemiba enzulu okanye yokuphela kwempilo , kwaye umniki wakho uyishiya intanethi, kungenokuba unomdla wokuqhubeka nokukhathalela ngokuphuma kwintanethi.
Unokwenza isibheno ngokuqhubekayo kokunxibelelana kwenethiwekhi, ukuba kuphela ixesha okanye ixesha elibekiwe lokutyelela.
Ukunyamekela ngaphandle kwedolophu: Ukuba ufuna uncedo lwezonyango ngelixa usuka ekhaya, unokufuneka uphume kwintanethi, kodwa abanye abatshutshisi baya kubamba ukutyelela kwakho kumboneleli ongeyithathi-nxaxheba njengokungathi inethiwekhi. Nangona kunjalo, ababoneleli ngee-network banokufumaneka. Ukuba akuyonto yongxamiseko, kukulungele ukuqhagamshelana nomshuwalense wakho kuqala ukufumanisa.
Imiba yokukhawulelana: I-ACA idinga inshurensi ukugcina amanethiwekhi enkonzo aneleyo ngokusekelwe kumgama kunye nexesha apho amalungu kufuneka ahambe ukuze afumane umboneleli wezonyango, kodwa izikhokelo ngokwaneleyo zihluka ukusuka kwelinye ilizwe ukuya kwelinye. Ukuba uhlala kwindawo yasemaphandleni kwaye akukho ukufikelela okunokungena kumboneleli we-intanethi kwindawo yakho, impilo yakho eqhubekayo inokuxhomekeke ekusebenziseni ugqirha ongekho inxaxheba. Kule meko, unokwazi ukubhenela ukufumana ingqalelo yomnikezeli-ngaphandle wenethiwekhi kwindawo yakho.
Izinhlekelele zemvelo: Imkhukula, imililo ephakamileyo, iziqhwithi, kunye neengqungquthela zingonakalisa izibonelelo zonyango kwaye ziphoqele abantu ukuba baphume kwezinye iindawo apho kufuneka bafune unyango lwempilo. Ngamanye amaxesha, ezi zi gulane ziyakwazi ukufumana iirhafu ze-intanethi njengenxalenye yesibhengezo soxinzelelo ngurhulumente okanye urhulumente wephondo.
Umnikezeli-ngaphandle-wenethiwekhi unokuba usithumela i-bill
Kubalulekile ukuba uqaphele ukuba nangona inkampani yakho yenkampani yomshuwalense inokunyamekela ukunyamekelwa kwakho ngaphandle kwenethiwekhi njengokuthi in-network, umthetho wesigqeba awudingi umniki-ntanethi ngaphandle kokufumana inkokhelo yakho yenkampani yomshuwalense njengentlawulo epheleleyo.
Ngokomzekelo, masithi inkampani yakho yomshuwalense inomlinganiselo " weengqiqo kunye nesiko " we-$ 500 kwenkqubo ethile, kwaye sele udibene ne-in-network deductible yakho. Emva koko uphelela kwimeko apho umniki-ngaphandle wenethiwekhi wenza inkqubo, kodwa enye yeemeko ezichazwe ngentla kwaye umgcini-mali wakho uyavuma ukuhlawula i-$ 500.
Kodwa ukuba umniki-ntanethi-ngaphandle-wenethiwekhi uhlawula i-$ 800, bangakuthumela i-bill yezinye i $ 300.
Oku kubizwa ngokuba yi- balance balance , kwaye ngokusemthethweni ngokomthetho ukuba umboneleli akakho kwinethiwekhi yesicwangciso sakho sezempilo.
Amanye amazwe alungiselele le ngxaki kwiimeko ezithile, kuquka iFlorida (ababoneleli bee-intanethi abasebenza kwizibhedlele ze-in-network) kunye ne-New York (imeko zexakeka). Kodwa ngokubanzi, ukuhlawula ibhalansi kusengumngeni xa izigulane zifumana unonophelo ngaphandle kwenethiwekhi yomshuwalense.
> Imithombo:
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, iZiko loLwazi loThengi kunye noLawulo lweNtshuwalense. I-FAQ yoQinisekiso lweMpilo yokuPhathwa kweeNtsebenzo, Setha 1. IiNkonzo zeeNkonzweni zangxamisekileyo.
> IFundwe yeFundwealth Fund. Ukuhlawula iBaling by Ababoneleli: Ukuvavanya ukuKhuselwa kwabaThengi kwilizwe lonke . 2017.
> Urban Institute. Robert Wood Johnson Foundation. Ukuqinisekisa ukuthotyelwa kweMigangatho yokuLungiswa kweeNethiwekhi: Izifundo ezivela kwiZizwe ezine . Matshi 2017.