Amanyathelo okuthabatha ukuba uMninimzi-mali wakho ukhusele
Okungakumbi, abahlawuli bezempilo bafuna ukuba izigulane zifumane imvume ngaphambi kokuvavanywa kwezonyango okanye unyango. Kwaye, emva kokuphononongwa, banokugqiba isigqibo sokuba bangayigqubuthela loo unyango. Ngama-premium aphezulu abantu abaninzi bahlawula, oku kuya kunzima kakhulu. Kutheni kubakho abahlawuli ngezinye iinkhathi bakhanyela ukugqithiswa kwonyango ocebisa unyango, kwaye unokwenza ntoni ukuba oko kwenzeka?
Ziziphi ezinye iindlela?
Iinjongo zeNkampani yeNkampani yeNkxaso-mali
Kukho ukuphazamiseka okukrakra ukuba ukuphikisana nokuguqulwa ukulungiselela ukugqithiselwa emva kokuba ugqirha wenze isiluleko esithile sonyango ukuphucula imeko yakho yonyango. Le nto ayikhathalelekanga kwaye ingenzeka nokuba unobshuwarensi yangasese okanye ihlanganiswe phantsi kweenkqubo zikaRhulumente ezifana ne-Medicare okanye iMedicaid. Xa usuva uvakalelwa kukuba unempendulo kunye / okanye isisombululo kwingxaki, ezi ziphikisayo zinokuziva ziphazamisekile.
Kutheni oku kwenzekayo?
Njengeminye imfihlelo yokunakekelwa kwezonyango ezihambelana neendleko zonyango, impendulo ephambili kulo mbuzo kukuba, " landela imali ."
Ukulahlwa yenkathalo yindlela yokuncediswa kwezempilo . Unokucinga ngale ndlela: Umshurensi okanye umhlawuli unethemba lokuthatha imali engaphezulu kunokuba ahlawule. Oko kuthetha ukuba rhoqo ngexesha ufuna uvavanyo okanye unyango, baya kwenza uvavanyo malunga nokuba ngaba yindlela ephezulu kakhulu yokufumana okanye ukuphatha kakuhle.
Ukuba ufuna unyango okanye uvavanyo, kwaye aluqwalaselwe njengenxalenye yomgangatho wenkathalo yengxaki yakho yonyango, ngoko banokuba nesizathu sokugcina imali yabo ngokukhanyela uvavanyo okanye unyango kuwe.
Abaphi na abahlawuli baziyo kukuba phakathi kwexantathu yezononophelo zempilo (wena, ugqirha wakho kunye nomhlawuleli wakho) iinjongo zomntu zonke ziyahluka.
Ufuna nje ukuba uphile. Umshwalense wakho ufuna ukwenza imali. Ugqirha wakho ufuna zombini, nokuba oko kuthetha ukuthini ukuhluka ngokusetyenzisweni. Abanye oogqirha banokukhetha uvavanyo okanye inkqubo eya kukwandisa ingeniso yakhe, okanye endaweni yoko, ixhomekeke ekuvavanyeni okanye kunyango apho angahlawulwa khona. Xa kukho abahlawuli, ukwenza imali eninzi ayithethi ukuphika iimvavanyo. Imiqathango engaphathwa kakuhle ingabakhokelela kakhulu kwixesha elide.
Nangona le ntlukwano kwimpembelelo inokukhathaza izigulane, akuyona into embi ukuba ezinye iindlela zonyango ezifanelekileyo okanye iimvavanyo zifumaneka. Imali engaphantsi umhlawuli uyachitha, ngaphantsi koko ekugqibeleni sigqityile kwiiprayimari.
Ukulahlwa Xa kungekho Mvavanyo okanye Utyando
Ukulahlwa kunokuba ngumceli mngeni xa kungekho nonyango engaphezulu. Imizekelo ekungekho enye indawo iquka:
- Isifo esingavamile, sidinga iziyobisi ezibizayo, utyando okanye enye indlela yokonyango.
- Indlela entsha yezobugcisa bezempilo.
- Izilwanyana ezingabikhoyo (izilwanyana ezimiselwe unyango ngaphandle kwezo zivunyiwe).
- Ukusetyenziswa kweziyobisi ezinemfesane ( izidakamizwa zokuphanda azange zivunywe, kodwa oko kungayona nto ingcono kakhulu).
- Izongezelelo zezityalo kunye / okanye izondlo.
Yintoni Ongayenza Ukuba Unqatshelwe Ukunyamekela Ngomhlawuli?
Ukuba unqatshelwe ukuhlawula umhlawuli, ungakhathazeki. Ukukhanyela akuthethi ukuba umhlawuli wakho akayi kufikelela ngokupheleleyo uvavanyo okanye inkqubo. Kukho imiba emininzi kwiyeza kwaye akukho babini abantu abafana. Ngamanye amaxesha umvuzo kufuneka afundiswe ukuba kutheni uvavanyo oluthile okanye unyango luya kunceda kakhulu umntu othile.
Ngaphambi kokuba uthathe nawaphi na amanyathelo alandelayo enze amakholi ambalwa. Akuqhelekanga ukuvavanywa okanye inkqubo yokuphikiswa ngenxa yokuba ayilungiswanga ngokuchanekileyo . Uninzi oluvuthayo luyafuna ukuba umnxeba ucacise imeko kunye nesalathisi.
Kwakhona, ngaphambi kokuba ubize qinisekisa ukuba unyango onqwenela ukuwufakela alucaciswanga ngokucacileyo kwisicwangciso sakho. Ngokomzekelo, nokuba unesibonakaliso esamkelekileyo, abaqinisekali abanakho ukuhlawula i-marijuana yonyango . Kwimeko efana nale, i-inshorensi yakho ayiyi kuhlawula nokuba yintoni na imeko enayo okanye iimpawu ozijongene nayo.
Ukuba unqatshelwe ukunyamekelwa ngumhlawuli wakho, kukho izinto ezimbalwa onokuzenza.
- Ukulwa nokukhanyela . Ngamanye amaxesha yonke into efunekayo kukuba udibanise nomthengi wakho wesevisi. Buza ukuba kutheni unqatshelwe, kwaye yibuphi ubungqina abaya kufuna ukuba babuyiselwe kwisigqibo. Emva koko sebenze ngokuzimisela ukuguqula iingqondo zabo.
- Buza ugqirha wakho ukuba yeyiphi enye into ekhoyo . Oku kufanele ukuba kwenziwe ngexesha elifanayo nokulwa nokukhanyela ekubeni kunokwenzeka ukuba wakho umshwalense uya kukuxelela enye indlela. Ukuba le ngcaciso iza kukunceda uqhubeke nokulwa kwakho, okanye uza kukunika uxolo lwengqondo olucwangcisiweyo A akuyiyo yodwa inketho.
- Bhatala imali ngenkonzo . Kulula ukulibala ukuba unako ukuvavanya okanye inkqubo yokuba u-inshurensi yakho iphika ukuba ukhetha ukuhlawula iindleko. Ukuba ugqiba ukuqhubela phambili kwesi si cwangciso, qiniseka ukuba uxoxisana nexabiso legqirha wakho. Ngokuqhelekileyo oogqirha abamkela imali (akunjalo konke) baya kunciphisa iifizi zabo xa beyazi umntu kufuneka ahlawule i-pocket.
- Musa ukuphinda uvavanyo okanye unyango . Eli khetho lide lesine. Olu khetho luyakwamkeleka kuphela ukuba awukholelwa ngokwenene ukuba ufuna uvavanyo okanye unyango. Kwimeko apho ungayi kubuza lo mbuzo!
Ezinye iingcebiso ezinokukunceda le nkqubo zihambe ngokulula ziquka:
- Gcina iirekhodi ezicwangcisekileyo . Bhala imihla, amaxesha, kunye namagama omntu othetha naye kwiinkampani zakho ze-inshorensi. Cela ukuba nayiphi na ingcebiso okanye utshintsho kuqinisekiswe ngokubhaliweyo, ngokukhethekileyo nge-imeyile ukuze ithwale isitampu ngexesha kunye nomhla. Ngamanye amagama, yakha umzila wephepha.
- Funda ngesicwangciso sakho soxanduva ngokucophelela. Yilungiselele ukunika izizathu ezixhasa iimfuno zesicwangciso sakho. Mhlawumbi uya kuziva uxhalabile kukuba kufuneka utshele inkampani yakho yomshuwalense oko kubhaliweyo kwisicwangciso sabo, kodwa akuqhelekanga ukuba wenze njalo.
Umxholo ophantsi Ukuba Umshuwalense wezeMpilo unqabile
Ukunyuka kwe-inshorensi yezempilo kunokuxhalabisa xa usisigulane. Ngakumbi xa ugqirha wakho ekholelwa ukuba kufuneka ube novavanyo oluthile okanye unyango. Kulula ukuthukuthela kwaye ufuna ukumemeza!
Kunoko, kudla ukucinga ngokucophelela ngeendlela ozikhethayo. Njengenyathelo lokuqala, xela ugqirha wakho malunga nezinye iindlela ezigqityiweyo. Ukukwazi ezi zikhetho unako ukubeka ingqalelo imeko yakho ngokubhala uluhlu kunye nokuzinyameka kokunakekelwa kunye nokungafumaneki. Wonke umntu uhlukile kwaye kunokubakho izibonakaliso ezicacileyo ukuba kutheni unyango olunye lungcono (mhlawumbi ngempumelelo okanye kwimiphumo emibi) ngaphezu kwesinye esekelwe kwimeko ethile yonyango. Oogqirha abaninzi 'baya kuhlamba' ukuba ngaba kunjalo.
Ukuba kubonakala ngokunyanisekileyo ukuba uvavanyo olungagqitywanga okanye unyango luya kuba ngcono kuwe, ungayeki. Ukulwa nokukhanyela. Njengoko ukwenza oku khumbula ukuba abaqinisekisi bajonga iinombolo xa besenza izigqibo, kwaye abantu abayizibalo. Umshuwalense wakho unomngcipheko wolwazi xa uhlaziya isicelo sakho, kwaye ngamanye amaxesha ufuna nje "imfundo" encinane kwimeko yakho kunye nembali yonyango yakho ukuba uqaphele imfuno yonyango olufunwayo.
Nangona i-insurer yakho ekugqibeleni iphika unyango lwakho (emva kokuba ulwa nokukhanyela) khumbula ukuba akuyiyo igunya eliphambili kwimpilo yakho. Nangona ingaba yindleko enkulu, inkokhelo yokuzihlawula i-self-pay pay remains. Ukuba unayo imali kwi-akhawunti yakho yokujonga, njengokuba abantu abaninzi bengaboni, qwalasela iindlela zokuxhaswa ngonyango ezifana nokuthatha enye imali yokuboleka imali, ukuboleka kubahlobo kunye nosapho, usebenzisa i-Go Fund Me kumaphepha e-Facebook, kunye ne-fundraiser kunye Okuninzi. Ukuba uhamba kule ndlela, khumbula ukuba iindleko zonyango ozihlawulayo ngaphandle kwipokotho zihlala zichithwa , kwaye kwimiba efana nale, ngokuqhelekileyo uyongezelela ukunika uncedo olukhulu.
> Imithombo:
> Gilmore, A. I-Complexity Value of Patterns of Denials. Ulawulo lwezeMpilo lwezeMpilo . 2016. 70 (4): 80-5.
> Healthcare.gov. Indlela yokuBhenela kunye neNkampani yeNkcampu. https://www.healthcare.gov/appeal-insurance-company-decision/appeals/