Indlela Yokuphepha Iingxaki Ezibangelwa Ziimangalo Zangaphandle Zomnxeba kunye neeMithetho-mali
Kwakuqhelekile ukuba izigulane zinokwenza isigqibo malunga naluphi na ugqirha okanye isibhedlele esifuna ukuyifumana, kwaye singaniki ncam na ingqalelo ukuba ingaba inkampani yethu yomshuwalense yayiya kuhlawula abo baqeshwa okanye ukuhlala esibhedlele. Nangona kunjalo, oko akuseyinyaniso. Njengokuba ukhetho lwe-inshorensi yempilo kunye neendleko ziba nzima kunokuba izigulane zijongane nazo, kuyafana noogqirha, izibhedlele, amaziko okuvavanya, amayeza kunye nabanye ababoneleli ngezempilo.
Ngenxa yoko, oogqirha abancinci kunye namaziko azimisele ukusebenzisana neenkampani zomshuwalense ezimbalwa-kwaye oko kuchaza ingxaki kwizigulane.
Akuseyona into eqhelekileyo kwiinkonzo zonyango okanye ezinye iinkonzo ukuba zingabhekiswa zizicwangciso zethu ze-inshorensi. Uninzi lwezicwangciso ze-inshorensi zithintela ukuba ngubani onokuzibona, okanye apho singaya khona ngononophelo lwempilo ngokungafuni ukuhlawula ezo nkonzo kunye nokunakekelwa . Ukuba sibona ugqirha okanye omnye umboneleli ongagqunywanga yi-inshurensi-nokuba mhlawumbi asizimisele ukwenza oko-kuthiwa "ngaphandle kwenethiwekhi" .
Ngamanye amaxesha senza eso sinqumo ngokuzithandela. Mhlawumbi uyazi ukuba umgqirha wakho awusayi kuhlanganiswa nesicwangciso sakho se-inshorensi kodwa awuvumelekanga ukuba omnye umntu ahlangule umntwana wakho. Uza kuhlawula okongezelelweyo kulolu hlobo lwentlalo-ntle-yenethiwekhi ngenxa yokuba ukholelwa ukuba iinkonzo zegqirha zinokubaluleka kweyongezelelweyo ngaphandle kweendleko.
Ngamanye amaxesha sibhekisiwe ngamanye amabhilikhwe avela kumntu ongekho ngaphandle kwenkonzo esiye sacinga ukuba yayihlanganisiwe kodwa yayingekho.
Ugqirha wakho inxalenye yentsebenziswano yenkampani yakho yomshuwalense, kodwa i-radiologist ugqirha wakho osebenzayo ayikho kwaye ufumana ibhajethi evela kwi-radiologist. Okanye uya kubona ugqirha ogqithiseleyo oyibonile iminyaka, kuphela ukufumanisa ukuba ibhajethi ephakamileyo kakhulu kunokuba ulindele ukuba ugqirha wakho akasayi kwamkela isicwangciso sakho se-inshorensi.
Okanye, i-inshurensi yakho ibuyisela iindleko zebhedlele, kodwa kungekhona kwigumbi labucala kunye negumbi labucala, yinto ekhethekileyo kuphela, ngoko ke ugqiba ukuhlawulwa kwigumbi labucala njengoko ungenayo inshorensi.
Mhlawumbi into ephazamisayo yindleko ze-out-of-network kukuba kukho izakhiwo ezahlukeneyo zeenkampani ze-inshorensi ezibhekiselele kubantu ngabanye. Umzekelo: Ugqirha u tyelele obiza i-inshurensi yakho imali engama-40 eyi-reimbursement iyakubiza i-$ 100 ephaketheni lakho njengenkonzo ye- out-of-network . Okanye isilwanyana esisetyenziselwe ukuhlawula i-$ 10 yokuhlawula i-co-pay, kunye neendleko ze-insurer yakho i-$ 50, ngoku ubiza i-$ 120 kwi-pharmacy kuba awuseyona nxalenye yale nethiwekhi.
Yintoni esinokuyenza ngabagulane ngayo? Kukho amanyathelo ambalwa esinokuthatha ukuze siphephe iindleko ze-intanethi okanye uzame ukuzilawula
Indlela yokuphepha ukuhlawula kwe-Out-of-Network
- Ngaphambi kokufumana unonophelo, musa nje ukubuza ukuba ugqirha okanye inkonzo "isebenza kunye" ne-inshorensi yakho. Amagqirha amaninzi kunye namaziko okunakekelwa kwezempilo aya kukuxelela ukuba yebo, "baya kusebenza" kunye ne-inshurensi yakho , nokuba ngaba loo msebenzi uthathwa njenge-network. Kunoko, buza ukuba ngaba yinxalenye yesicwangciso sakho senethiwekhi. Kwaye, ke, fumana impendulo ngokubhaliweyo xa kunokwenzeka.
- Musa ukucinga ukuba nantoni na i-oda lakho logqirha liya kugutyungelwa nje ngokuba ugqirha wakho uhlanganiswe. Ugqirha wakho unokuyalela ukuhlolwa kwegazi kwaye akuthumelele ebhabheni kwisakhiwo esifanayo. Kodwa loo bhu ingahlawulwa yinshurensi yakho yempilo. Hlola ngokuphindaphindiweyo zonke iindlela zendlela.
- Ukuba kunokwenzeka, khangela i-insurer yakho phambi kokunyamekela, kwakhona. Buza i-insurer yakho okanye uye kwi-intanethi kwiwebhusayithi ye-inshurensi ukufumanisa) ukuba isicwangciso sakho sibandakanya oogqirha kunye neenkonzo oza kuzifuna. Oku kungabi lula ukuyifumanisa kwimeko efana nesibhedlele esibhedlele esichazwe ngasentla, kodwa kulungele ukuzama. Kwaye, ke, fumana iimpendulo ngokubhala xa kunokwenzeka.
Ukuba Ufumana I-Bill ye-Out-of-Network yonyango
- Cacisa inkampani yomshuwalense kuqala, kwaye ubone ukuba unokufumana ukuba bahlawule iibhili. Unokufumana inkcazo kumgaqo-nkqubo wakho. Phuma zonke izitorethi ukuqinisekisa ukuba wenza nzima kakhulu ukuba bathi cha.
- Ukuxoxa ngezi bhili. Biza isibhedlele okanye isebe lokuhlawula iprojekthi, xelela iibhilikhwe zakho zingenakulungiswa, kwaye zicele ngokuzikhethela ukuba zikuncede ukuba zihlawule kumgangatho onokuwufumana. Buza ukuba ubuncinane bazukise oko inkampani yomshuwalense yayiya kubahlawula. Buza ukuba bakubeke kwisicwangciso sokuhlawula, nabo.
- Ukuba awukwazi okanye awuyi kukhononda kumxhasi, okanye akakwazi okanye akayi kuxoxisana nawe ngokwakho, thola ummeli wenkokhelo yezokwelapha ukukunceda. Baza kuxoxisana ngenxa yakho, baya kuqinisekisa ukuba iintlawulo ezingenasidingo kunye nokungalungi zisuswe, kwaye ziya kukubeka kwisicwangciso sokuhlawula esibhedlele. Uya kufuneka uhlawule iinkonzo zabo, kodwa uya kuba neyona ndlela ininzi ngaphezu kokuba uchithe ngenxa yolwazi lwendlela inkqubo isebenza ngayo.
Indlela yokuCalula kwiiNjongo zokuTshintsha ukwanda kweNkqubo yokuNakekelwa kweNethiwekhi
- Cacisa ngokukhawuleza nangokukhawuleza. Cetyisa esibhedlele okanye umboneleli (Emva kokuba uxoxiselwano lugqityiwe.) Gwebela umgcini wakho womshuwalense. Futhi khalazo kwiSebe le-inshurensi yezempilo kunye nommeli jikelele kwilizwe lakho.
- Yilumke ngokukhawuleza xa ukhetha i-inshorensi yakho yezempilo xa unako ukwenza utshintsho. Iiprogram zomshuwalense kufuneka zinike uludwe lwabagqirha abamukela izicwangciso zabo ngaphambi kokuba uzibophezele kwi-inshurensi yabo, ngoko uqala khona. Unokubuza ugqirha wakho okanye imibuzo yakhe yomphathi weofisi, naye.