Kukho izizathu ezininzi onokuya ngaphandle kwintanethi ye- inshurensi yempilo ukuze unakekele. Nangona kunjalo, ukunyamekela ngaphandle kwe-network kukunyusa ingozi yakho yemali kunye nomngcipheko wokuba nemicimbi esemgangathweni kunye nolondolozo lwempilo oyifumanayo. Nangona ungeke uphelise ngokupheleleyo ingozi yakho, unokunciphisa xa wenza umsebenzi wakho wesikolo kwangaphambili .
Ngaphambi kokuba uphume ngaphandle kwenethiwekhi, fumana ukuqonda okucacileyo kweengozi ezibandakanyekayo kunye nento ongayenza ukuze uziphathe. Qala ngokuqonda ukuba kutheni ukunakekelwa kwezempilo ngaphandle kwe-network kuthatha ingozi enkulu.
Kutheni Ukunyamekela Ngaphandle kweNethiwekhi Kungengozi zezeMali
Ulahlekelwa isaphulelo sesicwangciso sempilo.
Xa inkampani yakho yomshuwalense yempilo iyamkela ugqirha, iklinikhi, isibhedlele, okanye olunye uhlobo lomnikezeli kumnatha-nkonzo walo, ithetha iirhafu ezithengiweyo zeenkonzo zenkonzo. Xa usuka ngaphandle-wenethiwekhi, awukhuseli kwisihlomelo sakho sezempilo. Isaphulelo esisodwa sokuxoxisana oza kuzuza kuso isaphulelo uxoxisana nawe. Ekubeni aninabo bathathi-ngxowankulu abaxhasiweyo kubasebenzi ukuqinisekisa ukuba ufumana into embi, unomngcipheko okhulayo wokuhlawuliswa kakhulu kunonophelo lwakho.
Isabelo sakho seendleko siphezulu
Isabelo sakho seendleko yi- deductible , copay , okanye i- coinsurance kufuneka uhlawule nayiphi na inkonzo enikezelwayo.
Xa usuka ngaphandle-wenethiwekhi, isabelo sakho seendleko siphezulu. Ingakanani ephakamileyo kuxhomekeke kukuphi uhlobo lwe-inshurensi yezempilo onayo.
Ukuba isicwangciso sakho sezempilo si- HMO okanye i- EPO , asikwazi ukujongana nokunakekelwa kwenethiwekhi. Oku kuthetha ukuba uya kuba noxanduva lokuhlawula i-100% yeendleko zokunakekelwa kwe-out-of-network.
Ukuba isicwangciso sakho sempilo siyi- PPO okanye iplani ye-POS, inokubangela inxalenye ethile kwiindleko zokunakekelwa kwe-out-of-network. Nangona kunjalo, ayiyi kuhlawula ikhulu lepesenti yebhilikhwe njengoko yayiya kuhlawulwa xa wawuhlala kwinethiwekhi. Ngokomzekelo, unakho uqinisekiso lwe-20% lweenkonzo zokunakekelwa kwe-intanethi kunye ne-50% ye-coinsurance yokunakekelwa kwe-out-of-network.
Nokuba i-deductible yakho inokuchaphazeleka. Ukuba isicwangciso sakho sezempilo sinegalelo kwiindleko zokunakekelwa kwe-network-out-of-network, unokufumanisa ukuba unonophelo olulodwa lokunakekelwa kwenethiwekhi kunye nolunye, oluphezulu, olususwe kwi- care -of-network ukunakekelwa.
Unako ukuhlawula imali.
Xa usebenzisa umboneleli we-intanethi yeenkonzo zokucwangciswa kwezempilo, lowo mniki-mvume uye wavuma ukuba angayinakutyala imali nayiphi na enye ngaphandle kwe-deductible, ikopi kunye ne-coinsurance ukuba isicwangciso sakho sezempilo sixoxisane.
Xa usebenzisa umnikezeli womnatha-ngaphandle, kungekhona nje ukuba lowo umniki-mboleko unokuhlawulisa nantoni na ayifunayo, unokukuhlawula imali nayiphi na eyishiywe emva kokuba inkampani yakho yinshorensi yemali ihlawule inxalenye yayo. Ebizwa ngokuba yi-balance balance, oku kungakhokhela amawaka eedola.
Nantsi indlela esebenza ngayo. Unquma ukusebenzisa umnikezeli we-out-of-network yakho ye-catheterization yakho yentliziyo. I-PPO yakho ine-50% ye-coinsurance yokunakekelwa kwe-network-out-of-network, ngoko ucinga ukuba isicwangciso sakho sezempilo siya kuhlawula isigamu seendleko zokunakekelwa kwakho kwenethiwekhi, kwaye uya kuhlawula esinye isiqingatha.
Intliziyo ye-catheterization iza ne-bill ye-$ 15,000, ngoko ucinga ukuba uza kuhlawulwa i-$ 7,500. Aphosakeleyo!
I-PPO yakho iya kujonga i-bill ye-15,000 yee-bill kwaye ithetha into ethile kwimpembelelo "Yeyona nto. Inkokhelo ecacileyo kule nkathalo i-$ 6,000, ngoko sivumela kuphela i-$ 6,000. Siza kuhlawula isiqingatha se-$ 6,000 efanelekileyo. "I-PPO ihlawula i-$ 3,000.
Umnikezeli-ngaphandle-wenethiwekhi akakhathaleli ukuba isicwangciso sakho sezempilo sicinga ukuba yinto efanelekileyo. Inika imali ye-PPO ye-3,000 yentlawulo kwi-bill ye-15,000 yee-bill kwaye ikuthumela ibhilikhwe ye-balance (yingako le nto ibizwa ngokuba yi- balance balance ). Ngoku uhlawula i-12,000 $ kunama-$ 7,500 ocinga ukuba uya kuba netyala.
Unciphisa ukukhusela ukuphuma kwakho kwe-pocket.
Umgaqo-nkqubo we-inshorensi yakho ye-inshorensi yempilo yenzelwe ukukhusela kwiindleko zonyango ezingenamlinganiselo. Ibeka i-cap, okanye iphezulu, kwisixa-mali esiya kufuneka uhlawule ngamnye ngonyaka kwii-deductible, i-copays, kunye ne-coinsurance. Ngokomzekelo, ukuba isicwangciso sakho sempilo singaphandle kwe-$ 6,600, emva kokuba uhlawule i-$ 6,600 kwiingxowankulu, i-copays, kunye ne-coinsurance ngaloo nyaka, unokuyeka ukuhlawula ezo ntlawulo zokwabelana ngeendleko. Isicwangciso sakho sezempilo sithatha i-100% yethebhu kwiindleko zakho zokunakekelwa kwempilo ngoncedo kulo lonke unyaka.
Nangona kunjalo, izicwangciso zempilo ezininzi azikhatali ngetyala lokufumana uncedo lwe-out-of-pocket. Ekubeni i- out-of-pocket maximum ingaba yodwa into emele phakathi kwakho kunye nenkunkuma yezimali xa uhlakulela imeko yempilo ebiza ixabiso, ukhetha ukunyamekela ngaphandle kokukhusela ukukhutshwa kwe-pocket kwenyusa ingozi yakho yemali.
Umgangatho woLondolozo lweeNkcazo ezineNkqubo yokuNakekela iNethiwekhi
Abantu abaninzi bafuna ukunakekelwa ngaphandle kwenethiwekhi kuba banomuva wokuba banokufumana umgangatho ophezulu wokunyamekela kunokuba ababoneleli babo be-intanethi bayakubonelela. Nangona le nto inokwenzeka okanye ingenakwenyaniso, qaphela ukuba unokulahlekelwa ukukhuselwa kwekhwalithi ethile xa uphuma ngaphandle.
Unokuba neengxaki ngokulungelelaniswa kwakho.
Ngokukodwa kwizicwangciso zempilo ezingayi kuhlawula nayiphi na into yokunakekelwa kwenethiwekhi, akukho zixhobo ezifanelekileyo zokunxibelelana ngokukhawuleza kwenkathalo enikezelwa ngumniki-ntanethi ngaphandle kwenkonzo enikezelwa ngababoneleli bakho be-network.
Ekugqibeleni, i-onus ikukuqinisekisile ukuba oogqirha bakho abakwi -network bayazi ukuba ugqirha wakho osebenzayo ngaphandle, kunye nangoko. Uya kuba sisigulane kunye nomgca wolwazi phakathi kwabanikezeli bakho be-intanethi rhoqo kunye nomnikezeli wakho wenethiwekhi.
Ngaphambi kokuba uvume ngokugqithiseleyo ukuba ibhakede iye kunye nawe ... qaphela ukuba le buck ayiyi kuyeka. Akuyi ku funeka uhambe ngokukhawuleza ukuzalisa le gaphulo. Uya kufuneka uyenze rhoqo xa unemivuzo, uvavanye, wenze utshintsho kwimpilo yakho, okanye utshintsho kwisicwangciso sakho sokonyango.
Awukho nje ukukhawulela isikhala soqhagamshelwano phakathi koogqirha bakho, nokuba; uya kuyenza phakathi komnikezeli wakho ongaphandle kwisevisi kunye nesicwangciso sakho sempilo, kwakhona. Ngokomzekelo, ukuba i-cardiologist yakho ngaphandle kwe-network ufuna ukuyivavanya uvavanyo okanye unyango olufuna ukugunyazwa kwangaphambili kwinkampani yakho yomshuwalense, uya kuba noxanduva lokuqinisekisa ukuba ufumene lo mbandela. Ukuba awufumani ukugunyazwa kwangaphambili, isicwangciso sakho sempilo sinokungafuni ukuhlawula .
Uza kulahlekelwa ukuhlolwa kwesicwangciso sezempilo kubaboneleli.
Ngaphambi kokuba uvumele umboneleli wezempilo ukuba athathe inxaxheba kumnatha wezoncedisi, isicwangciso sakho sezempilo siyamrhola. Oku kunokuba kube lula njengokutshekisha ukuba ilayisenisi yomniki-ntle inokuma okanye ukuba izibonelelo zivunywe yimibutho yokunakekelwa kwempilo yoncedo njengeJCCO. Nangona kunjalo, inqubo yokubhengezwa inokuba yinkimbinkimbi kwaye ichaneke ngaphezu koko, ukubonelela ngenkonzo enokuba nzima ukuba uziphindiselele. Ukongezelela, ezininzi izicwangciso zempilo zinenkqubo eqhubekayo yokubeka esweni umgangatho wonyango olunikezelwa ngamalungu abo ngabanikezeli benethiwekhi. Ababoneleli abangaqhathaniswa nemingcipheko yemigangatho yemigangatho yokuhlaselwa kwi-intanethi.
Xa uphuma ngaphandle kwenethiwekhi, ulahlekelwa ngumnatha wokhuseleko lwenkqubo yesicwangciso sempilo yakho yokuhlola nokujonga inkqubo.
Uza kulahlwa yiprogram yakho yezempilo yokubhengezwa nababoneleli.
Ukuba unenxaki okanye impikiswano nomnikezeli we-intanethi, inkampani yakho yomshuwalense yempilo ingaba ngummeli onamandla egameni lakho. Ekubeni isicwangciso sakho sezempilo sichaza amawaka abathengi kumniki-nkonzo, umboneleli uya kuqaphela ukuba isicwangciso sezempilo siphosa isisindo esinamandla emva kwengxabano yakho. Ukuba isicwangciso sezempilo asicinga ukuba umniki-mpawu uziphatha ngokufanelekileyo, kunokumnciphisa naye kwinethiwekhi. Nangona izinto aziqhelanga ukuba ziqhubele phambili apha, kulungile ukwazi ukuba unomntu onamathele ecaleni lakho.
Ngakolunye uhlangothi, umnikezeli-ngaphandle wenethiwekhi akanakukhathalela ngaphantsi kwinto yakho yenkampani yomshuwalense. Ukongezelela, kungakhathaliseki ukuba isiganeko esichengileyo senze ukuba ingxabano yakho ibe yintoni, inkampani yakho yinshorensi yezempilo ayiyi kuchitha ixesha elikunika lona umniki-ntanethi ongenakukuchaphazela.
Indlela yokuLawula ingozi eyongeziweyo enxulumene noKhathalelo lwangaphandle lweNethiwekhi
Ekubeni uza kuba nendima ebalulekileyo ekuqinisekiseni ukuba ufumana unyango olusemgangathweni kumnikezeli wakho we-out-of-network, funda. Ezi ziqhagamshelwano zinokukunceda:
Indlela yokufumana iRekodi yokuLawulwa kweeNyango zezoTywala .
Indlela yokukhetha iSiphedlele esiPhezulu .
Qinisekisa ukuba ababoneleli bakho be-intanethi banalo iirekhodi ezivela kubanikezeli bakho be-network, kwaye ababoneleli bakho be-network banaloo rekhodi kubanikezeli bakho be-network. Uninzi lwabantu luya kufuna ukufumana iirekhodi zabo zonyango. Unokucela njani iiRekhodi zakho zezoNyango .
Ukulungelelanisa kwakho ukunyamekela ingqalelo kwiinkcukacha. Kufuneka ube yincutshe yezona zinto zonyango kwiziko lakho lononophelo lwempilo. Ungumthetheli weqela lakho lononophelo lwempilo, kwaye kufuneka ukuba ukhawuleze malunga nokuba yeyiphi iqela lamalungu akho okwenzayo kwaye kutheni.
Ukongezelela ekunikezeni iirekhodi zezokwelapha, kufuneka uthathe amanqaku akho xa unakekelwa. Ukusebenzisa amanqaku akho, unokunika ingxelo ngokukhawuleza kokunikezela ngomlomo kubanikezeli bakho malunga neenguqu kwezinye iinjongo zabanikezeli benkonzo yakho. Kufuneka ukwazi ukuchaza isizathu sokuba umniki-nkonzo enze iinguqu kwisicwangciso sakho sokunyamekela akwenzileyo, kungekhona nje oko utshintsho.
Ekubeni uza kuba uhlawula inxalenye enkulu enokhathalelo lwakho xa ufumana unonophelo lwangaphandle-kwenethiwekhi, kufuneka ukwazi ukuba iyintoni iindleko ngaphambi kokufumana unonophelo. Cwangcisa ukuxoxisana nomyinge ohlawulelwayo kunye nomboneleli wakho wokungena-wenethiwekhi; awufuni ukuhlawula umlinganiselo "wokukhawuleza." Ukuba isicwangciso sakho sezempilo sinceda ekuhlawuleleni ukunyamekela kwe-network-out-of-network, cela ukuba yintoni inqanaba elifanelekileyo kunye nesiko lenkathalo oyifunayo. Ezi zixhobo ziya kunceda: