Iinkampani zomshuwalense zisebenzisa ukugunyazwa kwangaphambili ukugcina iindleko zonyango kwi-check
Ukugunyaziswa kwangaphambili kuyimfuneko yokuba ugqirha wakho ufumana imvume evela kumboneleli wakho wezempilo ngaphambi kokumisela imithi ethile okanye ukwenza umsebenzi othile. Ngaphandle kwalokhu kuvunywa kwangaphambili, umniki-nkonzo wakho we-inshurensi yezempilo ayinakubonelela nge-coverage, okanye ukuhlawula, amayeza akho okanye ukusebenza, ukushiya ukufihla ezinye, okanye zonke, ngeendleko eziphuma ephaketheni.
Kutheni i-Health Insurers ifuna ukugunyazwa kwangaphambili?
Kukho izizathu ezininzi ukuba umniki-inshorensi yempilo ufuna kuqala imvume. Inkampani yakho yinshorensi yempilo isebenzisa imfuneko yokugunyazwa kwangaphambili njengendlela yokugcina iindleko zonyango kwi-check. Ifuna ukuqinisekisa ukuba:
- Inkonzo okanye iziyobisi ozicelayo ziyimfuneko ngokwenene.
- Inkonzo okanye iziyobisi zilandela iziphakamiso zentsuku zonyango ojongene nayo.
- Isilwayo yinkqubo yokunyanga kakhulu yonyango efumanekayo kwimeko yakho. Ngokomzekelo, iDrug C (ixabiso elincinci) kunye neDrug E (ezibizayo) kokubili ukuphatha imeko yakho. Ukuba ugqirha wakho umisela i-Drug E, isicwangciso sakho sezempilo singafuna ukwazi ukuba kutheni i-Drug C ingasebenzi kakuhle. Ukuba ungabonisa ukuba iDrug E iyona ndlela ingcono, inokuthi igunyaziswe ngaphambili. Ukuba akukho zizathu zonyango ezenza ukuba i-Drug E ikhethwe kwi-Drug C ephantsi, isicwangciso sakho sezempilo singenalo ukugunyaza i-Drug E.
- Inkonzo ayiyi kuphindwa. Oku kuyinkxalabo xa iingcali ezininzi zibandakanyeka kwinkathalo yakho. Ngokomzekelo, ugqirha wakho wamaphaphu unokuyalela i- CT scan , engaqapheli ukuba, iiveki ezimbini ezimbalwa ezedlule, ube nesifuba sikaT. Kule meko, umshwalense wakho akayi kugunyaza ukukhangela kwesibini uze uqiniseke ukuba udokotela wakho wamaphaphu ubonile ukutshekisha kwakho unayo iiveki ezimbini ezidlulileyo kwaye ukholelwa ukuba ukukhangela okufunekayo kuyimfuneko.
- Inkonzo eqhubekayo okanye ephindaphindiweyo inokunceda ngokwenene. Ngokomzekelo, ukuba unesipilisi sonyango kwiinyanga ezintathu kwaye ucela imvume yezinye iinyanga ezintathu, ingaba unyango ngokwenyama uncedo? Ukuba wenza inkqubela, inkqubela phambili, iinyanga ezongezelelweyo zingaphambi kokugunyazwa kwangaphambili. Ukuba awukwenzi naluphi na inkqubela phambili, okanye ukuba i-PT ngokwenene yenza ukuba uzive ungakumbi, isicwangciso sakho sezempilo asinakugunyaza nayiphi na iseshoni seP PT uze uthethe nodokotela wakho ukuba aqonde kakuhle ukuba kutheni ecinga ezinye iinyanga ezintathu PT izakunceda.
Enyanisweni, imfuneko yokupasa isigunyaziso yindlela yokuncedisa unyango lwempilo . Isicwangciso sakho sezempilo sisilinganisela ukufumana ukuhlawulwa okuhlawulwayo kumachiza aphezulu kunye neenkonzo, ukuqinisekisa ukuba abantu abodwa abafumana ezi zi yobisi okanye iinkonzo ngabantu abo izilwanyana okanye inkonzo ezifanelekileyo.
I-ACA (i-Obamacare) kunye nokugunyazwa kwangaphambili
Umthetho woNonophelo ongenakunqwenelekayo, osayinwe ngumthetho ngo-2010 (kunye nokujongene nokuchithwa kunye nokutshintshwa phantsi koLawulo lweTrump ) ngokubanzi uvumela abaqinisekisi ukuba baqhubeke besebenzisa ukugunyazwa kwangaphambili njengendlela yokulawula iindleko nokuqinisekisa ukuba izigulane zifumana unyango olusebenzayo.
Kodwa inqabela izicwangciso zezempilo ezingabonakaliyo ukuba zifune ukugunyazwa kwangaphambili ukuba zibone i-OB-GYN kwaye ivumela izigulane ukuba zithathele ugqirha wazo ozinzileyo (kubandakanya ootitshala bezilwanyana okanye i-OB-GYN).
Inqabela kwakhona izicwangciso zempilo ekufuneni ukugunyazwa kwangaphambili kwenkathalo engxamisekileyo kwisibhedlele esingaphandle kwe-network.
Ukuhlaziywa nguLouise Norris.
> Umthombo:
> Amasebe e-Medicare neeNkonzo zeMedicaid. Iziko loLwazi loThengi kunye noLawulo lweNtshuwalense. UmThetho oYilwayo wamaLungelo omNyango ongenakunceda.