Ukulinganisela ukuhlawulwa kwentlawulo kwenzeka emva kokuba uhlawule imali yakho, i- coinsurance okanye ikhoyayment kunye nenkampani yakho yomshuwalense nayo ihlawule yonke into enyanzelekile ukuba uyihlawule kwi-bill yakho yezobisi. Ukuba kusekho ibhajethi efunekayo kuloo bhaloli kwaye ugqirha okanye isibhedlele silindele ukuba uhlawule elo bhalansi, uhlawule imali.
Ngaba Ubhaliso Lwemali Elingumthetho okanye Akunjalo?
Maxa wambi kusemthethweni, kwaye ngamanye amaxesha awunjalo; kuxhomekeke kwiimeko kunye nemithetho yomshuwalense karhulumente.
Ukulinganiswa kwemali ngokungekho mthethweni ngokungekho mthethweni :
- Xa unayo i-Medicare kwaye usebenzisa umboneleli wezempilo owamkela isabelo seMagare.
- Xa unesiXhosa kunye nomniki-nkonzo wakho wempilo unesivumelwano kunye neMedicaid.
- Xa ugqirha okanye isibhedlele sakho sinesivumelwano kunye nesicwangciso sakho sezempilo kwaye sikuhlawula ngaphezu kwekhontrakthi evumela.
Kwimeko nganye yezi zizathu, isivumelwano phakathi komboneleli wezempilo kunye ne-Medicare, Medicaid, okanye inkampani yakho yomshuwalense ibandakanya isigatya esinqabela ukuhlawula imali. Ngokomzekelo, xa isibhedlele sibonisa ngeMedare ukubona izigulane zeMedare, kufuneka zivumelane ukuba zamkele umyinge we-Medicare, kunye nokuhlawulwa kwentlawulo yakho, njengentlawulo epheleleyo. Oku kubizwa ngokuba kwamkela isabelo seMagare .
Ukulinganisela ukuhlawula ngokuqhelekileyo kubhejwa ngokomthetho :
- Xa usebenzisa umboneleli wezempilo ongenalo ulwalamano okanye isivumelwano kunye ne-insurer yakho, i-Medicare, okanye iMedicaid. Oku kuqhelekileyo kwiinkqubo zonyango lwe-concierge , kwaye kunjalo nokuba ufuna unonophelo ngaphandle kwenethiwekhi yesicwangciso se-inshurensi yezempilo. Isicwangciso sakho singabhawula ezinye iindleko ze-out-of-network, kodwa umnikezeli-ngaphandle wenethiwekhi akabophekile ukuba amkele intlawulo yakho yomshuwalense njengentlawulo epheleleyo; banokuthumela i-bill yezinto eziseleyo, nokuba ngaba ngaphezulu kwepayili ye-copay yakho ye-out-of-network.
- Xa ufumana iinkonzo ezingagqitywanga ngumgaqo-nkqubo we-inshorensi yempilo, nokuba ngaba ufumana ezo nkonzo kumniki-nkonzo onesivumelwano kunye nesicwangciso sakho sempilo. Le meko iqhelekile kwiinkqubo zonyango ezingekho mfuneko yonyango. Kule meko, uya kuba noxanduva lwebhilikhi yonke.
Ekubeni i-inshorensi yempilo ilawulwa yiphondo ngalinye, imithetho yelizwe inokuchaphazela nokuba kwaye ukuhlawula ibhalansi kusemthethweni. Amanye amazwe anemithetho ethile ngokumalunga nokuhlawula imali eyahlukileyo kwimimiselo engundoqo apha ngasentla. Funda kabanzi malunga nemimiselo yomgaqo-nkqubo yokuhlawula imali evela kwi-Kaiser Family Foundation.
Iimali zokuTyala kweeBhalansi
Xa ugqirha ugqirha, isibhedlele, okanye omnye umboneleli wezempilo ongekho inxalenye yomncedisi wakho wenethiwekhi (okanye, ukuba unayo i-Medicare, kumnikezeli ongenamkeli i-Medicare assignment), loo mniki-nkonzo unika ukuhlawula nayiphi na into afuna ukukuhlawula ngayo. Ekubeni inkampani yakho yomshuwalense ayizange ixoxisane nayiphi na irhafu kunye nomniki-mboleko, yena akabophelwa ngesivumelwano kunye nesicwangciso sakho sezempilo.
Ukuba inkampani yakho yomshuwalense yempilo iyavuma ukuhlawula ipesenteji yokunakekelwa kwakho kwe- out-of-network , isicwangciso sezempilo asihlawuli ipesenti yento ehlawulwa ngayo . Endaweni yoko, ihlawula ipesenti yento ekuthethwa ngayo kufuneka ihlawulwe, mhlawumbi iyaziwa njengexabiso elifanelekileyo kunye nesiko . Njengoko ucinga ukuba, isixa esivakalayo nesiqhelekileyo sisoloko sincinane kunomthamo owenziwe ngawo. Ibhajethi yebhanki ivela kwi-gap phakathi kwezinto umgcini wakho womshuwalense athi uqikelele kunye nesiko, kunye noko ugqirha okanye isibhedlele.
Nasi umzekelo wokubhedlelelwa esibhedlele nge-20% ye-coinsurance ye-hospital network kunye ne-40% ye-coinsurance ye-hospital-out:
| Isibhedlele se-intanethi (i-20% ye-coinsurance) | Isibhedlele se-Out-of-network (40% ye-coinsurance) kunye ne-bill balance | |
| Iindleko zeBhedlele | $ 60,000 | $ 60,000 |
| Umshurensi uxoxisana nezinga lokunciphisa | $ 40,000 | Akukho saphulelo ngenxa yokuba esi si bhedlele siphumelele |
| I-insurer isingqinisiso nesiko lesintu | $ 45,000 | |
| Umshurensi uyahlawula | Iingama-32,000 zamaRandi (i-80% yezinga lama-40,000 elihlawulelwayo) | $ 27,000 (i-60% yee-45,000 zamaRandi ezinengqiqo kunye nesintu) |
| Uhlawula imali | Ii-8,000 zamaRandi (i-20% yee-40,000 zamaRandi) | I-18,000 yezigidi (i-40% yeedola ezingama-45,000) |
| Ukulinganiswa kwemali ekhokhwayo | $ 0 | $ 15,000 (Isibhengezo sokuqala sebhedlele esibhedlele kunye neentlawulo zemali-mali) |
| Xa uhlawulwa ngokupheleleyo, uhlawule | $ 8,000 | $ 33,000 (Ubuncwane bakho kunye ne-balance balance). |
Ukuhlawuliswa kweeMali kuyenzeka ntoni?
EUnited States, ukuhlawula ibhalansi kwenzeka njalo xa ufumana unyango kumgqirha okanye kwisibhedlele esingeyona inxalenye yesikhokelo senkonzo yenkampani yomshuwalense wezempilo okanye ayamkeli isabelo seMagare.
Umrhumo weBhanance Balance: Ababoneleli beNethiwekhi abaSebenza kwiiNethiwekhi zoLuntu
Oku kunokwenzeka kungalindelekanga, nangona uzama ukuhlala kwinethiwekhi. Umzekelo, uya kwisibhedlele se-intanethi, kodwa i-radiologist efunda i-x-ray ayikho kwinethiwekhi. Isibhengezo esibhaliweyo esibhedlele sibonakalisa izinga le-in-network kwaye asixhomekeke kumyinge wokuhlawula imali, kodwa i-radiologist, ekubeni ingenayo isivumelwano kunye nomshuwalense wakho, inokukuhlawulisa nantoni na ayifunayo kwaye ikhululekile ukulinganisela ibhajethi. Iimeko ezifanayo zivela kunye:
- Anesthesiologists
- Iipathologists (oogqirha bezobugcisa)
- I-Neonatologists (oogqirha beintsana)
- Iingqinisiso (oogqirha abazodwa kwizigulane ze-ICU)
- Izibhedlele (oogqirha abazodwa kwizigulane ezibhedlele)
- Iingcali ze-Radiologists (oogqirha abachazela i-ray-ray kunye neengcingo)
- ER oogqirha
- Ababoneleli bezonyango ezizinzileyo (oko kukuthi, inkampani enika iinkonzo, i-braces, izihlalo zabakhubazekile, njl.
- IiNkonzo ezifunyenwe kumboneleli okhethwe ngumnye umntu. Oku kunokwenzeka xa unempap-smear okanye i-biopsy eyenziwa kwiofisi yakho yegulana, okanye igazi elibanjwe ngumhlengikazi wezempilo ekhaya. Ukuba ugqirha okanye umongikazi uthumela umzekelo kwi-lab ngaphandle kwenethiwekhi, lebhu ibanako ukulinganisela ibhilikhwe.
Iziganeko zokuhlawula ukulingana zixakeke kakhulu kwizigulane, abahlala bekholelwa ukuba nje kuphela ukuba bakhethe indawo yezokwelapha, zonke iinkathalo zabo ziya kugqitywa phantsi kwemigangatho ye-intanethi yesicwangciso sabo sempilo. Ukujongana nale meko, amaqela amaninzi ayenze imithetho yokukhusela abathengi (umlinganiselo wokubhatala ukuhlawula imali (kubalulekile ukuqaphela ukuba imithetho yelizwe ngokubanzi isebenza kuphela kwizicwangciso zempilo ezilawulwa nguRhulumente. ngumthetho wesigqeba, phantsi kwe-ERISA):
- I-Arizona yenziwe iBill ye-Senate 1441 ngo-2017. Iya kusebenza ngo-2019, kwaye iza kuvumela izigulane ezithola ibhajethi yebhanki yamangalisa (kusuka kumnikezeli-ngaphandle wenethiwekhi owenza iinkonzo kwi-network-in-network) eyi-$ 1,000 okanye ngaphezulu ukufuna mbambano. Inkqubo yokubambisana iya kugqiba ukuxazulula imbambano phakathi komboneleli wezonyango kunye nenkampani yomshuwalense, ngaloo ndlela uyasigxina isigulane somthwalo kwi-bill balance.
- I-New York ikhusele izigulane kwi-balance balance balance since 2015.
- I-California yenze i-AB72 ngo-2016; lisebenza kwiiplani ezikhutshwe okanye zivuselelwe emva okanye ngoJulayi 1, 2017, kwaye zivimbela izigulane ukuba zihlawule iindleko ze-network zokunakekelwa ezifunyenweyo kwiindawo ezisenkundleni.
- IFlorida yenziwe i-HB221 ngo-2016. Umthetho ukhusela izigulane kwiimeko ezixakekileyo kunye neemeko apho isigulane sifuna ukunyamekela kwi-network inthanethi kwaye siphathwa-ngaphandle kolunye uhlobo-ngumniki-nkonzo ngaphandle indawo.
- I-Maryland, i-Illinois, ne-Connecticut nayo ineemimiselo ezikhusela abathengi kwi-balance balance balance. Amanye amanani amaninzi afumana ukukhuselwa okukodwa endaweni.
Ukulinganisela ukuhlawula akuqheleki ukuba kwenzeke nabanikezeli benethiwekhi okanye ababoneleli abafumana isabelo seMagare ngenxa yokuba, ukuba bahlawulelana ne-bill, baphula isivumelwano sekhontrakthi yabo kunye ne-inshurensi okanye i-Medicare. Baya kulahleka isivumelwano, babhekane neentlawulo, bahlwaywe izigwebo ezinzima, kwaye bajongane neentlawulo zobugebengu kwezinye iimeko.
Ukungafani nalokhu kwenzeka xa usebenzisa umnikezeli we-in-network, kodwa ufumana inkonzo engagqunywanga yinshurensi yakho yempilo. Ekubeni i-insurer ayixoxiswanga nemilinganiselo yeenkonzo ezingabonakaliyo, awukhuselwanga naso isaphulelo esihlawulelwayo. Umniki unakho ukuhlawula nayiphi na into ayifunayo, kwaye unembopheleleko yebhilikhi yonke.
Ukuba Unokulinganisela
Ukuba ufumene ibhilikhi yebhanti okanye ucinga ngokufumana iinkonzo zonyango eziza kubangela ibhajethi yebhanti, unokhetho oluthe ngqo malunga nendlela yokusingatha imeko. Funda ukuba zeziphi izinto ozikhethayo kunye neziphi iindlela onokuzisebenzisa ukusingatha ibhalansi yentlawulo kwi-" Balance Billing-Indlela Yokusingatha, Oko Ukwenza ."
> Imithombo:
> IFundwe yeFundwealth Fund. Ukuhlawula ibhajethi ngababoneleli ngezeMpilo: Ukuvavanya ukukhuselwa kwabathengi kwilizwe lonke
> United States Isebe Lemisebenzi. UMthetho woKhuseleko loNgeniso loMhlala-phantsi.