Ukukopela iShidi kwiibhiliki zonyango

Yonke imisebenzi yeofisi yonyango ejongene nokuhlawula kunye nokuqokelelwa kweentlawulo - ukususela ngexesha umgulane ulungiselelwe ukuqeshwa de kube ixesha elihlawulwayo livela kwinkampani yomshuwalense-ibaluleke kakhulu ekukhuliseni imali yokubuyisela i-inshorensi. Ubunzima bokuhlawula ngonyango kunye neemfuno zeenkampani ezahlukeneyo ze-inshorensi zingenza kube nzima ukuba iofisi yezobugcisa i ngenise ngempumelelo kwaye iqokelele iintlawulo zonyango.

Ukudala iphepha lokukopela kubasebenzi be-ofisi yezobugqirha banokunceda ukwenza ukuhlawula kunye nokuqokelela iintlawulo lula kakhulu.

Nazi izinto ezi-7 ukuba zifake kwi-ofisi yakho yezokwelapha.

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Abahlawuli bomshuwalense

Qala uluhlu lwakho ngokuchonga abahlawuli ukuba amagqirha okanye isikhungo sivumelwano kunye. Oku kufuneka kufake yonke inkcukacha zoqhagamshelwano ezifana needitalithi, i-website, kunye neenkcukacha zeenombolo zomnxeba.

Ungalibali ukubandakanya:

• LweMida
• Uxilongo (ngurhulumente)
• I-Blue Cross Blue Shield (ngurhulumente)
• Cigna
• Aetna
• IWorld HealthCare
• Ukulinganisa

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UkuFakela ngexesha

Qaphela ixesha elifihlayo lokufakela ixesha elide ngexesha lokuhambisa i-inshurensi nganye. Bonisa inani leentsuku umniki-mboleko kufuneka afake ibango emva kokuba iinkonzo zifunyenwe. Imida yokufakela ngokukhawuleza ichazwe kwisivumelwano somnikeli.

Eminye imizekelo yexesha elifihlayo lokuthumela ixesha liquka:

• I-Medicare : Amabango kufuneka angeniswe kungangonyaka owodwa emva komhla wenkonzo.
• Ukunakekelwa kweMpilo yeZizwe eziManyeneyo: Imida yokufakela ngexesha elifanelekileyo ichazwe kwisivumelwano somnikeli
• I-Cigna: Ngaphandle kokuba umthetho welizwe okanye omnye usebenziso lusebenza -
  1. Abaniki-nxaxheba benonophelo bempilo banamalungu amathathu (3) (iintsuku ezingama-90) emva komhla wenkonzo.
  2. Abanikezeli bee-out-of-network baneenyanga ezintandathu (6) (iintsuku eziyi-180) emva komhla wenkonzo.
• I-Aetna: Ngaphandle kokuba umthetho welizwe okanye omnye usebenziso lusebenza -
  1. Oogqirha baneentsuku eziyi-90 ukususela ngomhla wokubonelela ukufaka ibango lokuhlawula.
  2. Izibhedlele zinomnye umnyaka ukususela kumhla wenkonzo ukuhambisa ibango lokuhlawula.
• I-TRICARE: Amangalo kufuneka angeniswe kungangonyaka omnye emva komhla wenkonzo.

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Ukuqinisekiswa kunye nokugunyazwa kwangaphambili

Bonisa ukuba ngabaphi abakhokheli bomshuwalense badinga ukugunyazwa kwangaphambili kunye / okanye ukuhanjiswa kunye naziphi na iinkqubo. Kwakhona, zibandakanya inkqubo yokuba ngamnye umhlawuli-mali ayenokufumana ukugunyazwa kunye naluphi ulwazi abayidingayo ukulungiselela ugunyaziso.

Kaninzi

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Ukuphindaphinda

Cacisa iivama ezivunyelwe iinkonzo ezithile okanye iinkqubo ngabahlawuli. Oku kufuneka kuquke inani leenkqubo ezivunyelwe kunye nenkqubo yokuhlawula ezininzi iinkqubo.

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UkuBangelwa kweziBango

Bonisa indlela kunye nohlobo lwesibango olufunekayo ukuhambisa amabango kumntu ngamnye ohlawula i-inshorensi kubandakanye amabango e-elektroniki, amabango ephepha, amabango asekondari, kunye nokulungiswa kwamabango.

Uninzi lwabahlawuli bafuna ukufakwa kweekhompyutheni zombini kwiibango eziziiprayimari nezesekondari besebenzisa ifomathi efanelekileyo kumabango oqeqesho okanye amaziko .

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Izidingo zokuhlawula

Abahlawuli bomshuwalense kufuneka bathumele intlawulo ngexesha elithile, ngokuqhelekileyo iintsuku ezingama-30. Khangela isivumelwano sakho sokuhlawula ukuze ufumane ixesha elithile ongalindela ukufumana inkokhelo kumvuzo ngamnye ngokulandela imeko yobango.

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Izibheno

Ukuchonga inkqubo yokubhenela efunekayo kwintlawulo yomshuwalense ngamnye. Ikhampani nganye yomshuwalense inexesha lokugcina ixesha elifanelekileyo ngexesha elifanelekileyo kwaye ngamanye amaxesha xa izibango zingasombululwanga ngokukhawuleza, zinokushiywa kwiingxelo ezifunyenwe ixesha elide ukuhluleka ukwenza umgca wokugqibela.

Xa zenziwe ngokuchanekileyo, amabango enkcazo echaphazelekayo angaba yindlela esebenzayo yokusombulula nokufumana intlawulo kula mabango aphikisiwe ngenxa yezizathu ngaphandle kwezinye iziphoso zokubhalisa.

Kaninzi