Kungenxa yokuba umniki-nkonzo uthatha i-inshorensi yakho yempilo ayithethi ukuba inethiwekhi
Ukuba unayo i-HMO, i-PPO, i-EPO, okanye isicwangciso sezempilo se-POS, ukunyamekela ngaphandle kwenkqubo yomncedisi wecebo lakho kunokukuhlawula imali eninzi kunokuhlala kwi-network. Kodwa, akulula ngaso sonke isikhathi ukufumanisa ukuba umniki - mboleko owubonayo usekho-inethiwekhi okanye ngaphandle kwe-intanethi yakho yinshuwalense yezempilo, ingakumbi xa ungeke ukwazi ukuhlala phantsi kwikhompyutheni yakho kwaye u tyelele iwebhusayithi yakho yeziko lezempilo .
Ukuba ukwenza ukuqeshana nomniki omtsha, unako ukujonga rhoqo isimo senethiwekhi ngaphambi kokuba uqeshwe kwaye ukhansele ukuqesha xa ufumanisa ukuba ungaphandle kwenethiwekhi. Nangona kunjalo, ukuba ufumana unonophelo lwempilo olungenakulungiswa, awuvumelekanga ukuba uthathe ixesha ukujonga ukuba okanye umniki-mboleko oza kuwusebenzisa ungaphakathi. Le meko ingavela xa unenkathalo kwiziko lokunakekelwa ngokukhawulezileyo, ekliniki yokuhamba, kwiklinikhi yokuthengisa, okanye nokuba ufumana i-X-ray okanye umsebenzi webhu ebanjwe endleleni yakho ekhaya evela kwiofisi yegqirha.
Kule meko, unokulingwa ukuba ubuze umniki-mpahla, "Ngaba uthatha i-inshurensi yezempilo ye-XYZ?" Xa ummkeli ephendulayo, "ewe," ungathanda ukucinga ukuba usebenzisa umnikezeli wenethiwekhi. Kodwa, unokuphosakela kwaye loo mpazamo ingakubiza ixesha elikhulu. Kungenxa yokuba umniki-mvume uyamkela i-inshorensi yakho yempilo ayithethi ukuba it-inethiwekhi kunye nesicwangciso sakho sezempilo.
Yintoni eyamkela i-Intshurensi yakho yempilo iyathetha
Kumnikezeli wonyango, ukwamkela i-inshorensi yakho yempilo kuthetha
- Iya kufaka ibango ngecebo lakho lempilo.
- Kuya kwamkela nayiphi na imali isicwangciso sakho sezempilo sihlawula.
- Kuya kuhlawulwa iintlawulo zemboleko kwisicwangciso sakho sezempilo ukuya kwibhilikhi yakho.
Akuthethi ukuba ungumniki-inethiwekhi kunye nesicwangciso sakho sezempilo.
Enyanisweni, umniki-mfuneko akafanele abe kwinethiwekhi kunye naluphina isicwangciso sezempilo, kodwa usenokukwamukela zonke iintlobo ze-inshorensi yezempilo.
Oko Kuthetha Ngokunxibelelwano Kwisimo Sithetha Ngokwenene
Xa umboneleli wezempilo enomnatha-intanethi, kuthetha okungaphezulu kunokuba uya kwamkela i-inshorensi yakho yempilo. Ithatha ukuba
- Kuya kuhlonipha ireyithi eziphuculwayo isicwangciso sakho sezempilo sixoxisane nayo.
- Kuya kwamkela inkokhelo yakho yesicwangciso sezempilo kunye ne- copayment yakho, i- coinsurance , okanye ichithwe njengentlawulo-ngokupheleleyo .
- Akuyi kulungelelanisa-inkokhelo yakho kwi-inethiwekhi, isicwangciso sezempilo sivalelwe iinkonzo.
- Ukuba inengxaki ngexabiso elivunyelweyo lichanekileyo ngesicwangciso sakho sempilo enkonzweni enikezelweyo, kuya kuthatha eso siphakamiso ngesicwangciso sempilo kunokuba nawe.
- Kuye kwagqithisa inkqubo yakho yokuzibonakalisa isicwangciso sezempilo esiqhele ukuquka izinto ezifana nemfundo kunye nokuqinisekiswa kwelayisenisi kunye nokuhlolwa kwekhwalithi.
- Iya kufaka ibango ngecebo lakho lempilo.
- Kuya kwamkela nayiphi na imali isicwangciso sakho sezempilo sihlawula.
- Kuya kuhlawulwa iintlawulo zemboleko kwisicwangciso sakho sezempilo ukuya kwibhilikhi yakho.
Kutheni Umboneleli weNethwekhi elungileyo kunomnikezeli owamkelayo i-Intshuwalense yakho
Ngoku ukuba uqonde ukuba ukuba-inethiwekhi kunye nokwamkela isicwangciso sakho sezempilo akuyona into efanayo, kufuneka uqonde ukuba kutheni ukuba inethwekhi ibhetele kunokumkela i-inshorensi yakho yempilo.
Xa usebenzisa umnikezeli we-in-network, unalo ukhuseleko oluninzi ongenawo xa usebenzisa umnikezeli we-intanethi owamkela i-inshorensi yakho yempilo.
Umnikezeli-ngaphandle-wenethiwekhi unako ukuhlawula nayiphi na into efuna iinkonzo zayo. Ukuba unogqirha ongaphandle komnxeba ufuna ukuhlawula i-$ 5,000 kwi-ofisi elula, uhambo lwakhe; unako ukwenza loo nto nangona kubonakala kungenangqondo. Nangona kunjalo, umboneleli we-in-network unesivumelwano kunye nesicwangciso sakho sezempilo esichazela ngokuchanekileyo ukuba ingahlawuliswa kangakanani na iinkonzo zayo. Umnikezeli we-intanethi akavumelekanga ukuba akuhlawulise ngaphezu kwesilinganiselo sokuphuhlisa isicwangciso sakho sezempilo sele sathethathele ezo nkonzo.
Isicwangciso sakho sezempilo siya kuhlawula inxalenye encinci yowiso-mthetho kumnikezeli wenethiwekhi ngaphandle kokuba uya kuhlawula inkonzo efanayo enikezelwe kwinethiwekhi. Enyanisweni, ezinye izicwangciso zempilo aziyi kuhlawula i-dime yokunakekelwa kwe-out-of-network.
Ukuba isicwangciso sakho sezempilo sihlawulela ukunakekelwa kwe-network-out-of-network, unakho uqinisekiso lwe-20% lweenkonzo zokunxibelelana kwi-network kodwa i-50% ye-coinsurance yeenkonzo zangaphandle. Ngaphandle kwe-50% ye-coinsurance, oku akuthethi ukuba isicwangciso sakho sezempilo siya kuhlawula i-50% ye-bill ye-out-of-network. Iya kuhlawula kuphela i-50% yemali evumelekileyo. Unamathele ukuhlawula elinye i-50% yemali evumelekileyo kunye nesahlulo sonke sebhili-mali ngaphezu kwexabiso elivunyelweyo. Funda kabanzi malunga nalokhu " Indlela Yokubala Iindleko Zakho Zokunakekelwa Kwangaphandle-Ukwenza iMathe ."
Okubi nakakhulu, i-out-of-network deductible ngokubanzi ikhudlwana kune-deductible ye-in-network ukunakekelwa. Iimali ozihlawulayo ngononophelo lwangaphandle kwee-network aziqhelekanga zibheke kwi-in-network deductible yakho. Iimali ozihlawulayo ngononophelo lwangaphandle kwezonxibelelwano aziqhelanga ngokubhekiselele kwi-out-of-pocket yakho enkulu , nokuba. Funda kabanzi malunga nale micimbi " Yintoni Okufuneka Uyazi Ngaphambi Kokunakekelwa Kwinkonzo Yogxininiso " kunye " Yintoni Engayibaleki Ngaphandle Kwakho? "U
Indlela yokuqinisekisa ukuba usebenzisa i-In-Network Provider
Kukho iindlela ezintathu zokuqinisekisa ukuba usebenzisa i-in-network provider. Maxa wambi kufuneka usebenzise ngaphezulu kweyodwa. Ngamanye amaxesha enye iya kuba yanele.
- Hlola iwebhusayithi yakho yeziko lezempilo.
- Shayela isicwangciso sakho sempilo uze ucele. Inombolo mhlawumbi ingemva kwekhadi le-inshurensi yezempilo.
- Buza umniki wakho ukuba uyena-network kunye nesicwangciso sakho sezempilo.
Nangona ukukhangela iwebhusayithi yakho yeziko lezempilo kudla ngokuba yindlela elula kakhulu kwaye ekhawulezayo yokufumanisa ukuba ngabaphi abanikezeli-nkonzo abakwi-intanethi kwaye abangenjalo, iwebhusayithi ye-plan yezempilo ine-sneaky piece of print print ephantsi kwoluhlu lwababoneleli nge-intanethi. . Ithetha into ethile kwimpembelelo yalo, "Nangona silwela ukugcina olu luhlu luchanileyo kunokwenzeka, alukwazi ukubonakalisa ukuhlaziywa kutshanje kumncedisi wethu wenethiwekhi. Njalo qwalasela umboneleli wakho ukuqinisekisa ukuba kusekhona-inethiwekhi. "Ngenxa yoko, kulungile ukucela umniki-mboleko phambi kokuba ufumane inkonzo, nangona usuvele uhlolisise isimo somnikeli ngewebhusayithi yakho yesicwangciso.
Funda nzulu
Kukho iimeko apho isicwangciso sakho sezempilo sinokukulungele ukuhlawula isibonelelo sokunakekelwa kwempilo ngaphandle kwe-network njengokuba uye wasebenzisa umnikezeli wenethiwekhi.