Umboneleli wezempilo unomntu okanye inkampani enika inkonzo yonakekelo yezempilo kuwe. Ngamanye amazwi, umniki-nkonzo wakho unakekele impilo.
Ixesha elithi "umboneleli wezempilo" ngamanye amaxesha lisetyenziswe ngokungafanelekileyo ukubhekisela kwisicwangciso se-inshorensi yempilo, kodwa i-inshorensi yempilo iyahluke kwiinkonzo zempilo.
Bani ababoneleli ngezeMpilo?
Umboneleli wezempilo unomntu owaziwayo kakhulu yi- PCP okanye ugqirha wezempilo.
Kodwa, kukho zonke iintlobo ezahlukeneyo zabanikezeli bezempilo. Naluphina uhlobo lwenkonzo yononophelo lwempilo onokuyidingayo lunikwa luhlobo oluthile lomboneleli wezempilo.
Nazi ezinye izibonelo zengcali ezingabangazigqirha zabanikeli bezempilo:
- Umphathiswa wenyama okunceda ukuba uphinde uzuze emadolweni akho.
- Inkampani Yenkxaso Yempilo Yasekhaya eyenza umhlengikazi wakho wokutyelela.
- Inkampani yezoxhobo zenkxaso yexesha elide elibonelela nge-oxygen yakho okanye kwisihlalo sabakhubazekile.
- Yakho yekhemisi.
- Ibhubhoratri ekhangela kunye neenkqubo zakho zegazi.
- Isakhiwo sokucinga esenza i-mammograms, i-X-rays kunye ne-MRI ihlola.
- Ingcali yomlomo osebenza kunye nawe ukuqinisekisa ukuba unokugwinya ukutya ngokukhuselekileyo emva kokuphazamiseka.
- I-clinic yokugulisa isiguli apho uyenze ikhoonoscopy yakho.
- I-specialty laboratory eyenza ukuhlolwa kweDNA yakho.
- Iziko lokunakekelwa ngokukhawuleza okanye ukuhamba-kwiklinikhi kwindawo yokuthenga yezitolo.
Kutheni Kubalulekile
Ukongeza kwizinto ozikhethele zona malunga nabanikezeli benkonzo onokukukhathalela, ukhetho lwakho lwemicimbi yabanikezeli ngezizathu zemali kunye ne-inshurensi.
Uninzi lwezicwangciso zezempilo zinomncedisi womnatha . Ezi nxu lumano ngamaqela ababoneleli abavumile ukubonelela ngeenkonzo kumalungu esicwangciso sezempilo ngesilinganiso esaphuculwayo kwaye baye bahlangabezana nemilinganiselo esemgangathweni efunekayo yomshuwalense wakho. Isicwangciso sakho sempilo sikhetha ukuba usebenzise abanikezeli bee-network kunokuba basebenzise abanikezeli benethiwekhi ngaphandle.
Enyanisweni, ii-HMO nee- EPO aziyi kuhlawula iinkonzo ozifumanayo kumniki-nkonzo okhupheleyo ngaphandle kweenethiwekhi ngaphandle kweemeko ezongeziweyo . Ii-PPOs, kwaye kwinqanaba elingaphantsi kwezempilo ze-POS, ngokuqhelekileyo ziza kuhlawula ngononophelo olunikezwa ngabanikezeli benethiwekhi ngaphandle. Nangona kunjalo, bakukhuthaza ukuba ufumane unonophelo lwababoneleli nge-intanethi ngokukuhlawula i-copayment ephezulu okanye i-coinsurance xa usebenzisa umnikezeli wangaphandle.
Ukuba uthanda ugqirha wakho okanye omnye umboneleli wezempilo, kodwa abangekho kwinethiwekhi kunye nesicwangciso sakho sezempilo, unokukhetha. Ngethuba lokubhalisa ngokuzayo, ungatshintshela kwisicwangciso sezempilo esizibandakanya kwinethiwekhi yaso.
Unokubhenela kwisicwangciso sakho sezempilo esicelayo ukuba sizinakekele unonophelo olusuka kulo mnikezeli wenethiwekhi ngaphandle kokungakhathaliseki ukuba unonophelo lwenethiwekhi. Isicwangciso sakho sezempilo sinokukulungele ukwenza oku ukuba ungeyimijimeni yonyango eyinkathalo elawulwayo okanye ephethwe ngulo mnikezeli.
Esinye isizathu sokuba isicwangciso sakho sivumele ukuba oku kungenjalo ukuba ungabonisa isicwangciso sokuba kungani umnikezeli wakho ukhetha ngcono kule nkonzo kunomnikezeli wenethiwekhi. Umzekelo, ngaba unedatha esemgangathweni ebonisa ukuba lo gqirha unomlinganiselo ophantsi kakhulu weengxaki ze-post-op kunokuba ugqirha we-in-network?
Ngaba unokubonisa ukuba lo ogqirha unamava kakhulu ekusebenzeni inkqubo yakho engaqhelekanga neyinkimbinkimbi? Ukuba unogqirha we-in-network wenza kuphela inkqubo oyifunayo amaxesha angama-6, kodwa ugqirha wakho ogqithiseleyo owenziweyo uyenze kabini ngeveki iminyaka elishumi, unethuba lokukholisa umgcini-mali wakho.
Ukuba unako ukuqinisekisa isicwangciso sakho sezempilo sokusebenzisa lo mnikezeli-ngaphandle wenethiwekhi unokugcina imali ngexesha elide, unokukwazi ukuphumelela sakho isibheno.
Ukuqonda uluhlu olubanzi lwababoneleli lunokukunceda ukuba ugweme ukuhlawula iindleko zebhilidi
Iibhilikithi zebhanki zongxamisekileyo zenzeke xa isigulane siphethwe kwi-in-network indawo, kodwa ifumana unyango okanye iinkonzo ezivela kumniki-ntanethi ngaphandle.
Ngokomzekelo, unokuba nokuhlinzwa kwamadolo kwisibhedlele kwisicwangciso sakho senkqubo yezempilo, kwaye kamva ufumene ukuba umthengisi wezixhobo zonyango oluhlala ixesha esisebenzisayo esibhedlele ayikho isivumelwano kunye nesicwangciso sakho se-inshorensi.
Ngoko ukongeza ukuba kufuneka udibane nesicwangciso sakho sempilo esise-inethiwekhi ngaphandle kwe-pocket esiphezulu, ungagqiba nokuhlawula iindleko ezingaphandle kwee-knee brace kunye ne-crutches, walker, okanye isihlalo sabakhubazekile ophelile emva utyando.
Okwazi ngakumbi malunga nodidi lwababoneleli abandakanyekayo kunyango lwezempilo, bhetele ulungele ukuba ube, ubuncinane kwiimeko ezingezoxakeka. Amanye amazwe adlulisele imithetho yokunciphisa ukunyanzeliswa kwezigulane ukulinganisela ukuhlawula kwiimeko apho abanye ababoneleli kwiziko elinikezelweyo abayiyo inxalenye yamanethiwekhi e-inshurensi apho izivumelwano zesikhungo.
Kodwa ngokubanzi, eminye imibuzo oyicelayo ngaphambi kwexesha, bhetele uya kuba. Buza malunga nenxaxheba yomnatha-nshurensi nxaxheba nawuphi na umboneleli onokukuphatha-ngokuthe ngqo, okanye ngokungathanga ngqo, njengokuba kunjalo kunye nezixhobo zonyango ezide, ii-radiologists kunye neelabhu. Buza isibhedlele okanye iklinikhi ukuba kukho inketho ye-in-network kwimeko nganye, kwaye uchaze umnqweno wakho wokusebenzisa abasebenzisi-inethiwekhi-ukugcina engqondweni ukuba "umboneleli" uya ngaphaya kogqirha ekujongeni ukunakekelwa kwakho.
> Imithombo:
> Hoadley, Jack; Ahn, Sandy; ULucia, uKevin. URobert Wood Johnson Foundation kunye neZiko kwiNguqulelo ze-Intshumo yezeMpilo (i-Yunivesithi yaseGeorgetown yeNkcubeko yezeMpilo). Ukuhlawula imali: Iimali zikhusela njani abathengi kwiiNkokhelo ezingalindelekanga? Juni 2015.
> I-National Academy yoMgaqo-nkqubo wezeMpilo kaRhulumente, uMthetho oYilwayo woTywala owenziwe ngo-2016.