Ukungqubuzana Phakathi Kwabanikezeli Bezokwelapha Abathintekayo nabangabandakanyeki
Funda mayelana nokwahlukana phakathi kwabahlinzeki abathintekayo (par) nabangabambi iqhaza (abangewona). Umhlinzeki wezempilo angakhetha ukufaka izivumelwano ezinkampanini zomshuwalense kanye nabanye abakhokha noma cha, kodwa kunezinzuzo nezithiyo zebhizinisi labo neziguli zabo.
Abahlinzeki abathintekayo (Par)
"Abahlinzeka ngamalungu noma ababambe iqhaza bangamadokotela noma abanye abahlinzeki bezempilo abanesivumelwano nomkhokhisi othile womshuwalense. Lezi zivumelwano ziveza imigomo nemibandela yokubamba iqhaza komkhokhi nomhlinzeki.
Kunezimpendulo ezimbalwa kwabanikezeli abahlanganyelayo abafaka isivumelwano noma inkontileka nabakhokhisi bomshuwalense. Okubaluleke kakhulu, abahlinzeki kumele bahambisane nemithetho ethile nemigomo ebekwe ngumkhokhi:
Izinsizakalo Zokunakekela Iziguli
Isigaba sezinsizakalo zokunakekelwa kwesiguli sesivumelwano phakathi komnikezeli nomkhokheli kufaka ulwazi mayelana nokudingwa kwezokwelapha kanye nokuphathwa kokusetshenziswa. Umkhokhi ngamunye angaba nencazelo yakhe yokudinga usizo lwezokwelapha esekelwe incazelo ejwayelekile: "Ngokuqondile ekubhekiseni nezinsizakalo, ukwelapha, izinto, noma imisebenzi ehlobene nayo edingekayo futhi efanelekile ngokusekelwe ebufakazini bezokwelapha kanye namazinga okunakekelwa kwezokwelapha ukuxilonga kanye / noma ukuphatha ukugula noma ukulimala noma; ukwelashwa, izinsizakalo, noma imisebenzi ezokwenza ngcono impilo yesiguli noma ukuthi ukungabi khona okufanayo kuyolimaza isiguli. "
Izidingo zokuphathwa komsebenzi zikhombisa imihlahlandlela yokuthola isitifiketi sokuqala, ukugunyazwa kwangaphambili, noma ezinye izidingo ezikhethiwe ngenhloso yokuqinisekisa ikhwalithi yesiguli kanye nokulawula izindleko.
Isibopho Somonde
Bonke abathengi badinga ukuthi isiguli sibe nesibopho senye ingxenye yezindleko zabo zezokwelapha. Lo mthwalo wemfanelo wesineke uboniswa imali ekhishwe ngokubambisana, imali yokukhokha kanye nezimali zokubambisana. Isivumelwano phakathi komkhokheli nomhlinzeki ohlanganyelayo sibonisa nokuthi umhlinzeki kudingeka ukuba enze yonke imizamo yokuqoqa umthwalo wesiguli.
Izidingo zokukhokha
Izidingo zokukhokhisa zingahlukahluka ngokuya kumhlinzeki kanye nemigomo echazwe kwisivumelwano somhlinzeki esibambe iqhaza. Lezi zidingo zicacisa imininingwane ephathelene nolwazi lwekhodi, ukucubungula izimangalo, ukucela imininingwane yefomu, ukufaka isikhathi esifanele, amarekhodi wezokwelapha kanye nemibhalo, imihlahlandlela yezikhalazo, nokubuyisela.
Ukunquma ukuthi kungaba ngumhlinzeki noma umhlanganyeli ozobamba iqhaza kuyoxhomeka kumkhokheli nokuthi kuyoba usizo kanjani ekufinyeleleni imigomo yenhlangano.
Abahlinzeki abangabandakanyeki (Abangewona)
Abahlinzeki abangabambisanga noma ababambe iqhaza bangodokotela noma abanye abahlinzeki bezempilo abangavumelanga ukungena esivumelwaneni nomkhokhisi othile womshuwalense, ngokungafani nabahlinzeki abathintekayo. Bangase futhi babizwe ngokuthi abahlinzeki be-out-of-network .
Umehluko omkhulu phakathi kwabahlinzeki ababambe iqhaza nabangabambi iqhaza ukungabi nokuqiniseka. Abahlinzeki abakhetha ukungabambi iqhaza abanesiqinisekiso sokuthi bayothola inkokhelo kusuka kumkhokheli womshuwalense.
Ukuba nesibonakaliso sesineke isabelo seFomu lezinzuzo
Isabelo sefomu lezinzuzo yifomu egunyaza inkampani yomshuwalense wezempilo ukuba akhokhe ngqo odokotela, umuthi wezokwelapha noma esibhedlela ukuze uthole ukwelashwa okutholiwe.
Ngenkathi isabelo sezinzuzo akusikho isiqinisekiso sokuthi umkhokheli uzobuyisela umhlinzeki ongewona umhlinzeki wezinsizakalo, umhlinzeki angase afanele ukuthola inkokhelo yezindleko eziphelele. Abahlinzeki abangabambe iqhaza abaphoqelekile ukulungisa noma ukuphumula noma iyiphi ingxenye yezindleko eziphelele ngoba bengenayo isivumelwano.
Kungase kube khona okunye okukhethekile kubahlinzeki abangewona abakhetha ukuvuma isabelo sabathengi baseMedare. I-Medicare idinga ukuthi abahlinzeki abangekho nge-projekthi abamukela isabelo sokwamukela okungewona ngavumelekile njengokukhokha ngokugcwele.
Enye ingozi yokuba ngumhlinzeki ongewona ophawula ukuthi iziguli zikhuthazwa yinkampani yabo yomshuwalense ukusebenzisa abahlinzeki abahlanganyele kuphela. Lokhu kungase kube nomkhawulo kumhlinzeki ngenxa yenani elingenzeka lamagciwane okungenzeka lilahlekelwe kubahlinzeki abathintekayo.