Uma ugijima ngaphesheya kwegama elivumelekile lemali kwimininingwane yomshuwalense wezempilo wezinzuzo , kungabangela ukudideka okuthile. Yonke inani lemshwalense yenkampani yakho yomshuwalense ucabanga ukuthi umhlinzeki wakho wokunakekelwa kwempilo kufanele akhokhelwe ukunakekelwa akunikezile. Inani elivunyelwe liphathwa ngendlela ehlukile uma usebenzisa umnikezeli we-inthanethi kunalokho uma usebenzisa umhlinzeki wangaphandle.
Inani elivunyelwe elinokuNakekelwa kweNethiwekhi
Uma usebenzisa umhlinzeki osenkundleni ngecebo lakho lempilo, inani elivunyelwe yikhiqizwayo intengo yakho yokunakekelwa yokunakekelwa ephethwe ukuxoxwa kusengaphambili kule nsizakalo. Ngezinye izikhathi umhlinzeki we-in-network uzokhokhisa okungaphezu kwenani elivunyelwe, kodwa uzokhokhwa kuphela inani elivunyelwe. Asikho isidingo sokwenza umehluko phakathi kwenani elivunyelwe kanye nenani langempela elikhokhwayo uma usebenzisa umhlinzeki we-in-network. Lokho kungenye yokuvikelwa komthengi okuza nokusebenzisa umhlinzeki we-in-network.
Nokho, lokhu akusho ukuthi ngeke ukhokhe lutho. Ukhokha ingxenye yenani eliphelele elivunyelwe ngesimo se- copayment , i- coinsurance , noma i- deductible . Umshwalense wakho wempilo ukhokha yonke imali evunyelwe.
Noma yikuphi okukhokhiswa ngenhla nangaphezulu kwemali evunyelwe akuyona imali evumelekile. Umnikezeli wezempilo ngeke akhokhelwe. Uma i-EOB yakho inekholomu yenani elingavunyelwe, lokhu kusho isaphulelo inkampani yomshuwalense wezempilo oxoxisana nomhlinzeki wakho.
Inani elivunyelwe Ukunakekelwa Kwangaphandle KwamaNethiwekhi
Uma usebenzisa umhlinzeki wangaphandle, inkokhelo evumelekile yinani lakho inkampani yomshuwalense wezempilo inqume ukuthi imali ejwayelekile, eyokwezifiso neyengqondo yale nsizakalo. Umhlinzeki ongaphandle kwe-inthanethi angakwazi ukukhokhela noma yiliphi inani alikhethayo. Uhlelo lwakho lwezempilo alukho inkontileka nomhlinzeki wangaphandle, ngakho-ke akukho saphulelo esivumelwaneni.
Ngakanani uhlelo lwakho lwezempilo oluzokhokhwa luzosekelwe esilinganisweni esivunyelwe, hhayi ngemali ekhokhisiwe.
Ngomhlinzeki wangaphandle , umshwalense wakho uzobala imali yakho yokubambisana ngokusekelwe emalini evumelekile, hhayi inani elikhokhisiwe. Uzokhokha noma yiliphi ikhophi, u-coinsurance, noma i-out-of-network efanelekile; umshwalense wakho wezempilo uzokhokha lonke inani elivunyelwe.
Indlela umhlinzeki ongaphandle kwe-inthanethi ophatha ngayo ingxenye yesikweletu esiphezulu nangaphezulu kwezinga elivunyelwe lingashintsha. Kwezinye izimo, ikakhulukazi uma uxoxisana kusengaphambili, umhlinzeki uzoyeka lesi sikali esiphezulu. Kwezinye izimo, umhlinzeki uzokukhokhela umahluko phakathi kwenani elivunyelwe kanye namacala okuqala. Lokhu kubizwa ngokuthi ukukhokhiswa kwe-balance futhi kungakubiza kakhulu.
Kungani izinkampani zomshuwalense wezempilo zinikezela imali evumelekile yokunakekelwa kwe-out-of-network? Kuyindlela yokunciphisa ingozi yabo yezezimali. Njengoba izinhlelo zezempilo azikwazi ukulawula izindleko ze-in-net izindleko ngezaphulelo zangaphambi kokuxoxisana, kufanele zilawule ngokunikeza umkhawulo ongaphezulu kumthethosivivinywa.
Ake sithi uhlelo lwakho lwezempilo ludinga ukuthi ukhokhe imali engu-50% yokunakekelwa kokunakekelwa kwe-out-of-network. Ngaphandle kwenkontileka ngaphambi kokuxoxisana, umhlinzeki ongaphandle kwe-inthanethi angakhokhisa u-$ 100,000 ukuze ahambele ihhovisi elilula.
Uma uhlelo lwakho lwezempilo lungazange lunikeze imali evumelekile, bekuyobophezela ukukhokha u-$ 50,000 ukuvakashelwa kwehhovisi okungase kuvame ukubiza amaRandi 250. Uhlelo lwakho lwezempilo luzivikela kulokhu ngokunikeza imali evumelekile kumasevisi angaphandle kwenethiwekhi.
Ngeshwa, ekuzivikeleni ekukhokhweni okungenangqondo, ishintsha umthwalo wokubhekana nalezi zinkokhelo ezingenangqondo kuwe. Lokhu kuyinkinga ehlukile yokuthola ukunakekelwa kwe-out-of-network futhi yisona isizathu okufanele ngaso sonke isikhathi uxoxisane namacala okunakekelwa kwangaphandle kwenethiwekhi kusengaphambili.