Kukhona Kungenzeka Kwangathi I-Times Lapho Umhlinzeki Ongaphandle Kwenethiwekhi Kunesidingo
Umnikezeli ongaphandle kwe-inthanethi ongowodwa ongahambisani nenkampanhla yakho yomshuwalense ngokubuyisela ngenani elivunyelwene ngalo. Ezinye izinhlelo zezempilo, njenge- HMOs , azibuyiseli abahlinzeki bangaphandle, okusho ukuthi njengesiguli, uzobe unesibopho semali ephelele ekhokhwa udokotela wakho. Ezinye izinhlelo zezempilo zinikeza ukuhlinzekwa kwabahlinzeki be-out-of-network, kodwa umthwalo wakho wesineke uzoba ngaphezulu kunokuba ngabe ubona umhlinzeki we-in-network.
Izizathu Zokukhetha Ukunakekelwa Kwezempilo Kwe-Out-of-Network
Nakuba ekuqaleni kungabiza imali eyengeziwe, kungase kube nezikhathi lapho ungase uthole kuyadingeka, noma kuphakanyiswe, ukusebenzisa umhlinzeki wangaphandle.
Ngezinye izikhathi awunayo ikhetho, noma kunengqondo ukukhetha umhlinzeki wezempilo ongewona wenethiwekhi. Ngezansi uhlu lwezimo ongakwazi ukukhalaza ngazo ekuthungeni kwenethiwekhi, noma kungenziwa ngokuzenzakalelayo:
Izimo eziphuthumayo: esimweni esiphuthumayo, kumele ufune usizo olutholakala kakhulu. I-Care Affordable Act idinga inshuwalense ukuba ihlanganise ukunakekelwa okuphuthumayo njengokungathi kuseku-inethiwekhi, kungakhathaliseki ukuthi ukunakekelwa okuphuthumayo kuyatholakala kwi-in-network noma ngaphandle kwenethiwekhi. Kodwa-ke, igumbi eliphuthumayo le-out-of-network kanye nodokotela bangakuthumela ibhalansi yesabelomali , futhi ukukhokhiswa kwe-balance akukhawulelwe yi-ACA (nakuba ezinye izifunda zivimbele ). Uma kungesiyiphuthumayo ngempela, ukuhambela kwakho ngeke kusetshenzwe njengokwelashwa kwenethiwekhi; kufanele uhambe kumhlinzeki ohlanganisiwe.
Ukunakekelwa okukhethekile: Uma unesifo esingavamile lapho kungekho ochwepheshe efakiwe kuhlelo lwakho, ukunakekelwa okungaphandle kwe-inthanethi kungabalulekile.
Abahlinzeki abaguqukayo bangaphazamisa impilo yakho: Uma uphakathi kokwelapha izinto ezibucayi noma zokuphela kokuphila, futhi umhlinzeki wakho ushiya inethiwekhi, kungase kube inzuzo yakho ukuqhubeka nokunakekelwa ngokuphuma kwinethiwekhi.
Ungafaka isikhalazo sokuqhubeka kokuthengwa kwenethiwekhi, uma nje isikhathi esithile noma inombolo ehleliwe yokuvakashelwa.
Ukunakekela ngaphandle kwedolobha: Uma udinga ukunakekelwa kwezokwelapha ngenkathi usuka ekhaya, kungase kudingeke uphume kwinethiwekhi, kodwa abanye abatshuwalense bazosingatha ukuvakashelwa kwakho kumhlinzeki ongabambi iqhaza njengokungathi kunethiwekhi. Noma kunjalo, abahlinzeki ngo-inthanethi bangatholakala. Uma kungesiyiphuthumayo, kungcono ukuxhumana nomqashi wakho kuqala ukuthola.
Izinkinga eziseduze: I-ACA idinga inshuwalense ukugcina amanethiwekhi omhlinzeki akwanele ngokusekelwe ebangeni nesikhathi amalungu okumele ahambe ukuze afinyelele umhlinzeki wezokwelapha, kodwa imihlahlandlela ngokwanele iyashintsha kusuka kwesinye isimo kuya kwesinye. Uma uhlala endaweni yasemaphandleni futhi akukho ukufinyelela okungokoqobo kumhlinzeki we-in-in endaweni yakho, impilo yakho eqhubekayo ingathembela ekusebenziseni udokotela ongabambe iqhaza. Kulezi zimo, ungakwazi ukukhalaza ukuze uthole ukuhlinzeka ngomhlinzeki wangaphandle wenethiwekhi endaweni yakho.
Izinhlekelele zemvelo: Izikhukhula, imililo evamile, iziphepho, nezinkanyamba zingabhubhisa izikhungo zezokwelapha futhi ziphoqele abantu ukuba bahambe kwezinye izindawo okufanele bafune ukunakekelwa kwezempilo. Ngesinye isikhathi, lezi ziguli zingase zifanelekele ama-in-rates amanani njengengxenye yesimemezelo esiphuthumayo nguhulumeni noma uhulumeni wesifundazwe.
Umhlinzeki wangaphandle we-network angakuthumela imali yakho
Kubalulekile ukuqaphela ukuthi ngisho noma inkampani yakho yomshuwalense ithatha ukunakekelwa kwakho ngaphandle kwenethiwekhi njengokungathi in-inethiwekhi, umthetho wesifundazwe awudingi umhlinzeki wangaphandle wenethiwekhi ukwamukela inkokhelo yakho yenkampani yomshuwalense njengenkokhelo ngokugcwele.
Isibonelo, ake sithi inkampani yakho yomshuwalense inezinga "elilinganayo nelisiko " lika-$ 500 ngenqubo ethile, futhi usuvele uhlangabezane ne-in-network deductible yakho. Khona-ke ugcina esimweni lapho umhlinzeki ongaphandle kwe-inthanethi enza inqubo, kodwa kungenye yezimo ezichazwe ngenhla futhi umshwalense wakho uyavuma ukukhokha u-$ 500.
Kodwa uma umhlinzeki wangaphandle wenkokhelo ebiza imali engu- $ 800, angakuthumela ibhilikhithi enye enye engu-300.
Lokhu kubizwa ngokuthi ukukhokhiswa kwe-balance , futhi ngokuvamile kusemthethweni uma umhlinzeki engekho kwinethiwekhi yakho yezinhlelo zezempilo.
Ezinye izifundazwe ziye zabhekana nale nkinga ngezimo ezithile, kufaka phakathi iFlorida (abahlinzeki abangaphandle kwe-network abasebenza ezibhedlela ezisenkundleni) naseNew York (izimo eziphuthumayo). Kodwa ngokubanzi, ukukhokhiswa kwe-balance kubalulekile uma iziguli zithola ukunakekelwa ngaphandle kwenethiwekhi yabo yomshuwalense.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services, Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshwalense. Imibuzo Yokwenziwa Kwemisebenzi Yokunakekelwa Engenakusiza, Setha 1. Izinsizakusebenza Eziphuthumayo Zenethiwekhi.
> Isikhwama se-Commonwealth. Ukulinganisa Ukulinganisa Ngabanikezeli: Ukuhlola Ukuvikelwa Kwabathengi Kuzo Zonke Izindawo . 2017.
> Urban Institute. Robert Wood Johnson Foundation. Ukuqinisekisa Ukuhambisana Namazinga Wokulinganiswa Kwenethiwekhi: Izifundo Ezivela Ezizweni Ezine . NgoMashi 2017.