Ngenxa yokuthi umhlinzeki uthatha umshuwalense wakho wezempilo akusho ukuthi ku-inethiwekhi
Uma unayo uhlelo lwezempilo lwe-HMO, PPO, EPO, noma i-POS, ukunakekelwa ngaphandle kwenethiwekhi yomnikezeli wakho wezinhlelo kungakubiza imali eningi kunokuhlala ku-inethiwekhi. Kodwa, akulula ngaso sonke isikhathi ukuthola ukuthi umhlinzeki obonayo useku-inethiwekhi noma ngaphandle kwenethiwekhi nomshuwalense wakho wezempilo, ikakhulu uma ungakwazi ukuhlala phansi kukhompyutha yakho bese uvakashela iwebhusayithi yakho yezempilo .
Uma wenza i-aphoyintimenti nomhlinzeki omusha, ungahlala uhlola isimo senethiwekhi ngaphambi kokuqokwa kwakho futhi ukhansele ukuqokwa uma uthola ukuthi kungaphandle kwenethiwekhi. Kodwa-ke, uma uthola ukunakekelwa kwezempilo okungahleliwe, kungenzeka ukuthi ungathandeki ukuthatha isikhathi ukuhlola ukuthi ngabe umnikezeli ozoyisebenzisa yini noma cha. Lesi simo singavela uma uthola ukunakekelwa esikhungweni sokunakekelwa okuphuthumayo, emtholampilo yokuhamba, emtholampilo wokudayisa, noma ngabe uthola umsebenzi we-ray noma i-lab owenziwe ekhaya lapho usuka ehhovisi likadokotela.
Kulezi zimo, ungase ulingeke ukubuza umhlinzeki, "Ingabe uthatha umshuwalense wezempilo we-XYZ?" Uma umamukeleli ephendula, "Yebo," ungathanda ukucabanga ukuthi usebenzisa umhlinzeki we-in-network. Kodwa, ungase uphutha futhi iphutha lingakudla isikhathi esikhulu. Ngenxa yokuthi umhlinzeki owamukela umshuwalense wakho wezempilo akusho ukuthi ku-inethiwekhi ngecebo lakho lempilo.
Yini Engamukela Umshwalense Wezempilo Yakho Ngempela Kusho
Kumhlinzeki wezempilo, ukwamukela umshuwalense wakho wezempilo kusho
- Izobe ifake isimangalo ngecebo lakho lempilo.
- Izokwamukela noma yimaphi imali yakho uhlelo lwezempilo olukhokhela.
- Kuzokhokhela izinkokhelo zemali kusuka ohlelweni lwakho lwezempilo olubhekene ne-bill yakho.
Akusho ukuthi ungumhlinzeki we-in-network necebo lakho lempilo.
Eqinisweni, umhlinzeki akudingeki abe in-inethiwekhi nanoma yiluphi uhlobo lwezempilo, kodwa namanje angasamukela zonke izinhlobo zemishwalense yempilo.
Okushiwo Ngempela -Inethiwekhi Kusho Ngempela
Lapho umhlinzeki wezempilo e-inethiwekhi, kusho okuningi kunalokho ukuthi uzokwamukela umshuwalense wakho wezempilo. Kusho ukuthi
- Kuzohlonipha amazinga ahlaziyekile uhlelo lwakho lwezempilo oluxoxisane nayo.
- Izokwamukela inkokhelo yakho yokuhlelwa kwempilo kuhlanganiswe nekhophi yakho, ukukhokhelwa kwezimali , noma ukukhishwa njengokukhokhelwa ngokugcwele .
- Ngeke ukulinganisela-ukukhokhisa ukuthi u-in-network, uhlelo lwezempilo luhlanganiswe nezinsizakalo.
- Uma inenkinga ngemali evunyelwe ekhethwe uhlelo lwakho lwezempilo ngenkonzo eyinikezile, kuzothatha lokho kuphakanyiswe ngecebo lempilo kunokuba nawe.
- Kuye kwadlula inqubo yakho yezempilo yokuqinisekisa ukuthi ngokuvamile kuhlanganisa izinto ezifana nokuqinisekiswa kwezemfundo nokulayisensi kanye nokuhlolwa kwekhwalithi.
- Izobe ifake isimangalo ngecebo lakho lempilo.
- Izokwamukela noma yimaphi imali yakho uhlelo lwezempilo olukhokhela.
- Kuzokhokhela izinkokhelo zemali kusuka ohlelweni lwakho lwezempilo olubhekene ne-bill yakho.
Kungani Umnikezeli Ongaphakathi Kwangcono Kunomhlinzeki Owamukela Umshuwalense Wakho Ngempela
Manje ukuthi uyaqonda ukuthi ukuba in-inethiwekhi nokwamukela uhlelo lwakho lwezempilo akuyona into efanayo, udinga ukuqonda ukuthi kungani uku-inethiwekhi kungcono kunokwamukela umshuwalense wakho wezempilo.
Uma usebenzisa umhlinzeki we-in-network, unezivikelo eziningana ongenazo uma usebenzisa umhlinzeki wangaphandle ongamukela umshwalense wakho wezempilo.
Umhlinzeki ongaphandle kwe-inthanethi angakwazi ukukhokhela noma yini efunayo ngezinsizakalo zayo. Uma udokotela ongaphandle kwe-inthanethi efuna ukukukhokhela u-$ 5,000 we-office elula, kuyisenzo sakhe; angakwenza lokho ngisho noma kubonakala kungenangqondo. Noma kunjalo, umnikezeli we-in-network unenkontileka necebo lakho lempilo elichaza kahle ukuthi lingakhokhisa kangakanani izinsizakalo zalo. Umhlinzeki we-in-network akavunyelwe ukukukhokhisa ngaphezu kwesilinganiso esinqunyelwe uhlelo lwakho lwezempilo luxoxisane nalawo masevisi.
Uhlelo lwakho lwezempilo luzokhokhela ingxenye encane yomthethosivivinywa kumhlinzeki wenethiwekhi ngaphandle kokuthi uzokhokha insizakalo efanayo enikezwe inethiwekhi. Eqinisweni, ezinye izinhlelo zezempilo ngeke zikhokhe i-dime yokunakekelwa kwe-out-of-network.
Uma uhlelo lwakho lwezempilo lukhokhela ukunakekelwa kwe-out-of-network, ungase ube no-20% wezinkokhelo zezinsizakalo zangaphakathi-inethiwekhi kodwa u-50% wezinkokhelo zezinsizakalo zangaphandle. Ngisho ne-50% ye-coinsurance, lokhu akusho ukuthi uhlelo lwakho lwezempilo luzokhokha imali engu-50% ye-bill ngaphandle kwe-inthanethi. Izokhokha kuphela 50% yemali evunyelwe. Ukhokhise ukukhokha enye imali engu-50% yemali evunyelwe kanye nesabelo sonke somthethosivivinywa ngokweqile inani elivunyelwe. Funda kabanzi mayelana nalokhu ku- " Indlela Yokubala Izindleko Zakho Zokunakekela Ngaphandle Kwenethiwekhi-Ukwenza Izibalo ."
Okubi nakakhulu, i-out-of-network deductible ngokuvamile inkulu kunaleyo yokudonswa kwe-in-network. Amanani okhokhela ukunakekelwa kwe-out-of-network akuvamile ukubala ekubhekaneni ne-in-network deductible. Amanani oyikhokhela ukunakekelwa kwe-out-of-network ngokuvamile awabheki ekuphumeni kwakho kwepokhethi , noma. Funda kabanzi mayelana nalezi zinkinga ku-" Okudingeka Uzazi Ngaphambi Kokunakekelwa Kokuxhumana Kwangaphandle " nethi " Yini Engayifinyeleli Kokulinganiselwa Kwakho Kokuphuma Kwamapokhethi? "
Indlela Yokuqinisekisa Ukuthi Usebenzisa Umhlinzeki Ongaphakathi Nenethiwekhi
Kunezindlela ezintathu zokuqinisekisa ukuthi usebenzisa umhlinzeki we-in-network. Ngezinye izikhathi kufanele usebenzise okungaphezu kweyodwa. Ngezinye izikhathi nje eyodwa kuphela izothola.
- Hlola iwebhusayithi yakho yezinhlelo zezempilo.
- Shayela uhlelo lwakho lwezempilo bese ucela. Inombolo mhlawumbe ingemuva kwekhadi lakho leshuwalense lempilo.
- Buza umhlinzeki wakho uma ku-inethiwekhi ngecebo lakho lempilo.
Ngesikhathi ukuhlola iwebhusayithi yakho yezinhlelo zezempilo ngokuvamile kuyindlela elula futhi esheshayo yokuthola ukuthi yiziphi abahlinzeki abakwe-inethiwekhi futhi ezingekho, iwebhusayithi yami yezokwelapha ineqephu elihlelekile lokuphrinta okuhle ngaphansi kohlu lwabahlinzeki be-in-network . Ithi into ethize, "Nakuba silwela ukugcina lolu hlu lube olunembile ngangokunokwenzeka, lungase lungabonakali izibuyekezo zakamuva kunethiwekhi yethu yomhlinzeki. Hlola njalo nomhlinzeki wakho ukuqinisekisa ukuthi kusekhona inethiwekhi. "Ngenxa yalesi sizathu, kuwukuhlakanipha ukubuza umhlinzeki ngaphambi kokuba uthole isevisi, noma ngabe usuvele uhlole isimo somhlinzeki ngewebhusayithi yakho yezinhlelo.
Funda kabanzi
Kukhona ezinye izimo lapho uhlelo lwakho lwezempilo lungase luzimisele ukukhokha imali yokukhokhela ukunakekelwa kwezempilo ngaphandle kwe-network njengokungathi ususebenzise umhlinzeki we-in-network.