Ukukhokhisa ukulinganisa kungakumangaza ngezikweletu zezokwelapha ezingamakhulu, izinkulungwane, noma ngisho nezinkulungwane zamadola ngaphezulu kunalindelekile.
Uma udokotela noma isibhedlela sakho silindele ukuthi ukhokhe ibhalansi esele kumthethosivivinywa ngemuva kokuthi ukhokhe imali yakho yokubambisana , imali yokukhokhela imali , noma ikhodi yomshuwalense futhi inkampani yakho yomshuwalense ikhokhwe lokho okuphoqelekile ukukhokha, bese ukhokhiswa ibhalansi.
Ngezinye izikhathi ukukhokhiswa kwebhalansi kusemthethweni, futhi ngezinye izikhathi kungemthetho. Indlela oyisingatha ngayo iyoxhomekeka ukuthi noma ngabe ibhajethi yemali yezomthetho noma cha.
Uma Ukulinganisela Kugcwaliswa Ngomthetho
Ungakhokhi ingxenye ebhalansi-ikhokhelwe ye-bill yezokwelapha uma ubhalansi-ukhokhelwe ngokungemthetho. Kwezinye izimo, ukukhokhwa kwemali okungekho emthethweni kunesibindi, ngisho nezobugebengu, izijeziso. Unezinketho eziningana zokuthi ungaphendula kanjani uma usola ukuthi ubhalansi ukhokhiswa ngokungemthetho:
- Khuluma nomhlinzeki wezempilo bese uxoxa ngesimo. Ngalendlela, ngokuyisisekelo unikezela umhlinzeki wakho inzuzo yokungabaza, esondela enkingeni njengokungathi iphutha lokukhokha elilula. Chaza ukuthi kungani uzizwa ukukhokhiswa kwe-balance kungavunyelwe kulokhu, bese ubuza umhlinzeki ukuthi alungise iphutha lokukhokha.
- Uma ingxoxo yakho nomhlinzeki ingalungisi inkinga, khala kumkampani yakho yomshuwalense, Medicare, noma Medicaid, noma yikuphi okunikeza ukufaka kwakho. Tshela inkampani yomshuwalense ukuthi ubhalansi-ikhokhiswa, futhi ucele ukuthi ungenele egameni lakho. Uma une-Medicare noma i-Medicaid, xhumana ne-Centre for Medicare neMedicaid Services.
- Ngaphezu kwalokho, ungase ukhononde egunyeni elilawulayo lomhlinzeki wezempilo. Endabeni yodokotela, kungenzeka ukuthi iBhodi Lezokwelapha Likahulumeni. Thola ulwazi loxhumana nabo eBhodini ngalinye lomuthi lapha. Thola ulwazi olugunyaziwe lokulawula izibhedlela zikahulumeni ezivela ku-Empowered Patient Coalition. Uma unomuzwa wokuthi awuphathwe kahle yi-insurer yakho yezempilo, khala kuMnyango Womshuwalense Wombuso wakho.
Uma Uyazi Ngaphambi Kokuthi Uzothola Ukulinganisela Ngokomthetho
Okokuqala, zama ukuvimbela ibhalansi yokukhokha ngokuhlala ku-inethiwekhi futhi uqinisekise ukuthi inkampani yakho yomshuwalense ihlanganisa izinsizakalo ozitholayo. Uma une-ray-ray, i-MRIs, i-CT scan, noma i-PET, uqinisekise ukuthi indawo yokubona izithombe kanye ne-radiologist oyofunda ukuskena kwakho inethiwekhi. Uma uhlela ukuhlinzwa, buza ukuthi ngabe ama-anesthesiologists angaphakathi-inethiwekhi.
Uma wazi kusengaphambili ukuthi uzobe usebenzisa umhlinzeki ongaphandle kwe-inthanethi noma umhlinzeki ongawamukeli isabelo seMedare, unezinketho ezithile. Noma kunjalo, akekho kubo okulula futhi konke kudinga ukuxoxisana.
Cela ukulinganiswa kwezinkokhelo zomhlinzeki. Okulandelayo, cela umshwalense wakho ukuthi bacabangani ukukhokha okunengqondo nokujwayelekile kwesevisi. Ukuthola impendulo kulokhu kungase kube nzima, kodwa kube nokuphikelela.
Uma unesilinganiso sokuthi umhlinzeki wakho uzokhokhisa nokuthi yini inkampani yakho yomshuwalense ezoyikhokha, uzokwazi ukuthi yizinombolo ezikude kangakanani nokuthi iyiphi ingozi yakho yezezimali. Ngolwazi, unganciphisa igebe. Kunezindlela ezimbili kuphela zokwenza lokhu: thola umhlinzeki wakho ukuthi akhokhe kancane noma uthole umshwalense wakho akhokhe ngaphezulu.
Buza umhlinzeki uma ezokwamukela ukuthi inkampani yakho yomshuwalense isilinganiselwe futhi isiko njengokwakhokhelwa ngokugcwele.
Uma kunjalo, thola isivumelwano ngokubhala, kufaka nesigatshana esingekho-ibhalansi-lokukhokha.
Uma umhlinzeki wakho engasamukeli isilinganiso esilinganiselwe nesokwezifiso njengokukhokha ngokugcwele, qala ukusebenza ku-insurer yakho. Buza umshwalense wakho ukwandisa inani ababiza ngokuthi lifanele futhi lisiko kulesi simo. Khombisa impikiswano ekholisayo ngokukhomba ukuthi kungani icala lakho liyinkimbinkimbi, kunzima, noma isikhathi esiningi ukuphatha ukwedlula ukwelashwa okujwayelekile ukuthi izinkokhelo zomshuwalense zikhokhwa ngendlela efanele futhi engokwezifiso.
Enye indlela ukubuza umshwalense wakho ukuxoxisana ne- single-case yesivumelwano nomhlinzeki wakho ongaphandle kwenethiwekhi yale nsizakalo ethile.
Ngezinye izikhathi bangavumelana nesikhangiso se-single-case yenani lakho umshwalense ngokuvamile ukhokhela abahlinzeki bayo-inethiwekhi. Ngezinye izikhathi bayavuma esivumelwaneni se-single-case ngesilinganiso sokunciphisa udokotela wakho owamukelayo kusukela ezinkampanini zomshuwalense asevele ese-inethiwekhi. Noma, ngezinye izikhathi bangavumelana ngenkontileka ye-single-case yephesenti yamacala ekhokhwayo omhlinzeki. Kungakhathaliseki isivumelwano, qinisekisa ukuthi kuhlanganisa isigatshana esingekho-ibhalansi-lokukhokha.
Uma zonke lezi zinketho zihluleka, ungacela umshwalense wakho ukumboza lokhu ukunakekelwa okungaphandle kwenethiwekhi usebenzisa isilinganiso sakho senkokhelo ye-in-network. Nakuba lokhu kungavimbele ukukhokhiswa kwemali, okungenani umshwalense wakho uzokhokha iphesenti ephakeme yesikweletu ngoba ukuqinisekiswa kwakho kokunakekelwa kwenethiwekhi kuncane kunokunakekela ukunakekelwa kwe-inthanethi.
Uma uphishekela le nketho, yiba nengxabano ekholisayo yokuthi kungani umshuwalense kufanele aphathe lokhu njengenethiwekhi. Isibonelo, azikho izinhlinzeko ezihlinzekwayo zendawo ngaphakathi kwenethiwekhi ezitholakale kwinqubo yakho yokuhlinza ethile, noma izinga lokucindezeleka lalabo abahlinzayo abahlinzekwa inethiwekhi liphakeme kakhulu kunelabo ohlinzayo osebenza ngaphandle.
Uma Ungayitholi Inkinga Kuze Kube Ngemuva kokuthi Uthole Ukunakekelwa
Ukuxoxisana ngemuva kweqiniso lapho uthola isimali sokukhokhela ibhalansi yomthetho kunzima kakhulu, kodwa usenayo izinketho.
Ungakwazi ukuxoxisana ne-balance balance-billed portion nomhlinzeki wakho. Khumbula, umhlinzeki wakho ufuna ukukhokhelwa futhi angathanda ukuthola imali yakhe ngokushesha futhi ngaphandle kokukhokha ingxenye yayo ejensi lokuqoqa. Lokhu kusho ukuthi umhlinzeki angase avume ukunciphisa inani eliphelele elikhokhisiwe kwisilinganiso sesaphulelo asithola ezinkampanini zomshuwalense aku-inethiwekhi, uma uvuma ukukhokha isabelo sakho ngokushesha. Noma, umhlinzeki wakho angase amukele ingxenye yebhalansi esele njengenkokhelo ngokugcwele uma uvuma ukukhokha ngokushesha. Abanye bazokuvumela ukuba usethe uhlelo lokukhokha.
Ungakwazi ukuxoxisana nomshuwalense wakho. Uma ngabe umshwalense wakho usevele ukhokhele izinga lokuphuma ngaphandle kwenethiwekhi ekukhokhweni okunengqondo nangokwezifiso, uzoba nobunzima bokufaka isikhalazo esisemthethweni kusukela umshuwalense engakwenqabeli isimangalo sakho . Ikhokhelwe isimangalo sakho, kodwa ngezinga elingaphandle kwenethiwekhi. Kunalokho, cela ukubukwa kabusha. Ufuna inkampani yakho yomshuwalense ukuba iphinde isicabange ngesinqumo sokumboza lokhu njengokunakekelwa kwe-in-out-yenethiwekhi , futhi esikhundleni salokhu uyimboze njengonakekelo lwe-in-network. Uzothola inhlanhla ngale ndlela uma unesizathu esibalulekile sokudokotela noma isizathu sokukhetha umhlinzeki wangaphandle.
Uma uzizwa sengathi uphathwa ngendlela engalungile yinkampani yakho yomshuwalense, landela inqubo yakho yokuxazulula isikhalazo sezempilo. Ungathola ulwazi mayelana nenqubo yokuxazulula isikhalazo sakho somshuwalense ezincwadini zakho zenzuzo noma kumnyango wakho wemithombo yabantu. Uma lokhu kungakulungisi inkinga, ungakhononda kuMnyango Womshuwalense Wombuso wakho. Thola ulwazi loxhumana naye loMnyango Womshuwalense ngokuchofoza isimo sakho kule mephu.
Uma uhlelo lwakho lwezempilo luzimele ngokwezimali, okusho ukuthi umqashi wakho uyinhlangano ekhokha ngempela izikweletu zezokwelapha ngisho noma inkampani yomshuwalense ingase iqondise lolu hlelo, khona-ke uhlelo lwakho lwezempilo lungase lungabi ngaphansi kolawulo lomnyango womshuwalense wombuso wakho. Izinhlelo zokuzikhokhela zivame ukuwela ngaphansi koMnyango WezokuSebenza Abasebenzi beMisebenzi Yabasebenzi. Thola ulwazi oluthe xaxa kusuka kukhasi lewebhu le-EBSA lokusiza abathengi noma ngokubiza umeluleki wezinzuzo ze-EBSA ngo-1-866-444-3272.