Ehhovisi lezokwelapha, ukuqoqwa okuphezulu kokukhokhela okuyingxenye ebalulekile yomjikelezo wemali. Amaqoqo aphezulu anganciphisa inani lama-akhawunti aneziguli eziphelelwa yisikweletu esibi noma isimo seqoqo. Kulula ukuqoqa kusuka ezigungwini ngaphambi kwezinsizakalo ezinikeziwe ezinsukwini ezingu-60 kamuva emva kokuba umshuwalense ekugcineni akhokhe.
Thuthukisa uhlelo
Ihhovisi lakho lezokwelapha noma umkhuba udinga isistimu yeqoqo eliphambili elinembile nelingaguquguquki. Inqubomgomo yakho kumele ihambe ngaphezu nje kokuqinisekisa ukuthi iziguli zicelwa i-copay noma imali uma zifika ukuze ziqashwe noma inqubo yazo.
Isistimu yakho izoqala ngokushesha uma kuqokwa ukuqokwa ukuze wazi ukuthi umthwalo wesiguli uzoba yini. Emva kokunquma lokhu, udinga ukuqinisekisa ukuthi isiguli siyazi ukuthi yini okufanele silindele ngomthwalo wabo wemali ngaphambi kokuqokwa. Uma befika enkonzweni, uzophinde uphinde wenze izinqubo endaweni ukuze ucele njalo ukukhokha futhi unikeze izinketho.
Ukunemba nokungaguquguquki, kanye nesistimu yokunquma nokuqoqa umthwalo wesiguli, yizihluthulelo zenqubomgomo yakho yokuqoqa ngaphambili. Uma uthuthukisa inqubomgomo yamaqoqo angaphambili ehhovisi lakho, qiniseka ukuthi ufake izinyathelo ezilandelayo.
Isinyathelo 1: Xhumana Nenkampani Yomshuwalense We-Patient Ngaphambi Kokuvakashelwa
Ngokushesha ngemuva kokuqokwa kwe-aphoyintimenti, xhumana nenkampani yomshuwalense wegciwane ukuqinisekisa ukuthi isiguli sisaphila futhi wenze isheke kwanoma yimiphi imihlahlandlela yokuqinisekisa ngaphambili. Thola i- copay yesiguli , i-deductible, kanye ne-coinsurance ulwazi.
Isinyathelo sesi-2: Hlola isivumelwano sakho sokunakekela esiphethwe
Hlola inkontileka yakho yokunakekelwa ephethwe ukuze unqume ukuthi ukubuyisela kwakho ukuvakasha, ukuhlolwa, noma inqubo. Uzodinga lesi sibalo ukubala i-copay.
Isinyathelo sesi-3: Bala i-Co-Pay
Bala umthwalo olinganisiwe wesiguli. Bheka isibonelo ngezansi.
I-100 100.00 Izindleko zeNqubo
x 80% Isilinganiso semvumelwano
= 80.00 Inani elivunyelwe
- 50.00 Isiguli esineDeductible
- 10.00 I-Patient Copay
= 20.00
x 20% Amaphesenti okuQinisekisa koMguli
= 4.00 Inani lokuQinisekisa koMguli
+ 50.00 Isiguli esineDeductible
+ 10.00 Isiguli seCopay
= 64.00 Isibopho Esilinganisiwe Sokubekezela (iCopay)
Isinyathelo sesi-4: Isikhumbuzo Isibizo KuMguli Ohlanganisa I-Co-Pay Elindelekile
Faka umthwalo wemfanelo wesiguli endaweni yokuqokwa kwesikhumbuzi, i-imeyili, kanye nencwadi. Uma uxhumane nesiguli ukuqinisekisa isiqunto sabo esizayo, qiniseka ukuthi uyabakhumbuza ukuba balethe ilayisensi yokushayela noma enye ifomu ye-ID kanye nekhadi lakho lesikhwama somshwalense. Batshele ukuthi bazokulindela ukukhokha umthwalo wabo olinganisiwe ngaphambi kokuba benze inqubo yabo futhi babhale izindlela zokukhokha ezamukelekayo.
Isinyathelo sesi-5: Ukukhokha Isicelo ekufikeni kwe-Appontment
Abasebenzi bedesksi ngaphambili kufanele bacele ukukhokha lapho isiguli sifika ngenkonzo ngaphambi kokuba sibonwe ngumhlinzeki. Khumbuza isiguli ukuthi inani abakhokhayo lisekelwe kuphela ekulinganiseni. Ungalokothi ubhale ukhokhelwe ngokugcwele emarejisini kuze kube yilapho usuzuzile ukukhokha kwenkampani yomshuwalense futhi umthwalo wesiguli uboniswa ekuchazeni izinzuzo (EOB).
Isinyathelo 6: Izinketho zokukhokha zokunikezwa
Izinketho zokuhlelwa kwezinhlelo zokukhokha zokuhlolwa okuphezulu okuthengwa ngentengo nezinqubo zokuhlinza.
Isinyathelo 8: Thumela isibonakaliso
Qinisekisa ukuthi izimpawu zithunyelwe ezindaweni ezilinde iziguli ngokucacile:
"Inkokhelo ibalulekile ngaphambi kwemisebenzi ehlinzekwa"
Qaphela: Ungaceli Inkokhelo Ezigulini Eziphuthumayo Zamakamelo
Ungalokothi uzame ukuqoqa ukukhokha kusuka ezigulini ze-Emergency Room kuze kube yilapho sezibonwe udokotela ngenxa yemithetho ye-EMTALA.