Izinyathelo Zokuthatha Uma Umshuwalense Wakho Ulahlekelwa Ukuvota
Ngokuphindaphindiwe , abakhokhisi bezempilo bayagcizelela ukuthi iziguli zithola imvume ngaphambi kokuba zithole ukuhlolwa kwezokwelapha noma ukwelashwa. Futhi, ngemuva kokubuyekezwa, bangase banqume ukuthi bangalokothi bagubhe leso sonyango nhlobo. Ngama-premium aphakeme abantu abaningi bakhokhela, lokhu kungabangela ukuphazamiseka okukhulu. Kungani abakhokha ngezinye izikhathi bephika ukuhanjiswa udokotela okwenzelwe ukwelashwa, futhi yini ongayenza uma lokhu kwenzeka?
Yiziphi ezinye izindlela?
Imiphakathi Yomshuwalense Ukungafuni Ukunakekelwa
Kukhona ukuphazamiseka okuncane okuphikisanayo okuphikisana ukuze kutholakale ukutholakala ngemuva kokuba udokotela enze iseluleko esithize sokwelashwa ukuze uthuthukise isimo sakho sezokwelapha. Lokhu akukona ukukhathazeka okuhlukile futhi kungenzeka uma unomshuwalense wangasese noma uhlanganiswa ngaphansi kohlelo lukahulumeni olufana ne-Medicare noma i-Medicaid. Uma usuzwa sengathi unempendulo kanye / noma isisombululo senkinga, lezi zinguquko zingazizwa ziphazamisekile.
Kungani lokhu kwenzeka?
Njengamanye eminye imfihlakalo yokunakekelwa kwezokwelapha ezihlobene nezindleko zokunakekelwa, impendulo eyinhloko yalo mbuzo ithi, " landela imali ."
Ukwehla ukunakekelwa kuyindlela yokuhlelwa kwezempilo . Ungase ucabange ngale ndlela ngale ndlela: Umshwalense noma umkhokheli unethemba lokuthi uzothatha imali engaphezulu kunalokho abakhokhelwayo. Lokho kusho ukuthi isikhathi ngasinye lapho udinga ukuhlolwa noma ukwelashwa, bazokwenza ukuhlola mayelana nokuthi kuyindlela engcono kakhulu yokuthola noma yokuphatha ngempumelelo.
Uma udinga ukwelashwa noma ukuhlolwa, futhi kungabhekwa njengengxenye yezinga lokunakekela inkinga yakho yezokwelapha, khona-ke bangase babe nesizathu sokulondoloza imali yabo ngokuphika lokho kuhlolwa noma ukwelashwa kwakho.
Lokho abakhokhayo abakwaziyo ukuthi phakathi kolonxantathu wokunakekelwa kwempilo (wena, udokotela wakho, nomkhokheli wakho) imigomo yomuntu wonke ihlukile.
Ufuna nje ukuphola. Umshwalense wakho ufuna ukwenza imali. Udokotela wakho ufuna bobabili, nakuba lokho kusho ukuthi kungashintsha ngokuya komkhuba. Abanye odokotela bangase bakhethe ukuhlolwa noma inqubo eyokwandisa imali engenayo, noma kunalokho, ixhomeke ekuhlolweni noma ekwelapheni okungase kuhlawulwe. Ngabakhokhi, ukwenza imali eningi akusho ukuthi ukuphika izivivinyo. Izimo ezingaphathwa ngendlela efanele zingase zithengise kakhulu ngokuhamba kwesikhathi.
Ngenkathi lokhu umahluko phakathi kokugqugquzela kungase kuphazamise iziguli, akusiyo impela uma ezinye izindlela zokwelashwa eziphumelelayo noma izivivinyo zitholakala. Imali encane umkhokha echitha, kancane kancane ekugcineni sikhokhela ama-premium.
Ukwenqaba Uma Kungenayo I-Alternative Test noma Ukwelashwa
Ukulahla kungaba yinkinga enkulu uma kungekho ukwelashwa okunye okuhlanganisiwe. Izibonelo lapho kungase kube khona okunye okufaka khona kufaka phakathi:
- Isifo esingavamile, esidinga isidakamizwa esibizayo, ukuhlinzwa, noma olunye uhlobo lwezokwelapha.
- Indlela entsha yezobuchwepheshe bezempilo.
- Izidakamizwa ezingekho ngemvume (izidakamizwa ezinqunyelwe ukwelashwa ngaphandle kwalokhu ezivunyelwe).
- Imithi yokusebenzisa izidakamizwa ezinesihawu ( izidakamizwa zokuphenya ezingakavunyelwe, kodwa okungaba yiyona ndlela engcono kakhulu).
- Izithako zemithi kanye / noma okunomsoco.
Yini Ongayenza Uma Unqatshelwe Ukunakekelwa Ngomkhokhi?
Uma wenqatshelwe ukukhokhela umkhokhi, ungethuki. Ukuphika akusho ukuthi umkhokheli wakho ngeke akhiphe ukuhlolwa noma inqubo. Kukhona ama-nuances amaningi emithi futhi akukho bantu ababili abafana. Ngezinye izikhathi umkhokheli udinge ukuthi afundiswe ukuthi kungani ukuhlola noma ukuphathwa okuthile kuzomzuzisa kakhulu umuntu othile.
Ngaphambi kokuthatha noma yiziphi izinyathelo ezilandelayo wenze izingcingo ezimbalwa. Akuyona into engavamile ukuhlolwa noma inqubo yokwenqatshwa ngoba nje ayifakiwe kahle . Iningi eliphikayo eliphikayo ludinga kuphela ucingo lokucacisa isimo nesibonakaliso.
Futhi, ngaphambi kokubizela qinisekisa ukuthi ukwelashwa okufisa ukuyihlanganisa akukhiphi ngokucacile kusuka ohlelweni lwakho. Isibonelo, noma ngabe unesibonakaliso esamukelekayo, abahlinzeki bamashuwalense ngeke bakhokhele inambuzane yezokwelapha . Endabeni enjengale, umshuwalense wakho ngeke ukhokhe kungakhathaliseki ukuthi unjani isimo noma izimpawu ozibhekisayo.
Uma unqatshelwe ukunakekelwa ngumkhokhi wakho, kunezinto ezimbalwa ongayenza.
- Ukulwa nokuphika . Ngezinye izikhathi konke okudingekayo ukuxhumana nomsebenzi wamakhasimende wakho wakho. Buza ukuthi kungani wenqatshelwe, futhi yibuphi ubufakazi abazodinga ukuguqula isinqumo. Bese usebenza ngokuzimisela ukushintsha izingqondo zabo.
- Buza udokotela wakho ukuthi yini enye engase ibe khona . Lokhu kufanele kwenziwe ngesikhathi esisodwa njengokulwa nokuphika ngoba kungenzeka ukuthi umshwalense wakho uzokutshela ukuthi kukhona okunye. Ukuba nalolu lwazi kuzokusiza uqhubeke nokulwa kwakho, noma kuzokunika ukuthula kwengqondo okuhlela A akuyona inketho yakho kuphela.
- Khokha imali yesevisi . Kulula ukukhohlwa ukuthi usengaba nokuhlolwa noma inqubo umshwalense wakho ophika uma ukhetha ukukhokha imali. Uma unquma ukuqhubekela phambili ngalolu hlelo, qiniseka ukuthi uxoxisana nemithethini nodokotela wakho. Ngokuvamile odokotela abamukela ukheshi (akunjalo konke) banciphise imali yabo uma bekwazi ukuthi umuntu kumele akhokhe imali.
- Musa ukuphishekela ukuhlolwa noma ukwelashwa . Lolu khetho luyisine elide kakhulu. Lolu khetho luyamukeleka kuphela uma ungakholelwa ngempela ukuthi udinga ukuhlolwa noma ukwelashwa. Uma ngabe ngabe awuyikubuza lo mbuzo!
Amanye amathiphu angasiza le nqubo ahambe ngokushelela afaka:
- Gcina amarekhodi aqaphele . Bhala izinsuku, izikhathi, namagama omuntu okhuluma naye enkampanini yakho yomshuwalense. Cela ukuthi izincomo noma izinguquko ziqinisekiswe ngokubhala, mhlawumbe nge-imeyili ngakho ithwala isitembu isikhathi nesikhathi. Ngamanye amazwi, yakha umzila wephepha.
- Funda ngokusebenzisa uhlelo lwakho lokuhlomula ngokucophelela. Yilungele ukunikeza izizathu ezisekela izidingo zecebo lakho. Mhlawumbe uzokukhathazeka ngokuthi kufanele utshele inkampani yakho yomshuwalense lokho okulotshwe ohlelweni lwabo, kodwa akuyona into engavamile ukwenza kanjalo.
Ngezansi Uma Umshwalense Wakho Wezempilo Uchitha Ukuvota
Ukuphika komshuwalense wezempilo kungabangela ukukhathazeka kakhulu uma unesiguli. Ngaphezu kwalokho uma udokotela wakho ekholelwa ukuthi kufanele ube nokuhlolwa okuthile noma ukwelashwa. Kulula ukuthukuthela futhi ufuna ukumemeza!
Esikhundleni salokho, kungcono kakhulu ukucabanga ngokucophelela ngokusebenzisa izinketho zakho. Njengesinyathelo sokuqala, khuluma nodokotela wakho mayelana nezinye izindlela ezihlanganisiwe. Ukwazi lezi zinto ongakhetha kuzo ungabe usubekezela isimo sakho ngokubhala uhlu lwezinzuzo kanye nezindleko zokwelapha ezihlanganisiwe noma ezingekho. Wonke umuntu uhlukile futhi kungase kube nezibonakaliso ezicacile ukuthi kungani ukwelashwa okulodwa kungcono (noma ngempumelelo noma imiphumela emibi) kunomunye ngokusekelwe esimweni sakho sezokwelapha. Odokotela abaningi "bayokuya" uma ngabe kunjalo.
Uma kubonakala ngokwethembeka ukuthi ukuhlolwa okungenakuhlanganiswa noma ukwelashwa kungaba ngcono kuwe, ungayeki. Ukulwa nokuphika. Njengoba wenza lokhu khumbula ukuthi abatshuwalense babheka izinombolo lapho benza izinqumo, futhi abantu abangekho izibalo. Umshwalense wakho unolwazi olukhawulelwe kuphela uma ebukeza isicelo sakho, futhi ngezinye izikhathi uvele nje udinga "imfundo" encane kwisimo sakho nomlando wakho wezokwelapha ukuze ubone isidingo sokwelashwa okufunayo.
Ngisho noma umshwalense wakho ekugcineni ephika ukwelashwa kwakho (ngemuva kokulwa nokuphika) khumbula ukuthi akuwona amandla okugcina empilweni yakho. Yize kungase kube yindleko enkulu, ukhetho lokuzikhokhela ngokwakho lisekhona. Uma ungenayo imali ku-akhawunti yakho yokuhlola, njengoba abantu abaningi bengaboni, cabanga ngezindlela zokukhokha ukwelashwa njengokuthatha enye imali, ukuboleka kubangani nomndeni, usebenzisa amakhasi e-Go Fund Me ku-Facebook, ube ne-fundraiser futhi okuningi okuningi. Uma uhamba ngale ndlela, khumbula ukuthi izindleko zezokwelapha ozikhokhela ngaphandle kwephaketheni zivame ukukhishwa intela , futhi esimweni esinjengalezi, zivame ukwengeza ukuze unikeze usizo olukhulu.
> Imithombo:
> Gilmore, A. Ukuncintisana Kubaluleka Kwamaphethini Aphakathi Kwamazinga Okuncipha. Ukuphathwa Kwezezimali Kwezempilo . 2016. 70 (4): 80-5.
> Healthcare.gov. Indlela Yokudlulisa Isikhalo Nenkampani Yomshwalense. https://www.healthcare.gov/appeal-insurance-company-decision/appeals/