Indlela Yokugwema Izinkinga Ezibangelwa Izimangalo Nezingqikithi Zangaphandle
Kwakuvamile ukuthi thina iziguli singenza i-aphoyintimenti cishe nganoma yikuphi udokotela noma esibhedlela esifuna ukuzenza, futhi singaniki umcabango ukuthi inkampani yethu yomshuwalense izokhokhela labo abaqashiwe noma ukuhlala esibhedlela noma cha. Noma kunjalo, lokho akusekho iqiniso. Njengoba izinketho zomshuwalense wezempilo kanye nezindleko kunzima kakhulu ezigulini zokubhekana nazo, okufanayo kuyodokotela, izibhedlela, izindawo zokuhlola, ama-pharmacy nabanye abahlinzeki bezempilo.
Ngenxa yalokho, odokotela nezindawo ezimbalwa bazimisele ukusebenza nezinkampani zomshuwalense ezimbalwa-futhi lokho kubangela iziguli izinkinga.
Akuyona into engavamile kumasevisi kadokotela noma omunye umhlinzeki ukuthi angahlanganiswa izinhlelo zethu zomshuwalense. Izinqubo eziningi zomshuwalense zivimbela ukuthi ubani esingabona, noma lapho singaya khona ukunakekelwa kwezokwelapha ngokulahla ukukhokhela lezo zinsizakalo nokunakekelwa . Uma sibona udokotela noma omunye umhlinzeki ongahlanganiswa nomshuwalense-noma ngabe sihlose ukwenza kanjalo-kubizwa ngokuthi "ngaphandle kwenethiwekhi" .
Ngezinye izikhathi senza lokho ngokuzithandela. Mhlawumbe wazi ukuthi udokotela wakho wesibhedlela awusayikumbozwa uhlelo lwakho lomshuwalense kodwa ngeke uvumele omunye umuntu ukuba alethe ingane yakho. Uzokhokha okwedlule kulolu hlelo lokunakekelwa ngaphandle kwenethiwekhi ngoba ukholelwa ukuthi izinsizakalo zodokotela zifanele ukukhokhelwa okungaphezulu kwezindleko.
Ngezinye izikhathi sibhekwa izikweletu ezengeziwe ezivela kumhlinzeki wangaphandle we-inthanethi esasizicabange ukuthi zimboziwe kepha kwakungekho.
Udokotela wakho ohlinzayo uyingxenye yenethiwekhi yakho yenkampani yomshuwalense, kodwa i-radiologist udokotela wakho ohlinzayo usebenza naye futhi awutholi umthethosivivinywa ovela ku-radiologist. Noma uya ukubona udokotela oyinhloko oyithandayo owake wawubona iminyaka, ukuze uthole ukuthi ngabe ibhilidi ephakeme kakhulu kunalokho okulindelekile ukuthi udokotela wakho akasamukeli uhlelo lwakho lomshuwalense.
Noma, umshuwalense wakho ukhokhela izindleko zesibhedlela, kodwa hhayi ekamelweni langasese kanye negumbi elizimele kwakuwukuphela komhlobo owatholakalayo, ngakho-ke ugcina ukhokhiswa ekamelweni langasese njengokungathi awunayo umshuwalense.
Mhlawumbe into ephazamisayo kunazo zonke izindleko ezingaphandle kwe-network ukuthi kukhona izindlu ezahlukene zamanani ezinkampanini zomshuwalense nabantu ngabanye. Izibonelo: Ukuvakasha kukadokotela okubiza ukuthi umshuwalense wakho u-$ 40 wokubuyisela imali kuzokukhokhela i-$ 100 ephaketheni lakho njengesevisi engaphandle kwenethiwekhi . Noma umuthi owawujwayele ukukukhokhela imali engu-$ 10 yokukhokha, futhi ubiza umshwalense wakho u-$ 50, manje ukhokhela i-$ 120 ekhemisi ngoba awusenayo leyo nethiwekhi.
Yini esingayenza ngabaguli mayelana nayo? Kunezinyathelo ezimbalwa esingathatha ukuze sigweme izindleko ezingaphandle kwe-network noma ukuzama ukuzilawula
Indlela Yokugwema Ukukhokhwa Kwe-Out-of-Network
- Ngaphambi kokuthola ukunakekelwa, musa nje ukubuza ukuthi udokotela noma isevisi "isebenza" nomshuwalense wakho. Odokotela abaningi nezindawo zokunakekelwa kwezempilo bazokutshela ukuthi yebo, "bazosebenza" nomshuwalense wakho , noma ngabe lowo msebenzi ubhekwa njengewokungena kwenethiwekhi. Esikhundleni salokho, buza ukuthi bayingxenye yenethiwekhi yakho yezinhlelo. Futhi-ke, thola impendulo ngokubhala lapho kunokwenzeka.
- Ungacabangi ukuthi noma yini i-oda lakho lezokwelapha kuwe lizokwembozwa nje ngoba udokotela wakho uhlanganisiwe. Udokotela wakho angase alawule ukuhlolwa kwegazi futhi akuthumele ebhodini esakhiweni esifanayo. Kodwa lelo lebhu angeke limbozwe umshwalense wakho wezempilo. Hlola kabili izinyathelo zendlela.
- Uma kunokwenzeka, hlola nomshwalense wakho ngaphambi kokunakekela, futhi. Buza umshwalense wakho (noma ungene ku-intanethi kuwebhusayithi ye-insurer ukuze uthole ukuthi) uma uhlelo lwakho luhlanganisa odokotela nezinsizakalo ozodinga. Lokhu kungase kungabi lula ukumbulwa endabeni efana nokukhokha esibhedlela okuchazwe ngenhla, kodwa kudingeke uzame. Futhi-ke, uthole izimpendulo ngokubhala lapho kunokwenzeka.
Uma Uthola Umthethosivivinywa Wezokwelapha Ongaphandle KwamaNethiwekhi
- Cindezela inkampani yomshuwalense okokuqala, ubone ukuthi ungabathola ukuthi bakhokhele izikweletu. Ungathola incazelo enqubomgomo yakho inzima. Phuma zonke izitebhisi ukuqinisekisa ukuthi wenza kube nzima kakhulu ukuba bathi cha.
- Xoxa ngalezo zindleko. Shayela umnyango wesibhedlela noma umhlinzeki wokukhokhisa, ubatshele ukuthi izikweletu zakho azikwazi ukuzibuza, futhi uzibuze ngokuzithoba ukuthi zikusize ukubahlisele ezingeni ongakwazi ukuzikhokhela. Bacele okungenani bahloniphe ukuthi inkampani yomshuwalense yayiyoyikhokhela. Bacele ukuthi bakubeke ohlelweni lokukhokha, futhi.
- Uma ungeke ukwazi noma ungakhononda kumsizi wesikhwama somshwalense, noma awukwazi noma ungaxoxiswanga nezindleko zakho, thola ummeli wokukhokhisa wezokwelapha ukukusiza. Bazokuxoxisana ngenxa yakho, bazoqinisekisa ukuthi amacala angeke akudingekile futhi angalungile asuswe, futhi azokubeka ohlelweni lokukhokha nesibhedlela. Kuzodingeka ukhokhele izinsizakalo zabo, kodwa cishe uzosindisa okuningi kakhulu kunokuba uchithe ngenxa yolwazi lwabo lokuthi uhlelo lusebenza kanjani.
Indlela Yokuqaphelisa Ngamathemba Okuguqula Ukwanda Kokunakekelwa Kwangaphandle Kwenethiwekhi
- Cindezela ngokuzwakalayo futhi kaningi. Celezela esibhedlela noma kumhlinzeki (ngemuva kokuba izingxoxo zakho seziqedile.) Celezela umshwalense wakho. Futhi ukhononda komnyango womshuwalense womabili kanye nommeli jikelele esifundazweni sakho.
- Yiba lula ngokucophelela ekukhetheni umshuwalense wakho wezempilo uma ukwazi ukwenza ushintsho. Izinhlelo zomshuwalense kufanele zinikeze uhlu lwadokotela abamukela izinhlelo zabo ngaphambi kokuba uzinikele emshwalense wabo, ngakho ungaqala khona. Ungacela udokotela wakho noma imibuzo yakhe yemenenja yehhovisi, naye.