Ukukhokhisa ukulinganisa kwenzeka ngemuva kokuba ukhokhele imali yakho yokubambisana , uxhasomali noma ikhodi yomshuwalense futhi inkampani yakho yomshuwalense uye ukhokhe konke okuphoqelekile ukuthi ukhokhele ku-bill yakho yezokwelapha. Uma kusekhona imali ebhalansi kulowo mthethosivivinywa futhi udokotela noma esibhedlela ulindele ukuthi ukhokhe lelo bhalansi, ubhalansi ukhokhiswa.
Ingabe Ukukhokhiswa Kwezindleko Zomthetho noma Cha?
Ngezinye izikhathi kungokomthetho, futhi ngezinye izikhathi akunjalo; kuncike ezimweni nemithetho yomshwalense wakho wombuso.
Ukulinganisa ukulinganisa ngokuvamile akungekho emthethweni :
- Uma une-Medicare futhi usebenzisa umhlinzeki wezokunakekelwa kwezempilo owamukela isabelo se-Medicare.
- Uma une-Medicaid kanye nomhlinzeki wezempilo wakho unesivumelwane neMedicaid.
- Uma udokotela noma esibhedlela sakho sinesivumelwano nehlelo lakho lempilo futhi ukukhokha ngaphezu kwalokhu inkontileka ivumela.
Kuzo zonke izimo, isivumelwano phakathi komhlinzeki wezempilo kanye neMediare, Medicaid, noma inkampani yakho yomshuwalense ifaka isigatshana esivimbela ukukhokhiswa kwemali. Isibonelo, lapho isibhedlela sibonisa uMedarela ukubona iziguli ze-Medicare, kufanele kuvumelwane ukwamukela isilinganiso se-Medicare esivumelwaneni, kufaka phakathi ukukhokhwa kwakho okukhokhelwayo, njengokukhokha ngokugcwele. Lokhu kubizwa ngokuthi wamukela isabelo seMedare .
Ukulinganisela ukukhokha kuvame ukusemthethweni :
- Uma usebenzisa umhlinzeki wezempilo ongenawo ubuhlobo noma inkontileka ne-insurer yakho, i-Medicare, noma i-Medicaid. Lokhu kuvamile emisebenzini yezokwelapha ze-concierge , futhi kunjalo futhi uma ufuna ukunakekelwa ngaphandle kwenethiwekhi yakho yomshwalense wezempilo. Uhlelo lwakho lungase luhlanganise izindleko ezingaphandle kwe-network, kodwa umhlinzeki ngaphandle kwe-inthanethi akaphoqelekile ukwamukela ukukhokhwa kwe-insurer yakho njengokukhokha ngokugcwele; bangakuthumela umthethosivivinywa for the remaining of the amacala, ngisho noma ngaphezulu kuka plan yakho-out-of-network copay noma deductible.
- Uma uthola izinsizakalo ezingahlanganiswa nenqubomgomo yomshuwalense wezempilo, noma ngabe uthola lezo zinsizakalo ezivela kumhlinzeki onesivumelwano necebo lakho lempilo. Lesi simo sivame ukwenza izinqubo zezimonyo ezingekho isidingo sempilo. Kulolu cala, uzoba necala kulo lonke umthethosivivinywa.
Njengoba umshuwalense wezempilo ulawulwa yilowo nalowo mbuso, imithetho yombuso ingaba nomthelela ukuthi noma ngabe ukukhokhisa ibhalansi kungokomthetho. Amanye amazwe anemithetho ethize mayelana nokukhokhiswa kwe-balance okungafani nemigomo eyisisekelo ngenhla. Funda kabanzi mayelana nemithetho yombuso ekukhokhiseni ibhalansi kusuka ku-Kaiser Family Foundation.
Ukukhokhelwa kwe-Balance Kusebenza kanjani
Uma unakekelwa udokotela, esibhedlela, noma omunye umhlinzeki wezokunakekelwa kwezempilo engeyona ingxenye yenethiwekhi yomhlinzeki wakho we-insurer (noma, uma une-Medicare, evela kumhlinzeki ongawamukeli ukunikezelwa kwemithi), lowo mhlinzeki wezempilo uyakwazi ukukhokha noma yini ofuna ukukukhokha. Njengoba inkampani yakho yomshuwalense engazange ixoxisane nanoma yiliphi inani lelowo mhlinzeki, yena akaboshiwe inkontileka necebo lakho lempilo.
Uma inkampani yakho yomshwalense yempilo ivuma ukukhokha iphesenti yokunakekelwa kwakho ngaphandle kwenethiwekhi , uhlelo lwezempilo alukhokhi iphesenti yalokho empeleni ikhokhiswa . Esikhundleni salokho, ukhokha iphesenti yalokho okushiwo ukuthi kufanele ikhokhelwe, kungenjalo eyaziwa ngokuthi inani elifanele nelisiko . Njengoba ungase ucabange, inani elifanele nelisiko ngokuvamile liphansi kunanani okhokhisiwe ngempela. Ibhajethi yebhalansi ivela kugebe phakathi kwalokho umshwalense wakho akusho ukuthi kunengqondo nangokwezifiso, nokuthi yini udokotela noma isibhedlela esiyikhokhisayo ngempela.
Nasi isibonelo sokwesekwa esibhedlela nge-20% ye-coinsurance ye-in-hospital esibhedlela kanye no-40% ukuqinisekiswa kwe-hospitality-out-of-network:
| Isibhedlela sangaphakathi (uxhumano lwe-20%) | Isibhedlela esingaphandle kwe-network (40% coinsurance) nge-balance balance | |
| Amacala okubhedlela | $ 60,000 | $ 60,000 |
| Umshuwalense uxoxisana nesilinganiso esinqunyiwe | $ 40,000 | Asikho isaphulelo ngoba lesi sibhedlela singaphandle kwenethiwekhi |
| Umshuwalense uyinani elifanele futhi lendabuko | $ 45,000 | |
| Umshuwalense ukhokha | $ 32,000 (80% wezinga elilinganiselwa ku-$ 40,000) | $ 27,000 (ama-60% we $ 45,000 okulinganiselayo nesilinganiso sesintu) |
| Ukhokha imali yezimali | $ 8,000 (20% we $ 40,000) | $ 18,000 (40% we $ 45,000) |
| Ukulinganisa inani lemali elikhokhisiwe | $ 0 | US $ 15,000 (Umshuwalense wangempela wesikhwama sangasese esibhedlela kanye nezinkokhelo zezimali) |
| Uma ukhokhelwe ngokugcwele, ukhokhele | $ 8,000 | $ 33,000 (Ukubambisana kwakho nokuhlanganisa ibhalansi esele.) |
Ukukhokha Okulinganiselwe Kuphi Lapho?
E-United States, ukukhokhiswa kwe-balance kubonakala kwenzeka uma uthola ukunakekelwa kudokotela noma esibhedlela okungesiyona ingxenye yenethiwekhi yomhlinzeki yenkampani yomshuwalense wezempilo noma ongawamukeli ukunikezwa kweMedare.
Ukukhokhwa kwe-Balance Balance: Abahlinzeki be-Out-of-Network Abasebenza kwi-In-Network Facilities
Lokhu kungenzeka ngokungalindelekile, noma ngabe uzama ukuhlala kunethiwekhi. Isibonelo, uya esibhedlela esise-in-network, kepha i-radiologist efunda ama-x ray akho ayikho inethiwekhi. Isikweletu esivela esibhedlela sibonisa isilinganiso se-in-network futhi asikho ngaphansi kokukhokhiswa kwemali, kodwa i-radiologist, njengoba engenayo inkontileka nomshwalense wakho, angakukhokhisa noma yini ayifunayo futhi ayikhululekile ukulinganisela imali. Izimo ezifanayo zivela nge:
- Anesthesiologists
- I-Pathologists (odokotela bama-laboratory)
- I-Neonatologists (odokotela ngezinsana)
- Intensivists (odokotela abasebenza ngokukhethekile ngeziguli ze-ICU)
- Izibhedlela (odokotela abasebenza ngokukhethekile ngeziguli ezibhedlela)
- Ama-Radiologists (odokotela abahumusha ama-x-ray nama-scans)
- ER odokotela
- Abanikezeli bemishini yezokwelapha ezihlala njalo (ie, inkampani enikeza ama-crutches, amabhande, izihlalo zabakhubazekile, njll abantu abayidingayo emva kwenqubo yezokwelapha)
- Amasevisi atholakele kumhlinzeki okhethwe omunye umuntu. Lokhu kungenzeka uma une-pap-smear noma i-biopsy eyenziwa ehhovisi likadokotela wakho, noma igazi elidonsa umhlengikazi wezempilo ekhaya. Uma udokotela wakho noma umhlengikazi ethumela umcibisholo ebhodini lokuphuma ngaphandle kwenethiwekhi, lelobhule lingakwazi ukulinganisela imali.
Lezi zimo zokukhokha zokumaketha ezimangalisa "ikakhulukazi zithukuthelela iziguli, ezivame ukukholelwa ukuthi uma nje zikhethile isikhungo sezokwelapha esise-inthanethi, konke ukunakekelwa kwabo kuzobekwa ngaphansi kwemigomo ye-inthanethi yecebo labo lempilo. Ukubhekana nalesi simo, amazwe amaningana asungule imithetho yokuvikelwa kwabathengi ebeka umkhawulo wokukhokhiswa kwemali yokumangala (kubalulekile ukuqaphela ukuthi imithetho yezwe ngokuvamile isebenza kuphela ezinhlelweni zempilo ezilawulwa nguhulumeni. Izinhlelo zokuzimela, okuyizinto abaqashi abaningi abazisebenzisayo, zilawulwa ngumthetho wesifundazwe, ngaphansi kwe-ERISA):
- I-Arizona yenzelwe iBillate Bill 1441 ngo-2017. Izoqala ukusebenza ngonyaka ka-2019, futhi izovumela iziguli ezithola ibhalansi yokulinganisela emangalisweni (kusukela kumhlinzeki wangaphandle wenethiwekhi owenze amasevisi kusikhungo senethiwekhi) ye $ 1,000 noma ngaphezulu ukufuna ukuxabana. Inqubo yokubambisana izogcina ekuxazululeni inkinga phakathi komhlinzeki wezokwelapha kanye nenkampani yomshuwalense, ngaleyo ndlela isusa isiguli somthwalo wemali ebhalansi.
- I-New York ivikele iziguli ekukhokhelweni kokulinganisela kokusabalalisa kusukela ngo-2015.
- I-California yenze i-AB72 ngo-2016; kusebenza kumapulani akhishwe noma avuselelwe noma ngemuva kukaJulayi 1, 2017, futhi avimbela iziguli ukuthi zikhokhise amacala okukhishwa kwe-network okunakekelwa atholakele ezindaweni ezisenkundleni.
- I-Florida yenzelwe i-HB221 ngo-2016. Umthetho uvikela iziguli ekukhokhelweni kwemali esimangalisa ezimweni eziphuthumayo nasezimo lapho isiguli sifuna ukunakekelwa khona esikhungweni se-inthanethi futhi siphathwa-ngaphandle kokunye ukhetho-ngumhlinzeki wangaphandle wenethiwekhi ngaphakathi indawo.
- I-Maryland, i-Illinois, ne-Connecticut nayo ineziqondiso ezivikela abathengi ekukhokhelweni kwemali emangalisa. Ezinye izifunda eziningi zivikelekile kancane.
Ukulinganisa ukulinganisa akuvame kwenzeke nabahlinzeki be-inthanethi noma abahlinzeki abamukela isabelo seMedithri ngoba, uma belinganisela imali, bakhophula imigomo yesivumelwano sabo nomshwalense wakho noma uMedare. Bangase balahlekelwe inkontileka, babhekane nezinhlawulo, babhekane nezijeziso ezinkulu, futhi babhekane namacala amacala obugebengu kwezinye izimo.
Okungafani nalokhu kwenzeka uma usebenzisa umhlinzeki we-in-network, kodwa uthola isevisi engahlanganiswa nomshuwalense wakho wezempilo. Njengoba umshuwalense engaxoxisani amanani ezinsizakalo ezingasifaki, awuvikelwe yilesi saphulelo esixhunyaniswe ngomshuwalense. Umhlinzeki angakwazi ukushaja noma yini ayifunayo, futhi unesibopho sayo yonke ibhajethi.
Uma Ukulinganisela Kugcwaliswa
Uma uthola imali yesabelomali noma ucabangela ukuthola izinsizakalo zokunakekelwa kwezempilo okuzoholela ekubhaliseni ibhalansi, unezinketho ezithile mayelana nendlela yokusingatha lesi simo. Funda ukuthi yiziphi ongakhetha kuzo nokuthi yiziphi izindlela ongazisebenzisa ukusingatha ukukhokhiswa kwemali ku-" Ukulinganisa Ukulinganisa-Indlela Ongayisingatha Ngayo, Okufanele Ukwenze ."
> Imithombo:
> Isikhwama se-Commonwealth. Ukulinganisa Ukulinganisa Ngezinhlinzeko Zokunakekelwa KwezeMpilo: Ukuhlola Ukuvikelwa Komthengi Kuzo Zonke Izindawo
> UMnyango Wezabasebenzi wase-United States. Umthetho wokuKhuthazeka kokuThola umhlalaphansi wabasebenzi.