Indlela Yokunquma Ukuchaza Kwakho Izinzuzo
Kuyini Incazelo Yezinzuzo?
I-Explication of Benefits (EOB) ifomu noma idokhumenti engathunyelwa kuwe yinkampani yakho yomshuwalense amasonto ambalwa noma izinyanga ngemuva kokuthola insizakalo yezempilo eyakhokhwa yinkampani yomshuwalense (noma ngemuva kokufaka isimangalo, ngisho noma izindleko ezigcwele zasetshenziselwa ukukhishwa kwakho futhi uthathwa njengomthwalo wakho wemfanelo).
Kufanele uthole i-EOB uma unomshwalense wezempilo wangasese, uhlelo lwezempilo oluvela kumqashi wakho, noma u-Medicare.
Iphuzu elivela kuDkt Mike: Uma uyilungu lenhlangano yokugcinwa kwezempilo (i-HMO) ekhokhela udokotela wakho ngokuthungatha (imali ehleliwe inyanga ngayinye ukukunakekela), ungase ungatholi i-EOB ngoba udokotela wakho hhayi ukukhokhisa inkampani yomshuwalense. Lolu hlobo lwamalungiselelo aluvamile.
I-EOB yakho ikunika ulwazi mayelana nokuthi isimangalo somshuwalense esivela kumhlinzeki wezempilo (njengodokotela noma esibhedlela) sakhokhwa ngenxa yakho.
Yikuphi Ukwaziswa Okukuchaza Kwami Izinzuzo?
I-EOB yakho inolwazi oluningi oluwusizo olungakusiza ukulandelela izindleko zakho zokunakekelwa kwezempilo futhi ube yisikhumbuzo sezinsizakalo zezokwelapha ozitholile phakathi neminyaka embalwa eyedlule.
I-EOB evamile inolwazi olulandelayo:
- Isiguli: Igama lomuntu owathola le nsizakalo. Lokhu kungase kube wena noma omunye wabaxhomekile bakho.
- Inombolo yesazisi eqinisekisiwe: Inombolo yokuhlonza eyabelwe yona yinkampani yakho yomshuwalense. Lokhu kufanele kufane nenombolo ekhadini lakho lesikhuwalense.
- Inombolo Yemangalo: Inombolo ekhomba, noma ibhekisela ekumangalisweni ukuthi wena noma umhlinzeki wakho wezempilo othunyelwe kwinkampani yomshuwalense. Kanye nenombolo yakho ye-ID yomshuwalense, uzodinga le namba yesimangalo uma unemibuzo mayelana necebo lakho lempilo.
- Umhlinzeki: Igama lomhlinzeki owenze izinsizakalo zakho noma othembekile wakho. Lokhu kungase kube igama lodokotela, i-laboratory, isibhedlela, noma abanye abahlinzeki bezempilo.
- Uhlobo Lesevisi : Ikhodi kanye nencazelo emfushane yesevisi ephathelene nezempilo oyitholile kumhlinzeki.
- Idethi Yesevisi: Izinsuku zokuqala nezokuphela kwensizakalo ephathelene nempilo oyitholile kumhlinzeki. Uma isimangalo singokuhambela udokotela, izinsuku zokuqala nezokuphela zizofana.
- Inkokhelo (eyaziwa nangokuthi Izinkokhelo Ezikhokhelwayo): Inani umhlinzeki wakho ukhokhise inkampani yakho yomshuwalense ngenkonzo.
- Inani elingatholakali: Inani lemali inkampani yakho yomshuwalense ayizange ikhokhe umhlinzeki wakho. Ngalesi samba ungabona ikhodi enikeza isizathu udokotela engakhokhelwe inani elithile. Incazelo yalezi amakhodi ngokuvamile itholakala phansi kwe-EOB, ngemuva kwe-EOB yakho noma encwadini ehambisana ne-EOB yakho. Ababambisisi ngokuvamile baxoxisana ngamanani okukhokha nodokotela, ngakho-ke inani eliphelayo elikhokhwayo (kufaka phakathi izingxenye ezikhokhelwe umshwalense kanye nesiguli) ngokuvamile ngaphansi kwenani lezikhwama zomhlinzeki. Umehluko uboniswa ngandlela-thile ku-EOB, ngenani elingavunyelwe, noma inani eliphelele elihlanganisiwe elingaphansi kwecala elikhokhisiwe.
- Izindleko eziphelele zokubekezela: Inani lemali oyikweleta njengengxenye yakho yesikweletu. Lesi silinganiso sincike ezimfuno zakho zokuphuma ngaphandle kwepulani, njenge-deductible yonyaka, i-copayments, ne-coinsurance. Futhi, kungenzeka ukuthi uthole insizakalo engahlanganiswa uhlelo lwakho lwezempilo lapho ngabe unesibopho sokukhokha imali egcwele.
Ulwazi oluthe xaxa lungabandakanya inani lokukhokha empeleni elinikezwe kumhlinzeki wakho nokuthi ingakanani imali yakho yokukhishwa kwesikhwama kanye nokuphuma kwepokhethi esiphezulu .
Kuye nge-EOB yenkampani yomshuwalense, umyalelo wolwazi ungahluka.
Isibonelo se-EOB:
UFrank F.
uneminyaka engu-67 ubudala onesifo sikashukela sohlobo lwesibili nomfutho wegazi ophezulu. Ubhalise kwi- Medicare Advantage Plan futhi ubona udokotela wakhe njalo ezinyangeni ezintathu ukuze alandele isifo sikashukela sakhe. Emasontweni ayisithupha emva kokuhambela kwakhe kokugcina, uFrank wathola i-EOB ngolwazi olulandelayo:
- Isiguli: uFrank F.
- Inombolo yesazisi eqinisekisiwe : 82921-804042125-00 - Inombolo Yokuthola Uhlelo Lika-Frank's Medicvant Advantage Plan
- Inombolo Yemangalo : 64611989 - inombolo eyabelwe lesi simangalo yi-Frank's Medicare Advantage Plan
- Umhlinzeki: UDavid T. MD - igama likaDrank's primary care physician
- Uhlobo Lesevisi: Ukuvakasha Kwamahhovisi Okulandelela
- Idethi Yesevisi: 11/21/09 - usuku uFrank asebenze ngaso ehhovisi noDkt. David T.
- Ukukhokhisa: $ 135.00 - inani uDkt. David T. akhokhela i-Frank's Medicare Advantage Plan
- Inani elingavaliwe: $ 70.00 - inani likaDkt. David T's bill ukuthi uhlelo lukaFrank ngeke lukhokhwe. Ikhodi eduze kwalokhu yayingu-264, echazwe ngemuva kwe-EOB kaFrank ngokuthi "Ngaphezu Kweziphi Izifo Ezivumelayo"
- Izindleko eziphelele zomzimba : $ 15.00 - Ihhovisi likaFrank livakashela ikhophi
- Inani elikhokhelwa umhlinzeki: $ 50.00 - inani lemali ukuthi iFrank's Medicare Advantage Plan ithunyelwe kuDkt. David T.
Ezinye izibalo: UDkt. David T. uvunyelwe u-$ 65 (ukukhokha kwakhe imali engu-R1353 kunciphisa imali engakahlanganiswa ne $ 70.00 = $ 65.00). Uthola u-$ 15.00 uFrank no-$ 50.00 kusuka ku-Medicare.
Kungani Incazelo Yakho Yezinzuzo Kubalulekile?
Amahhovisi odokotela, izibhedlela kanye nezinkampani zokukhokha zezokwelapha ngezinye izikhathi zenza amaphutha okukhokha. Amaphutha anjalo angaba nemiphumela emibi futhi engaba yingozi, yesikhathi eside.
I-EOB yakho iyindiza emlandweni wakho wokukhokha kwezokwelapha. Buyekeza ngokucophelela ukuze uqiniseke ukuthi empeleni uthola insizakalo ekhokhwayo, inani othola udokotela wakho kanye nesabelo sakho silungile, nokuthi ukuxilongwa kwakho nenqubo yakho kubhalwe kahle futhi ikhodiwe.
Ukuze ufunde kabanzi mayelana nokuthi kungani i-EOB yakho ibalulekile nokuthi ungathola kanjani futhi ugweme amaphutha e-EOB, funda:
Ukuze ufunde ukuthi odokotela, izibhedlela, kanye nezinkampani zomshuwalense zisebenzisa kanjani amakhodi kuma-EOB nokucela amafomu, funda:
Ithiphu evela kuDkt Mike: I-EOB yakho kufanele ibe nenombolo yocingo yamakhasimende. Unganqikazi ukubiza leyo nombolo uma unemibuzo noma ukukhathazeka mayelana nolwazi ku-EOB.