Imininingwana Ilandelwa Njengokuthi Uyisebenzise Kweleti
Uma ufaka isicelo sezempilo noma umshuwalense wezokwelapha, kuyoba nezinamba eziningi zezahlulelo ezisetshenziselwa abakwa-underwriters ukuthola ukuthi bazokukhokhisa kangakanani ukuthi bakuqiniseke.
Njengoba, ngokomthetho, ababheki banshuwalense abakwazi ukunqaba ukukuqinisekisa (njengokungena kwe- Care Affordable Act ), kumele kunalokho banqume ukuthi kuzodingeka ukuthi ukhokhele kangakanani ukukhokhela ukunakekelwa kwakho, bese befaka inani lemali abayilindele ukwenza, futhi.
Ingqikithi izokhipha i- premium yomshuwalense wezempilo .
Iqoqo leDatha Yezokwelapha
Ukuze wenze lezo zihlulelo, zizokuthenga idatha evela kwimithombo ehlukahlukene; idatha eqoqwe ngawe nempilo yakho okungenzeka ukuthi wayengazi ukuthi yayiqoqwe. Phakathi kwalezo zicucu zedatha kuzoba umbiko wakho wezokwelapha wezokwelapha , isikolo sakho sekhredithi, umlando wakho wokubhaliswa kwemithi kanye nesilinganiso sakho sokunamathela emithi.
Abaningi bethu abazi ukuthi omunye ngaphandle kwethu noma odokotela bethu, ugcina umlando wemigomo yethu. Eqinisweni, lowo mlando ungathengwa ngabashuwalense kanye nabanye kusuka ezinkampanini ezimbili. I-database ye-IntelliScript (eyenziwe yinkampani ebizwa ngokuthi i-Milliman) kanye nedatha ye-MedPoint (eyenziwe yinkampani okuthiwa i-Ingenix) kokubili ilandelela le datha, bese iyithengisa empilweni, ukukhubazeka, nezinkampani zomshuwalense wokuphila.
Njengoba ulwazi oluphathelene nokuphila komuntu nomnakekeli, kokubili lezi zinkampani kudingeka zihambisane nemithetho ye-HIPAA .
Abakwazi ukuthengisa noma ukwabelana ngolwazi ngaphandle kwemvume yakho. Kodwa-ke, ukuze ufake isicelo somshuwalense wezempilo, kuyadingeka ukuthi unikeze leyo mvume.
Ukudonsa le datha ndawonye ngefomu abangayithengisa kubashuwalense, ulwazi lwe-IntelliScript ne-MedPoint lokuthenga kusuka ku-Pharmacy Benefits Managers (PBMs).
Ama-PBM avela ekhemisini lakho lekhoneni (okungenzeka ukuthi liyingxenye yohlu olukhulu) kuma pharmacy amaningi e-mail oda afana ne-ExpressScripts noma i-CVS Caremark. Uma ugcwalisa imiyalelo yakho kunoma yimaphi ama-PBM, akwazi ukulandelela ukuthi udokotela wakho ungubani (ngakho-ke lokho okukhethekile okukuyo), izidakamizwa nezilinganiso udokotela wakho anikezele kuwe nganoma yisiphi isizathu, noma ngabe ugcwalisile noma cha i-prescription, nokuthi ngabe ingagcwaliswa noma cha.
Kusukela kuleso datha, bangakwazi ukudweba iziphetho eziningana:
- Bangazi ukuthi yini okuhloliswe ngayo, noma okungenani ukusondelana, ngakho-ke noma ngabe unayo (noma unayo) inkinga enzima (eyodwa eyohamba) noma inkinga engapheli (okungenzeka ukuthi ibuyele ngesikhathi noma ikukhathaze impilo yakho yonke.)
- Bangabuye bakhulume ukuthi izinga lokuxilonga kwakho liyakuthinta kangakanani amandla okulinganisa noma ukuthi udokotela wakho ucabanga ukuthi kufanele uthathe isikhathi esingakanani. Inkinga enzima ingase ingabe ikukhathaza, ngakho ngeke ibone imali enkulu, uma kukhona. Kodwa inkinga engapheliyo, njengesifo sikashukela noma isifo senhliziyo, ngisho nje nokucindezelwa kwegazi eliphezulu, ingase ibize kakhulu ngokuhamba kwesikhathi. Uma bebona izinkinga ezingapheli ezithuthukisiwe, kuzoba yinkomba kubanini bezansi abadinga ukukhipha izindleko ezingaphezulu kwenkampani, futhi bakhulise ama-premium akho ngokufanele.
- Banganquma ukuthi unama- comorbidities , okusho ukuthi, okungaphezu kweyodwa into engalungile ngawe. Inhlanganisela yezinkinga zezokwelapha ingabakhokhisa ngisho nangaphezulu kwezindleko zokwelapha inkinga ngayinye ngabanye. Isibonelo, izindleko zokwelapha isifo senhliziyo kanye nomdlavuza ngesikhathi esifanayo zingabiza ngaphezu kokuphatha isifo senhliziyo kwesiguli esisodwa kanye nomdlavuza kwenye isiguli.
- Idatha izobonisa ukuthi ugcwalisa kanjani njalo imithethonqubo yakho ngakho-ke, ngabe uyahambisana noma cha. Lolu lwazi olunjengelokho olwenziwe yi-FICO yokunamathela kwemithi yokwelashwa lapho abakwa-underwriters abangasebenzisa ukuqhathanisa. Uma unamathela, yiqiniso, imithi yakho yezidakamizwa izoba nezindleko ezingayenza. Kodwa kungase futhi ubatshele, kuye ngokuthi uhlolwe kanjani, ukuthi uyayilawula le nkinga ngakho-ke ngeke kube khona izindleko ezinkulu esikhathini esifushane esingalindelekile.
- Abangaphansi komhlaba bazophinde babheke ukubona ukuthi ngabe yini izidakamizwa ezibuhlungu ezinqunyelwe isikhathi noma nini. Uma ubudinga eminyakeni embalwa eyedlule kodwa awuzange ugcwalise imithi yabo yamuva, khona-ke ngeke kube khona izindleko ezengeziwe. Kodwa uma okwamanje uthatha amaphilisi obuhlungu, futhi uma umthamo ukhulile noma amandla noma imvamisa, kuyoba ifulegi elibomvu kulabo ababhalise phansi abadinga ukuphakamisa izindleko zama-premium akho. Bangase bazame ukuhlola uma usebenzisa kabi izidakamizwa, isibonelo. Noma bangase banqume ukukukhokhisa ngaphezulu ngezinkinga ezinkulu nakakhulu ezingase ziholele uma uqhubeka ufuna ukunakekelwa ubuhlungu bakho, noma izindleko ezingaphezu kwezidakamizwa zobuhlungu.
Kungase kube nezinye iziphetho lezi zinkampani ezidonsa ekusetshenzisweni komlando wakho wemiyalelo, futhi. Futhi ngokuhamba kwesikhathi, njengoba ulwazi oluthe xaxa luyatholakala emithonjeni eyengeziwe njengokungathi amakhadi omvuzo wokuthembeka , abakwa-underwriters bazokwahlulela izici ezengeziwe zokuthi uhola kanjani impilo yakho, futhi uthenge ama-premiums abo yomshuwalense ngokufanele.
Ukuvikelwa kwesineke
Ngeshwa, akenzi umehluko uma iziphetho nezigwebo zabo zikhona, noma cha, zilungile. Futhi izindleko kuwe zizosekelwe kulazo ziphetho, kungakhathaliseki ukuthi zingalungile kangakanani.
Kukhona iziguli ezincane noma ezingenalutho ezingayenza ukuze zizivikele kulolu lwazi ngaphandle kokuqinisekisa ukuthi idatha yomlando wesidakamizwa ilungile. Njengoba isetshenziselwa ukunquma izindleko zomshuwalense wakho, kokubili i-IntelliScript ne-MedPoint kumele, ngokomthetho, ihambisane noMthetho Wezezimali We-Fair Credit (FCRA.) Lokhu kusho ukuthi, njengokwesikweletu sakho, ungacela ikhophi yekhemisi yakho umbiko womlando mahhala kunoma iyiphi yalezi zinhlangano kanye ngonyaka, noma ekugcineni uguqulwa umshwalense wokuphila noma ukhubazekile.
Thola Amarekhodi Azokwelapha
Kuyaqondakala ke-ke, uma usemakethe umshuwalense wezempilo, ukuthi uthola ikhophi yamarekhodi akho wezokwelapha (wonke amarekhodi, hhayi nje umlando wakho wezokwelapha), ubuyekeze ngokucophelela , futhi ulungise noma yimaphi amaphutha .
Ukuze uthole ikhophi yombiko wakho womlando we-IntelliScript yemithi, shayela u-877-211-4816.
Ngombiko wakho weMediPoint, shayela ucingo 888-206-0335 noma ubhalele ku:
Ukuhambisana kwe-MedPoint
Ingenix, Inc.
2525 Lake Park Blvd.
I-West Valley City, i-Utah 84120