Ithetha ntoni 'ngaphandle kwenethiwekhi'?

Inkampani yezeMpilo ichaziwe

Uya kuqeshwa rhoqo kugqirha omtsha kwaye-BAM! Ubethwe ngetyala elikhulu kunokuba bekulindelwe nokuba une-inshurensi yakho yezempilo. Ufumanisa ukuba eli xabiso liphezulu kukuba umboneleli wezempilo owasebenzisileyo uphumile kwinethiwekhi. Kodwa kuthetha ntoni oko? Masifumanise!

Ithetha ntoni ngaphandle kwenethiwekhi?

Ngaphandle kwenethiwekhi kuchaza ugqirha, isibhedlele, okanye indawo yokhathalelo lwempilo engeyonxalenye yenethiwekhi yomnikezeli ngenkampani yeinshurensi yezempilo. Oku kuthetha ukuba i-inshurensi yakho ayikhange ithethathethane ngenqanaba lenethiwekhi nalo gqirha, isibhedlele, okanye indawo, kwaye uya kuhlawuliswa ipesenti enkulu yetyala elipheleleyo lezonyango okanye ityala lonke, kuxhomekeke kwisicwangciso sakho esithile sezempilo.

Zonke izicwangciso zezempilo ezilawulwayo zinenethiwekhi, kubandakanya Unyango kwaye Unyango .

Olunye uqhushululu olusebenzisa umboneleli ongaphandle kwenethiwekhi kukuba ezi ndleko azisetyenziswanga ekunciphiseni kwakho ukuba isicwangciso sakho asizibandakanyi iindleko zangaphandle kwenethiwekhi. Abayi kubala baphume epokothweni ubuninzi nokuba.

Masikuphule oku xa uthelekisa ngaphandle kwenethiwekhi nakwiinethiwekhi.

In-network vs. ngaphandle kwenethiwekhi

Xa ubhalisela isicwangciso sokhathalelo lwempilo, inkampani yeinshurensi ikunika uluhlu loogqirha, izibhedlele, kunye namaziko ezempilo kwinethiwekhi . Ukutyelela ababoneleli benethiwekhi kwiinkonzo zononophelo lwempilo kuya kuthetha amaxabiso asezantsi ukusuka kwinkampani yeinshurensi kunye nomboneleli kuthethathethwano ngamaxabiso. Ngaphandle kokuba inkampani yakho yeinshurensi ibonelele ngesisa ngaphandle kwenethiwekhi, ukutyelela ngaphandle kwenethiwekhi kuya kuthetha ukuba iindleko zonyango lwakho ziya kunyuka njengoko inkampani yakho yeinshurensi izakugubungela kancinci okanye ingabinanto kwaphela.

Umzekelo, ubona umboneleli wakho okhathalelayo kuba izono zakho zibuhlungu. Ujonge kwaye ucebise ukuba ubone ingcali. Intlawulo iyonke yolo hambo kugqirha yi- $ 100. Kuba ekumnatha wonxibelelwano, isaphulelo sisetyenziswa kwityala elipheleleyo kuba i-inshurensi yakho ithethathethane kwangaphambili ngenqanaba nelo gqirha. Masithi, iyonke isaphulelo ngoku yi- $ 80. Unokuba noxanduva kwintsalela yebhili ngokuxhomekeke kwi-coinsurance yakho kunye ne-copay.

Nangona kunjalo, emva kokwenza uphando, uyaqonda ukuba ingcali ebekwe ngokulula ekufuneka uyibonile ingaphandle kwenethiwekhi. Ugqiba ekubeni uthathe umngcipheko kwaye ubhukishe idinga. Kwiiveki ezimbalwa emva kotyelelo, ufumana ibhilikhwe yeedola ezingama-250. Kuba loo ngcali yayingekho kwinethiwekhi, akukho saphulelo sisetyenziswa kwityala lezonyango lilonke, kwaye inkampani yakho yeinshurensi igubungela kancinane, okanye imbi kakhulu, akukho nto konke konke ukusukela oko umboneleli wayephumile kwinethiwekhi kwaye ikopi kunye nokuhlawulwa kwemali kungayi kubakho. faka isicelo.

Ukubona ngaphakathi nangaphandle kwenethiwekhi ukuthelekisa kwindawo yakho, le khalityhuleyitha inganceda. Kuhlala kubhetele ukusebenzisa umboneleli okhathalela impilo, ukuba kunokwenzeka, kuba iindleko ziya kuba sezantsi.

Kubalulekile ukuba uqaphele ukuba kukho umahluko ngokwendleko phakathi izicwangciso zeinshurensi yezempilo xa ujongene nenethiwekhi kunye nemirhumo engaphandle kwenethiwekhi.

• I-PPO imele uMbutho woMboneleli okhethiweyo. Ezi ntlobo zezicwangciso zibonelela ngezibonelelo ezingaphandle kwenethiwekhi-nangona, azilunganga njengezibonelelo zenethiwekhi. Inkampani yeinshurensi iyakunceda ukuhlawula isahlulo semali esayilwayo kwaye uya kuthi uhlawule isahlulo esikhudlwana sesiqinisekiso semali.
• I-HMO mfutshane kuMbutho woLondolozo lwezeMpilo. Ezi ntlobo zezicwangciso zihlala zinganikeli naziphi na izibonelelo ezingaphandle kwenethiwekhi-oko kuthetha ukuba kuya kufuneka ubhatale zonke iindleko ezingaphandle kwenethiwekhi ezipokothweni.
• EPO (okanye umbutho wababoneleli ababodwa) luhlobo lwesicwangciso sezempilo esigubungela kuphela iinkonzo zomnatha wonxibelelwano (ngaphandle kongxamiseko).
• POS (aka Point of Service) sisicwangciso esidinga ukuba abanini migaqo-nkqubo bagqithiselwe kugqirha wabo ukuze babone ingcali. Uya kugcina imali ngokusebenzisa ababoneleli benethiwekhi, kodwa ngokungafaniyo ne-HMO, unokufumana ukhathalelo kumnikezeli wangaphandle kwenethiwekhi.

Enye into engaphandle kwe-in-network ngokuchasene neendleko ezingaphandle kwenethiwekhi ziinkonzo zongxamiseko. Iinkampani ze-inshurensi azinako ukukohlwaya ngeemali eziphezulu kunye noqinisekiso lwemali ukuba ufuna ukhathalelo olungxamisekileyo kwisibhedlele esingaphandle kwenethiwekhi. Akunyanzelekanga ukuba ufumane imvume kwangaphambili kwiinkonzo zegumbi likaxakeka zoogqirha nabangaphandle kweinethiwekhi. Nangona kunjalo, ukuba igumbi elingxamisekileyo ngaphandle kwenethiwekhi alinaso isivumelwano kunye nenkampani yeinshurensi, ayinyanzelekanga ukuba yamkele intlawulo yabo njengentlawulo epheleleyo. Ukuba bahlawula imali engaphantsi kwebhanti engaphandle kwenethiwekhi, igumbi likaxakeka linokuthumela umthengi imali eseleyo yemali engahlawulwanga.

Ndenza ntoni ukuba ugqirha wam uphumile kwinethiwekhi?

Masithi ubutyelele ugqirha wezifo ezifanayo iminyaka eli-10, kodwa emva kokuqala umsebenzi omtsha nokutshintsha i-inshurensi yakho, uba ngumboneleli wangaphandle kwenethiwekhi. Usenokungakwazi ukuphinda umtyelele ngenxa yokuba ungenakukwazi ukuhlawula iindleko zokhathalelo lwempilo olongezelelweyo.

Kuya kuba lula ukutshintsha ugqirha okwi-network. Nangona kunjalo, ukuba awufuni ukushiya ugqirha wakho wangoku, thetha naye ukuze ubone ukuba akukho naziphi na iindlela onokuthi ukhethe kuzo. Abanye oogqirha bavumela abaguli ukuba bahlawule ixabiso lemali, elinokubiza ixabiso eliphantsi kunaleyo inikezelwa ziinkampani zeinshurensi xa kuthelekiswa namaxabiso angaphandle kwenethiwekhi-kodwa ayizukubala ukuya kunciphiso okanye ukuphuma epokothweni.

Unokucela inkampani yakho yeinshurensi ukuba yongeze umsantsa wenethiwekhi, apho i-inshurensi yakho iya kugubungela ugqirha ngokungathi bakwi-network. Nangona kunjalo, ezi zihlala zinikezelwa kuphela kwiimeko ezizodwa, ezinje kungabikho namnye ugqirha kuloo ndawo ikhethekileyo, njengoko ilahlekelwa yimali yeenkampani zeinshurensi yezempilo.

Ezinye iindlela ezingaphandle kwenethiwekhi

Izibonelelo zononophelo lwangaphandle kwenethiwekhi zibiza kakhulu. Kwezinye iimeko, kunokuba kubhetele ukuthenga malunga nesicwangciso se-inshurensi esitsha ngokubhengezwa okungcono kwinethiwekhi ngexesha ukubhalisa okuvulekileyo okanye Ixesha eliKhethekileyo loBhaliso lweziganeko eziphambili zobomi.

Enye yeendlela ezilula zokunciphisa iindleko zokhathalelo lwempilo kukusebenzisa i-SingleCare ukuxhasa iindleko zamayeza ngelixa ungaqinisekiswanga. Khangela ngokulula amayeza akho kwaye ufumane Amaxabiso aphantsi afumanekayo , kunye okanye ngaphandle kwe-inshurensi.