Organization Exclusive Provider (EPO)
Kodi mwaganiza kuti mukulembera ndondomeko ya umoyo wa EPO? Ngati ndi choncho, ndizofunika kumvetsetsa bwino momwe mapulaniwa aliri ndi momwe amagwirira ntchito, kuti zitsimikize kuti dongosololi lidzakwaniritsa zosowa zanu.
Bwanji ngati muli ndi inshuwalansi ya umoyo wa EPO? Kumvetsetsa ins and outs momwe EPO yanu ikugwirira ntchito ikuthandizani kugwiritsa ntchito ndondomeko yanu yathanzi ndikupewa zolakwa zamtengo wapatali.
Kodi EPO (Exclusive Provider Organization) ndi chiyani?
Inshuwalansi ya umoyo wodalirika yosamalidwa, EPO imangotanthauza bungwe lokhalitsa . Inshuwalansi ya inshuwalansi ya EPO ili ndi dzinali chifukwa mumayenera kupeza chithandizo chamankhwala okha kuchokera kwa ogwira ntchito zachipatala omwe EPO imagwirizana nazo, kapena EPO sichidzaperekera chisamaliro.
Monga msuweni wawo, PPOs ndi ma HMO, mapulani azaumoyo a EPO ali ndi malamulo okhudzana ndi momwe mungapezere chisamaliro chanu. Ngati simukutsatira malamulo anu a EPO mukalandira chithandizo chamankhwala, sichidzaperekera chisamaliro.
Malamulo a zachipatala a EPO amapanga njira ziwiri zoyendetsera ndalama:
- Kodi ndikuti ndi ndani amene mumalandira chithandizo chamankhwala kwa anthu omwe ali nawo omwe EPO idakambiranapo zotsalira.
- Ntchito zothandizira zaumoyo zimangokhala pazinthu zomwe zili zofunikira kapena zomwe zimapangitsa kuti chithandizo chaumoyo chanu chichepe msinkhu, ngati kusamalira .
Kodi EPO Health Insurance Work imatani?
Kodi muyenera kudziwa chiyani pogwiritsa ntchito inshuwalansi ya inshuwalansi ya EPT?
Onetsetsani kuti mwawerenga mosamala kwambiri inshuwalansi ya thanzi lanu. Kukhala mu-network ndi kutenga zilolezo zisanayambe pakufunika kungakupulumutseni ndalama zambiri. Tiyeni tione mfundo zofunika kwambiri kuti timvetse.
Zomwe Kugawana Zogulitsa Pa EPO ndizochepa
Kugawana mtengo ndizochita zomwe inu ndi kampani yanu ya inshuwalansi mumapereka gawo la mautumiki ndipo nthawi zambiri mumakhala ndi EPO.
Izi zimaphatikizapo zopatsa malipiro , mapepala, ndi ndalama zothandizira ndalama . Ndipotu ena a EPO samafuna ndalama iliyonse kapena ndalama zokhazokha. Chifukwa cha kugawa kwake mtengo wotsika mtengo ndi ndalama zochepa mtengo , EPO ndi imodzi mwa zosankha zambiri za inshuwalansi zaumoyo.
Muyenera Kugwiritsa Ntchito Wopereka Mtanda
EPO iliyonse ili ndi mndandanda wa osamalira chithandizo chamankhwala wotchedwa wothandizira othandizira. Pulogalamuyi imapereka chithandizo chamankhwala chilichonse kuphatikizapo madokotala, akatswiri, madokotala, zipatala, mabala, x-ray zipangizo, opaleshoni yolankhula, oksijeni ya kunyumba, ndi zina zambiri.
Mu ndondomeko ya umoyo wa EPO, mutha kupeza ntchito zothandizira zaumoyo kuchokera kwa opa-intaneti . Ngati mutasamala , EPO sichilipira; mudzakhala mukulipira ngongole yanu yonse. Kutuluka mwachisawawa kumatope kungakhale kosavuta kwambiri pamene muli ndi EPO.
Ndizofunikira udindo wanu wodziwa omwe ali pa-network ndi EPO yanu. Mwachitsanzo, simungaganize kuti chifukwa chakuti labu ili pansi pa holo kuchokera ku ofesi ya EPO ya udokotala, ili mu-network ndi EPO yanu. Muyenera kufufuza. Mofananamo, musaganize kuti malo ojambula zithunzi omwe apanga mammogram chaka chatha adakali pa intaneti ndi EPO wanu chaka chino.
Mapulogalamu ogulitsa akusintha. Ngati inu mukupanga lingaliro limenelo ndipo mukulakwitsa, mudzayenera kulipira ngongole yonse ya mammogram.
Pali zosiyana zitatu zomwe zili mu-network:
- Ngati EPO ilibe mndandanda wothandizira ntchito yapadera yomwe mukufuna. Ngati izi zikukuchitikirani, konzekerani chisamaliro chapadera cha pulogalamu ndi EPO. Sungani EPO yanu pachimake.
- Ngati muli pakati pa njira yapadera ya chithandizo pamene mukukhala membala wa EPO, ndipo katswiri wanu sali mbali ya EPO. EPO yanu idzasankha ngati simungathe kumaliza mankhwala anu ndi dokotala wanu pakalipano.
- Zoona zoopsa zenizeni. Ngati mukudwala sitiroko, matenda a mtima, kapena vuto linalake loyenera muyenera kupita ku chipinda chapafupi chapafupi ngati muli ndi intaneti ndi EPO yanu. Ambiri a EPO amawerengera mtengo wa chithandizo chodzidzimutsa chomwe amalandira kuchipatala chapafupi chapafupi ngati kuti chinali chithandizo cha intaneti. Ngati mukufuna kulandiridwa kuchipatala kuchokera kwa ER, komabe EPO yanu ikhoza kupempha odwala kuti asamalowe kuchipatala kuti alowe.
Simukuyenera Kukhala ndi Dokotala Wapamwino
Pulogalamu yanu ya umoyo wa EPO siidzafuna kuti mukhale ndi dokotala wamkulu (PCP) , ngakhale kutenga PCP akadali lingaliro labwino.
Simukusowa Kukhala ndi Cholozera Kuwona Wophunzira
Ndi EPO simudzafunsidwa kuti mutumizidwe asanayambe katswiri. Izi zimapangitsa kuti mukhale ovuta kuona katswiri kuyambira mukudzipangira nokha, koma muyenera kusamala kuti mukuwona akatswiri omwe ali pa-network ndi EPO yanu. Ubwino wokhala ndi PCP ndikuti nthawi zambiri amadziwika ndi akatswiri ammudzi mwanu, ndipo akatswiri ambiri ali ndi chidwi chapadera mwazochita zawo, mwachitsanzo, anthu ena odziwa za khansa yapamwamba angakhale ndi chidwi chapadera ndi khansa ya m'mawere pamene wina angakhale ndi chidwi chapadera mu khansa yamapapo.
Mudzakhala Wofunikira Kutsogoleredwa Kwa Ntchito Zothandizira Zamtengo Wapatali
EPO yanu idzakufunsani kuti mulandire chilolezo kwazinthu zina, makamaka zomwe zimapindulitsa kwambiri. Ngati ntchito inayake imafuna chisanayambe (chilolezo) ndipo ngati simukuchipeza, EPO yanu ingakane kulipira. Nthawi zambiri mautumiki omwe amafuna kuti maulamuliro akhale osankhidwa ndi osasamala, kotero kuchedwa kochepa sikungakhale koopsa.
Kuloledwa kumbuyo kumathandiza EPO kukhalabe ndi ndalama zambiri poonetsetsa kuti mukufunikiradi mautumiki omwe mumapeza. Mu zolinga monga ma HMO omwe amafuna kuti mukhale ndi dokotala wamkulu, PCP yanu ndi yotsimikiza kuti mukufunikiradi mautumiki omwe mumapeza. Popeza EPO yanu siifuna kuti mukhale ndi PCP, imagwiritsa ntchito chitsogozo choyambirira monga njira yokwaniritsira cholinga chomwecho: EPO ikhoza kulipira zinthu zomwe ziridi zofunikiradi.
Mapulogalamu a EPO amasiyana ndi mtundu wanji wa mautumiki omwe ayenera kutsogozedwa kale. Ambiri amafunika chitsogozo choyambirira cha zinthu monga MRI ndi CT scans, mankhwala okwera mtengo, opaleshoni, hospitalizations, ndi zipangizo zamankhwala monga mpweya wabwino. Phunziro la EPO la Benefits ndi Coverage liyenera kukuuzani zambiri zokhudza chololedwa chisanayambe, koma muyenera kuyembekezera kuti ntchito iliyonse yamtengo wapatali iyenera kukhala yoyenera.
Ngakhale dokotala wanu angadzipereke kuti adzilolereni, ndiye kuti ndi udindo wanu kutsimikizira kuti mumalandira chithandizo chisanayambe mutalandira chithandizo chamankhwala. Ngati simukutero, EPO yanu ili ndi ufulu wokana kulipira chisamaliro, ngakhale ngati kusamalidwa kunali koyenera ndipo mumalandira kuchokera kwa wothandizira.
Chilolezo chisanafike chimatenga nthawi. Nthaŵi zina, mudzakhala ndi chilolezo musanachoke ku ofesi ya dokotala. Kawirikawiri, zimatenga masiku angapo. Muzovuta, kapena ngati pali vuto ndi chilolezo, zingatenge masabata. Onani malingaliro athu a momwe mungapezere pempho lovomerezeka lisanavomerezedwe .
Simuyenera Kulemba Zolemba
Simukuyenera kuwononga ndi ngongole ndikupempha fomu mukakhala ndi inshuwalansi ya inshuwalansi ya EPO popeza chisamaliro chanu chimaperekedwa mu-intaneti. Pulogalamu yanu yaumoyo ya EPO mwachindunji kuti mukhale osamalira. Inu mutha kukhala ndi udindo polipira wanu deductible, ndalama, ndi coinsurance.
Pamunsi pa EPO Health Insurance
Ma EPO ali ndi makhalidwe ofanana ndi ma HMO ndi zina zomwe zimagwirizana ndi PPOs. Momwemo, mungaganizire kuti EPO ikhale pakati pa HMO ndi PPO. Anthu ambiri amakonda kukhala ndi mwayi wokonzekera zokambirana ndi katswiri popanda kufunsa dokotala wamkulu wa chisamaliro. Pa nthawi yomweyo, izi nthawi zina zingakhale zovuta poti ndinu ochepa kwa akatswiri ena mu intaneti yanu. Kukhala ndi EPO kumakufunikanso kuti muzitha kukonzekera ntchito zamtengo wapatali, ndipo simungakhale ndi udindo wokwaniritsa zilolezo zilizonse zoyenera. Zonsezi, kuphatikizapo ndalama zapansi ndi kugawa kwa mtengo wotsika kumachititsa EPO kukhala yabwino kwa anthu ambiri. Ngati mukuzipeza mutaganizira zofanana, yang'anani kufanana kwa ma HMO, PPOs, EPOs. ndi mapulani a POS .
> Chitsime:
> Healthcare.gov. Pulogalamu ya Exclusive Provider Organization (EPO). https://www.healthcare.gov/glossary/exclusive-provider-organization-epo-plan/