Zimene muyenera kuyembekezera mutalowa bungwe la zaumoyo
Kumvetsetsa zomwe HMO ili ndi momwe amagwira ntchito ndizofunikira pakusankha ndondomeko yaumoyo panthawi yolembera komanso pogwiritsa ntchito HMO mutatha kulembetsa.
Kodi HMO N'chiyani?
HMO imayimira bungwe lokonzekera zaumoyo , mtundu wa inshuwalansi ya umoyo wodalirika. Monga dzina limatanthawuzira, imodzi mwa zolinga za HMO ndizosunga ziwalo zake. HMO wanu amatha kugwiritsa ntchito ndalama zing'onozing'ono kutsogolo kukuletsa matenda kusiyana ndi ndalama zambiri poyesera kuchiza.
Ngati muli ndi matenda aakulu, HMO yanu idzayesa kuthetsa vutoli kuti mukhale ndi thanzi labwino.
Pofika m'chaka cha 2016, anthu oposa 92 miliyoni a ku America anali kufalitsa mu HMO. Izi zinaphatikizapo anthu ogwiritsidwa ntchito ndi ogulitsa ntchito, komanso anthu omwe amagwiritsidwa ntchito ku Medicare Advantage HMOs ndi Medicaid yosamalira ma HMO.
Kodi Zimagwira Ntchito Bwanji?
1. Muyenera kukhala ndi dokotala wamkulu wa chisamaliro.
Mlangizi wanu wamkulu , nthawi zambiri dokotala wa banja, internist kapena adokotala, adzakhala dokotala wanu wamkulu ndipo adzakonza chisamaliro chanu chonse. Ubale wanu ndi dokotala wanu wamkulu ndikofunika kwambiri mu HMO. Onetsetsani kuti mumakhala omasuka naye kapena musinthe. Muli ndi ufulu wosankha dokotala wanu wachisamaliro pokhapokha ngati ali mu intaneti ya HMO. Ngati simusankha nokha, bwana wanu wa inshuwalansi adzakupatsani gawo limodzi.
2. Dokotala wanu wamkulu akuyenera kukuthandizani chifukwa cha mankhwala enaake apadera.
Dokotala wanu wamkulu wa chisamaliro ndiye amene amasankha ngati simukusowa zina mwa chisamaliro ndipo muyenera kutumiza kuti mulandire. Zitsanzo ndikuwona katswiri, kupeza mankhwala kapena kupeza zipangizo zamankhwala monga chikuku. Kufuna kutumizidwa kumapereka chithandizo chamankhwala, mayesero ndi chisamaliro chapadera chomwe mukuchilandira ndizofunika kuchipatala.
Popanda kutumizidwa, mulibe chilolezo kwa mautumikiwa ndi HMO sichidzawalipira.
Phindu la dongosolo lino ndilo kuti odwala amalandira thandizo lochepa. Koma vutoli ndilo kuti odwala ayenera kuwona odwala ambiri (dokotala wamkulu wa chisamaliro komanso katswiri) ndipo amalipira ndalama kapena zogawana ndalama zina pa ulendo uliwonse.
3. Muyenera kugwiritsa ntchito othandizira pa intaneti.
HMO iliyonse ili ndi mndandanda wa odwala omwe amapereka chithandizo. Anthu omwe amapereka chithandizochi amapereka ntchito zosiyanasiyana zothandizira zaumoyo kuphatikizapo madokotala, akatswiri, apamtima, zipatala, mabala, x-radi malo, ndi othandizira olankhula. Ngati mutasamala, HMO sichilipira; mudzakhala mukulipira ngongole yanu yonse .
Kutuluka mwachisawawa kumatope kungakhale kosavuta kwambiri pamene muli ndi HMO. Lembani mankhwalawa pa mankhwala osokoneza bongo kapena muyesetse magazi anu opangidwa ndi labu lolakwika ndipo mukhoza kukhala ndi bili ya mazana kapena zikwi za madola.
Ndi udindo wanu kudziwa omwe ali ndi intaneti ndi HMO yanu. Izi sizili zovuta kwambiri ndi HMO monga Kaiser Permanente komwe ogwira ntchito pazithunzithunzi ali mu nyumba imodzi ndikuwona odwala koma odwala Kaiser.
Koma, ngati muli ndi HMO ndi inshuwalansi monga United Healthcare, Aetna, kapena WellPoint, omwe amapereka ma-networkwa sadzakhala nthawi yomweyo ndipo nthawi zambiri amawona odwala omwe sali mamembala a HMO. Simungaganize kuti, chifukwa labu ili pansi pa holo kuchokera ku ofesi yanu, labu ili mu-network ndi HMO yanu. Muyenera kufufuza.
Pali zosiyana zitatu kufunika kokhala mu-intaneti:
- Zovuta zenizeni.
- HMO ilibe mndandanda wothandizira pa ntchito yapadera yomwe mukufunikira. Ichi ndi chosowa. Koma, ngati zikukuchitikira, konzekerani chisamaliro chapadera cha pulogalamuyo ndi HMO- chitani HMO yanu.
- Muli pakati pa njira yapadera ya chithandizo pamene mukukhala membala wa HMO, ndipo katswiri wanu sali mbali ya HMO. Ma HMO ambiri amadziwa ngati mungathe kumaliza mankhwalawo ndi dokotala wanu wamakono payekha.
4. Zomwe mukuyenera kugawana nazo mu HMO nthawi zambiri zimakhala zochepa.
Kugawana mtengo kwa ndalama monga zopereka , mapepala, ndi ndalama zothandizira ndalama zimakhala zosachepera ndi HMO. Ma HMO ena omwe amagwiritsidwa ntchito ndi abwana samasowa deductible (kapena ali ndi ndalama zochepa) ndipo amangofuna ndalama zochepa pazinthu zina. Chifukwa cha kugawidwa kwawo kochepa mtengo komanso malipiro apansi, ma HMO amalingalira kuti ndi imodzi mwa zosankha zambiri za inshuwalansi zaumoyo.
Komabe, pa msika wa inshuwalansi payekha, komwe pafupifupi 7 peresenti ya anthu a ku United States anapeza kufotokoza kwawo mu 2016, ma HMO amakhala ndi ndalama zambiri zowonongeka komanso zopanda ndalama. M'madera ena, ndondomeko zokha zomwe zimapezeka pamsika pamsika ndi ma HMO, ndi zopereka zomwe zimakwera kufika pamtunda zikwi zikwi zambiri. M'mayiko ambiri, nthawi zambiri pamakhala msika wosasankhidwa pamsika pamtundu uliwonse ( HMO, PPO, EPO, kapena POS ), poyerekeza ndi msika wogulitsidwa ndi abwana, kumene kusankha makina opangidwa ndi magetsi amakhalabe olimba kwambiri.
HMO ndi Mitundu ina ya Inshuwalansi ya Umoyo
Inshuwalansi yaumoyo yonse yosamalidwa (yomwe imaphatikizapo kufotokozera kwapayekha ku US) ili ndi zinthu zina zofanana. Mwachitsanzo, palibe ndondomeko yathanzi yosamalidwa yothandizira yomwe idzapereke chisamaliro chomwe sichiri chofunikira kuchipatala, ndipo ndondomeko zonse zosamalidwa zowonongeka zili ndi njira zothandizira iwo kuti azindikire zosamalidwa ndi mankhwala, komanso chisamaliro chotani.
Ndondomeko zothandizira monga ma PPOs, EPOs, ndi mapulani a POS amasiyana ndi ma HMO m'njira zosiyanasiyana. Ena adzaperekera chisamaliro chatsopano, ndipo ena sadzatero (onse ayenera, ngati ndiwodzidzidzimutsa). Ena ali ndi zofunikira zogawana ndalama zambiri pamene ena ali ndi ndalama zambiri ndipo amafunikanso ndalama zambiri. Ena amafuna dokotala wamkulu, koma ena samatero.
Mungaphunzire zambiri za kusiyana pakati pa mitundu ya zaumoyo, HMO, PPO, EPO & POS-Kodi Kusiyana ndi Chiyani Kumene Ndiko Koposa?
> Zotsatira:
> Kaiser Family Foundation. Inshuwalansi ya Umoyo wa Anthu Onse. 2016.
> K aiser Family Foundation. Kulembetsa kwa HMO. January 2016.