Kodi kampani yanu ya inshuwalansi ya zaumoyo inakupatsani inu woyang'anira mlandu? Kodi mukuwonetsedwa ndi woweruza mlandu ku chipatala kapena kampani yathanzi? Kodi ndinu namwino amene akufuna kukhala woweruza mlandu? Osatsimikiza ndendende zomwe abwana amalephera kuchita, chifukwa chiyani mukusowa, kapena mutakhala bwanji ngati mutakhala woweruza mlandu? Nazi zomwe muyenera kudziwa.
Kusamalira Mlandu Kungatanthauze Zinthu Zosiyana M'madera Osiyanasiyana
Choyamba, muyenera kudziŵa kuti mtsogoleri wodalirika akudalira momwe akugwirira ntchito.
Mwachitsanzo, mkulu wothandizira kampani yothandizira zaumoyo panyumba adzapereka mautumiki osiyanasiyana kusiyana ndi mtsogoleri wa bungwe la inshuwalansi, kampani ya inshuwalansi ya antchito, kapena chipatala.
Komabe, pali zinthu zina zogwirizana ndi maudindo onse otsogolera. Momwemo, makampani oyang'anira nkhani amayesa zosowa za wodwalayo komanso zopezekapo. Aimayi oyang'anira nkhani amayesa kupeza njira yabwino kwambiri yopezera zosowa za wodwalayo ndizopezekapo.
Ndipo makamaka chifukwa cha matenda aakulu, odwala, kuthetsa vutoli kungabweretse zotsatira zabwino za wodwala, kutsata bwino malangizo a zachipatala, ndi kukhala ndi moyo wabwino wodwala wodzisamalira - ngakhale pali malire ku zotsatira zowonongeka. Pano pali zitsanzo za zomwe mtsogoleri wamkulu amachitiramo zosiyana.
Woyang'anira Zamlandu wa Chipatala
Katswiri wa chipatala nthawi zambiri ndi namwino amene amachititsa kafukufuku wogwiritsira ntchito komanso kukonzekera .
Kuwunika ntchito kumaphatikizapo kuonetsetsa kuti wodwala akulandira chithandizo chomwe chiri chofunikira kuchipatala ndikuchipeza pamalo oyenera. Kukonzekera kwadongosolo ndi ndondomeko yowonetsera odwala akupitiriza zosowa zachipatala pambuyo pa chipatala ndikuika ndondomeko yokwaniritsa zosowazo. Maofesi a chipatala akuyang'anira ntchito zosamalira zosamalidwa kudutsa nthawi ndi othandizira .
Mwachitsanzo, ndi mtsogoleri wamkulu wa chipatala chomwe chimatsimikizira kuti kampani ya inshuwalansi ya umoyo imamvetsa zomwe zikuchitika pa chipatala cha wodwalayo. Amaonetsetsa kuti inshuwalansi ali ndi zambiri zomwe akufunikira kuti avomereze kulipiritsa kwa chipatala ndikugwira ntchito kuti asamayesere kukana inshuwalansi. Amayankhula ndi wothandizira nkhani ya inshuwalansi tsiku lililonse kapena masiku angapo.
Ndiyo amene amakonza kuti wodwala azipita kunyumba kuchokera kwa namwino wochezera atatulutsidwa kuchipatala, kapena kuti akonzekezedwe kambirimbiri kuchokera kuchipatala chokonzekera kuchipatala. Ndi amene amathandiza wodwalayo kusankha kampani yathanzi kapena chipatala chomwe chili pa intaneti ndi wa inshuwalansi ndipo amulandira ngati wodwalayo.
Kuonjezera apo, mtsogoleri wa chipatala angayambe kukambirana zopindulitsa pakati pa inshuwalansi, wopereka, ndi wodwalayo. Pano pali chitsanzo: Mwinamwake wodwala matenda a mafupa osakayika ali ndi thanzi labwino loti apite kunyumba kuchokera kuchipatala ndikupeza mankhwala ake achinayi kunyumba kwa milungu itatu yotsatira. Komabe, inshuwalansi ya umoyo wa wodwalayo sichikuphimba mankhwala osokoneza bongo kapena mankhwala omwe ali ngati IV ndi mapampu omwe wodwalayo amafunika kulandira mankhwala kunyumba.
Mankhwala am'nyanja IV amafuna kuti wodwalayo azilipira madola 5,000 mu thumba lake chifukwa cha mankhwala ndi zipangizo.
Woweruza mlanduyo akhoza kukambirana ndi mankhwala a kunyumba IV, kampani yothandizira odwala, wodwala inshuwalansi, ndi wodwalayo. Mwina amalola wodwala kuti avomereze kulipira ndalama zokwana madola 1,000 pa mtengo wa mankhwala ndi zipangizo kotero kuti sayenera kukhala kuchipatala kwa milungu itatu.
Amapezanso mankhwala osungirako mankhwala a kunyumba (IV) kuti achepetse mtengo wa mankhwala ndi zipangizo ndi $ 1,000. Amapeza kampani yosamalira anthu kuchipatala kuvomereza kuti agwirizane kuti azitenga mapepala amadzimadzi a IV omwe amawononga madola 500.
Amapeza kampani ya inshuwalansi yaumoyo kuti agwirizane kulipira mankhwala otsala $ 2,500 ngakhale kuti sichiyenera chifukwa sichikuthandizira potsatira ndondomeko ya wodwalayo.
Wa inshuwalansi ali wokonzeka kulipira $ 2,500 kotero sichiyenera kupitiriza kuchipira chipatala kwa anthu odwala. Kampani yathanzi ikufuna kulipira madola 500 pamapope chifukwa ngati sichitero, wodwalayo sadzabwera kunyumba ndipo sadzasowa chithandizo choyamwitsa chithandizo chamankhwala kunyumba. Mankhwalawa ndi ofunitsitsa kuchepetsa mtengo wa mankhwala ndi zipangizo ndi $ 1,000 chifukwa kupanga phindu laling'ono kuli bwino kusiyana ndi kusasunga ndalama konse ngati wodwalayo asamasulidwe.
Wogwira Ntchito Zaumoyo Panyumba
Mayi wamkulu wa zaumoyo akusiyana ndi chipatala cha chipatala chifukwa nthawi zambiri amapereka chisamaliro chakumoyo. Kuphatikiza apo, amagwirizanitsa ntchito za anthu ena ogulu la zaumoyo ndi othandizira, amalankhulana ndi kampani ya inshuwalansi ya umoyo, amayankhula ndi dokotala wa wodwalayo, ndipo amawongolera anamwino ena obwereza kapena othandizira am'nyumba omwe amathandizanso wodwalayo.
Ndi zowonjezera kuchokera kwa wodwala ndi banja, woyang'anira ndondomeko ya chisamaliro cha kunyumba amapanga ndondomeko ya chisamaliro cha wodwalayo ndikupereka kwa wodwala wodwalayo kuti amuvomereze. Amagwirizanitsa kukwaniritsa dongosololi ndi wodwala, oyenerera ogwira ntchito, ndi tinthu tomwe tikufunikira.
Wothandizira Kampani ya Inshuwalansi ya Health Insurance
Bungwe la inshuwalansi la kampani ya inshuwalansi limalandira chidziŵitso kwa oyang'anira magulu a chipatala, makampani othandizira zaumoyo kunyumba, maofesi a madokotala, ogwira ntchito ndi anthu ena othandizira zaumoyo. Malingana ndi inshuwalansi ndi malo, angathenso kupita kwa wodwala kuchipatala.
Cholinga chake ndikutsimikiza kuti wodwala akupeza chisamaliro chofunikira cha mankhwala, chisamaliro chapamwamba, ndi kuti chisamaliro chikuperekedwa moyenera komanso mochuluka momwe zingathere. Amayang'anira zosowa za wodwalayo komanso amayesetsa kukhazikitsa njira zothandizira zosowa zawo moyenera.
M'makampani ena a inshuwalansi, angathe kuchepetsa ntchito yake kwa odwala omwe ali ndi matenda aakulu. Mwachitsanzo, ngati amagwira ntchito ndi odwala matenda a nyamakazi , ndiye katswiri wotsogolera chisamaliro cha odwala RA ndipo akhoza kuyembekezera kuti akusamalira ndi kuyika bwino njira zothandizira zosowa zawo. Amatha kudula tepi yofiira ndipo akhoza kukhala ndi mwayi wokwaniritsa zopindulitsa za inshuwalansi ndi kuvomereza zinthu kapena ntchito zomwe sizikugwiritsidwa ntchito ndi inshuwalansi ya umoyo koma zidzalola kusamalidwa bwino komanso kupulumutsa ndalama pamapeto pake. Amagwira ntchito kuti akwaniritse zosowa za wodwalayo pamene akuyang'ana zenizeni komanso zolinga zamtsogolo.
Kodi Ndani Amasamalira Mutu?
Kuwongolera ndondomeko kawirikawiri kumachitidwa ndi anamwino, koma osati nthawi zonse. Malingana ndi malo, mtundu wina wa akatswiri angapereke chithandizo cha makampani. Mwachitsanzo, munthu yemwe amapereka chithandizo pa nkhani yogwiritsira ntchito mankhwala osokoneza bongo angakhale ndi chiyambi cha uphungu woledzera. Si zachilendo kuti kasamalidwe kachitidwe kachitidwe ndi ogwira ntchito zachipatala.
Kuti mudziwe zambiri za kaye kayeti, onani Commission for Certification Manager Certification.
> Zotsatira:
> Achirendo Achimereka a Credentialling Center (Othandizira a American Nurses Association), Nursing Case Management.
> US Department of Health and Human Services, bungwe la Healthcare Research and Quality, Dipatimenti ya Umoyo wa Edzi, February 2013.