Kumvetsetsa Mabungwe Opereka Othandizidwa
Kodi mukuganiza kuti mukulembera inshuwalansi ya inshuwalansi ya PPO? Onetsetsani kuti izi zikugwirizana ndi zosowa zanu podziwa momwe zimagwirira ntchito. Kodi mwalembetsa kale PPO? Kumvetsetsa momwe zimagwirira ntchito kudzakuthandizani kugwiritsa ntchito inshuwaransi yanu yapamwamba ndikupewa zolakwa zamtengo wapatali.
Kumvetsetsa PPOs
PPO imayimira bungwe lopatsidwa mwayi . Ma PPO ali ndi dzinali chifukwa ali ndi mndandanda wa ogwira ntchito zaumoyo omwe amafuna kuti mupeze chithandizo chanu chaumoyo.
Ngati mutalandira chisamaliro chanu chaumoyo kwa operekera osankhidwawo, mumalipira zochepa.
PPOs ndi mtundu wa inshuwalansi yaumoyo wothandizira odwala monga mabwenzi awo apatali, mabungwe okonza zaumoyo, kapena ma HMO. Mapulani onse okhudzidwa okhudzidwa ali ndi malamulo okhudza mmene muyenera kukhalira ndi thanzi lanu. Ngati simukutsatira malamulo a mapulani omwe amatha kusamalira, mwina sangathe kulipiritsa, kapena kuti mudzaweruzidwa ndi kuyika gawo lalikulu la mtengo wa chisamaliro chanu m'thumba lanu.
Momwe Mungayendetsere Thandizo la Thanzi Labwino Pitirizani Kutsika
Mapulani onse okhudzidwa osamaliridwa ali ndi malamulowa kuti asunge ndalama zothandizira. Malamulo ambiri amachita izi mwa njira zazikulu ziwiri:
- Amachepetsa ntchito zanu zothandizira zaumoyo pazinthu zokhazo zomwe zimakhala zofunikira kapena zomwe zimapangitsa kuti chithandizo chaumoyo wanu chichepetse mofulumira, monga kusamalira chithandizo .
- Amachepetsa amene kapena malo omwe mungapeze thandizo lachipatala, ndipo amakambirana malingaliro ochokera kwa ogwira ntchito zaumoyo omwe mumaloledwa kulandira chithandizo chaumoyo.
Momwe PPO imagwirira ntchito
PPOs amagwira ntchito motere:
- Inu mumalipira gawo; PPO imapereka gawo.
PPO imagwiritsa ntchito kugawa ndalama kuti zithetse ndalama. Mukawona dokotala kapena kugwiritsa ntchito chithandizo chamankhwala, mumalipira ndalama zina mwazinthu zomwe mumadzipereka nokha, mwazinthu zowonongeka , zothandizira ndalama , ndi zolipira .
Kugawana mtengo ndi gawo la dongosolo la PPO kuti muwonetsetse kuti mumasowa thandizo lachipatala lomwe mukupeza. Pamene mukuyenera kulipira chinachake kuti muwasamalire, ngakhale ngongole yaing'ono, simungagwiritse ntchito ntchito zopanda ntchito mwachangu. Komabe, chifukwa cha Affordable Care Act , PPOs silingathe kugawana mtengo uliwonse kwa ntchito zothandizira.
Kugawana mtengo kwa ndalama kumathandiza kuchepetsa mtengo wa chisamaliro chanu. Mukamapereka malipiro anu, ndalama zanu zochepa zimakhala zochepa ndipo Pansi ikhoza kubweza ndalama za mwezi uliwonse.
- Ngati mumagwiritsa ntchito intaneti ya PPO, mumalipira pang'ono.
PPO imaletsa malire kuchokera kwa yemwe kapena kumene mungapeze thandizo la zaumoyo pogwiritsa ntchito gulu la ogwira ntchito zaumoyo omwe adakambirana nawo. Maselo a PPO samaphatikizapo madokotala okha, koma mtundu uliwonse wa chithandizo chamankhwala monga mabala, x-ray zipatala, opaleshoni zakuthupi, opereka zipangizo zamankhwala, zipatala, ndi malo opaleshoni opita kuchipatala.
PPO ikukulimbikitsani kuti muteteze chisamaliro chanu kuchokera kwa ogwiritsira ntchito awo pogwiritsa ntchito makina anu apamwamba kapena ndalama zothandizira pokhapokha ngati mutasamala. Mwachitsanzo, mungakhale ndi $ 40 copay kuti muwone dokotala wa-intaneti , koma 50 peresenti amalipira ndalama powona dokotala wotuluka kunja. Ngati dokotala wotuluka kunja akutenga ndalama zokwana madola 250 ku ofesi ya ofesiyi, mudzalipira madola 125 osati ndalama zokwana madola 40 omwe mungapereke mlandu ngati mutagwiritsa ntchito dokotala wa intaneti.
Komabe, ngakhale mutapereka zambiri mukamagwiritsa ntchito othandizira ogwira ntchito zaumoyo , imodzi mwa zofunikira za PPO ndi yakuti, pamene mumagwiritsa ntchito anthu omwe akugwira ntchito pa Intaneti, PPO imapereka kanthu kena pa mtengo wa misonkhano. Iyi ndi njira imodzi yomwe PPO imasiyana ndi HMO. HMO sichidzapereke chirichonse ngati mutasamala chisamaliro chanu.
- Muyenera kupeza mautumiki omwe amatsogoleredwa ndi PPO.
Njira imodzi yomwe PPO imatsimikizira kuti ikulipilira ntchito zothandizira zaumoyo zomwe ziri zofunika kwambiri ndi kukufunsani kuti mupeze chithandizo chisanayambe musanakhale ndi mayeso, ndondomeko, kapena chithandizo chamtengo wapatali. Ngati simulandira chilolezo ku PPO yanu musanayambe kugwira ntchitoyi, PPO sichidzalipira.
Ma PPO amasiyana ndi mayesero, ndondomeko, mautumiki, ndi chithandizo chimene amafunikira chisanayambe chilolezo, koma muyenera kuganiza kuti mudzafunikira chitsogozo chilichonse cha mtengo wapatali kapena chilichonse chomwe chingatheke mosavuta m'njira zosiyanasiyana. Mwachitsanzo, mungathe kupeza mankhwala a mankhwala achikulire odzaza opanda chilolezo chisanayambe koma muyenera kulandira chilolezo cha PPO kuti mukhale ndi mankhwala omwe amachititsa kuti mugwiritse ntchito mankhwala omwewo.
Pamene iwe kapena dokotala wanu akufunsa PPO kuti adzilamulire, PPO iyenera kudziwa chifukwa chake mukufunikira kuyesa, ntchito, kapena mankhwala. Ndiko kuyesa kutsimikiza kuti mukufunikiradi chisamaliro chimenecho, ndikuti palibe njira yowonjezera yowonjezera kukwaniritsa cholinga chomwecho. Mwachitsanzo, pamene dokotala wanu wa opaleshoni amafunsa chisanafike chilolezo cha opaleshoni yanu ya mawondo, PPO yanu ingafune kuti muyese chithandizo choyamba. Ngati mukuyesa chithandizo chamankhwala ndipo sichikonza vuto, ndiye PPO ingapite patsogolo ndikuyambitsanso opaleshoni yanu ya mawondo.
Kusiyana pakati pa PPO ndi mitundu ina ya inshuwalansi ya thanzi
Ndondomeko za chisamaliro monga ma HMO, mabungwe odzipereka okha (EPOs) ndi mapulani a pos-service (POS) amasiyana ndi PPOs ndi wina ndi mzake m'njira zosiyanasiyana. Ena amapereka chisamaliro cha kusamalidwa; ena samatero . Ena ali ndi kugawa kwapafupi; Zina zimakhala ndi ndalama zambiri zomwe zimapereka ndalama zambiri komanso zimakhala zofunikira kwambiri . Ena amafuna dokotala wamkulu wa chisamaliro (PCP) kuti azikhala ngati mlonda wanu wam'chipatala, kungokulolani kupeza ntchito zothandizira zaumoyo ndi kutumiza kuchokera ku PCP; ena samatero. Kuwonjezera pamenepo, PPOs ndizofunika kwambiri chifukwa zimakupatsani ufulu wochuluka.
> Chitsime:
> Humana. HMO vs. PPO: Ndi Ndani Amene Ali Woyenera? 2017.