Kulipiritsa zamankhwala kwa Medicare, Medicaid, ndi Tricare

Kumvetsetsa zofunikira za inshuwalansi za odwala inshuwalansi ndi olemba malipiro amathandiza ogwira ntchito ku ofesi yachipatala kuti alankhulane bwino ndi odwala za inshuwalansi za umoyo wawo ndi kukambirana nawo nkhani za odwala ndi oimira inshuwalansi. Ngati mukufuna kukhala wolemba zachipatala, apa pali phunziro pa Medicare, Medicaid, Tricare, ndi malipiro ena.

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Kumvetsetsa Medicare

Ndikofunika kumvetsetsa zomwe amafuna ku Medicare zomwe zingakhale zovuta. Taganizirani kupita ku zochitika ndi maphunziro. Othandizira ayenera kuonetsetsa kuti omwe ali ndi udindo wokonzekera ndikupereka madandaulo kwa Medicare amadziwa zoyenera kutsata ndondomeko ndi malamulo.

Pali zigawo zinayi zofunika za Medicare Program:

1. Medicare Part A: Medicare Part A ndi gawo la Medicare kuti anthu ambiri salipira kulipira inshuwalansi ya chipatala. Medicare Part A imatchedwa inshuwalansi ya chipatala chifukwa imathandiza kulipira chisamaliro chomwe wodwala alandira kuchipatala chachipatala, chipatala cholandira chithandizo, chipatala cha azamwino (SNF), chisamaliro cha kuchipatala ndi chisamaliro cha kunyumba.
2. Medicare Part B: Medicare Part B ndi gawo la Medicare wotchedwa mankhwala inshuwalansi. Gawo B limapereka ntchito zambiri zomwe sizinalembedwe ndi Gawo A monga Dokotala Wolozera, Kuchiza Mthupi, Kuteteza Kusamalira, Zamankhwala, Zamagwirizano, ndi zina zotero.
3. Medicare Part C: Medicare Part C imadziwikanso ngati Medicare + Chosankha koma imatchedwa Medicare Advantage Plans. Medicare Zopindulitsa Amapereka mwayi kwa odwala Medicare kulembetsa inshuwalansi ya thanzi labwino kapena ndondomeko yoyang'anira chisamaliro chomwe akufuna. Pali malingaliro osiyanasiyana omwe mungasankhe kuchokera kuzinthu zopereka zomwe nthawi zambiri zimagwiritsidwa ntchito ndi mankhwala a Medicare.
4. Medicare Part D: Chigawo ichi cha pulogalamu ya Medicare ndi Dipatimenti ya Drug Drug Benefit. Kuphunzira kwa mankhwala kumapezeka kudzera mwa Mapulani a Medicare Advantage.

Zambiri

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Kumvetsa Medicaid

Medicaid nthawi zonse amalipira malipiro omaliza . Izi zimangotanthauza kuti Medicaid nthawi zonse amalipira nthawi imene pali inshuwalansi zaumoyo. Ovomerezeka amafunika kuti Medicaid adziwe zambiri za inshuwalansi.

Othandizira ali ndi udindo wozindikiritsa Medicaid ya inshuwaransi ya chipani chomwe amapeza ndikudziwitsa Medicaid za malipiro onse omwe amalandira m'malo mwa wolandira.

Medicaid ndi boma lolamulidwa, choncho, boma lirilonse liri ndi zofuna zawo zokha. Billers ayenera kulankhulana ndi pulogalamu ya Medicaid mudziko lawo kuti adziwe zambiri zachitsulo.

Zambiri

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Kumvetsa Kukwera

TRICARE, mbali ya Military Health System, ndi pulogalamu yachipatala kwa mamembala omwe amagwira ntchito, omwe achoka pantchito komanso omwe ali pantchito komanso asilikali awo. Pali zigawo zinayi zosiyana siyana zomwe zimapereka chithandizo kwa opindula TRICARE:

• Kumpoto
• South
• Kumadzulo
• Kum'mawa

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Kumvetsetsa Ena Obwezera

Kukhala ndi chidziwitso chachikulu cha mtundu uliwonse wa inshuwalansi kungachepetse mavuto okhudza kufotokozera malingaliro ndi kusonkhanitsa malipiro. Pali mitundu iwiri ikuluikulu ya mapulani a inshuwalansi:

• Inshuwalansi Yodalirika : Ndondomeko ya inshuwalansi yodalirika imapereka malipiro ku ofesi ya zachipatala yokhazikika pa mtengo wothandizira.
• Ndondomeko Zosamalidwa : Kusamalira ndondomeko za chisamaliro zimayesetsa kuthetsa ndalama za chithandizo chaumoyo kwa mamembala awo mwa kukonza ndi kukonzekera chisamaliro ndi magulu a madokotala, akatswiri, ndi zipatala. Pali njira zinayi zosamalira zosamalira:
  • Mabungwe Omwe Amasamalira Odwala (HMOs)
  • Mabungwe Opereka Othandizira (PPOs)
  • Makampani Odzipereka Okhaokha (EPOs)
  • Mapulani a Point-of-Service (POS)