Gulu Lotsatiridwa la Othandiza Odwala
A inshuwalansi othandizira otetezera ndi gulu la athandizi omwe agwirizana ndi inshuwalansi wothandizira (kudzera HMO, EPO, kapena PPO ) kuti asamalire pa kuchotsera.
Mapulogalamu a zachipatala amatenga madokotala monga madokotala apadera, madokotala apadera, mabala, maofesi a X-ray, makampani othandizira zaumoyo, ogwira ntchito zachipatala, opereka zipangizo zamankhwala, malo opatsirana, operekera mankhwala osokoneza bongo, malo ochitira opaleshoni masiku ano.
Makampani a inshuwalansi a zaumoyo amafuna kuti mugwiritse ntchito ogwira ntchito mu intaneti zawo pa zifukwa zikuluzikulu ziwiri:
- Owapatsa ameneĊµa agwirizana ndi ndondomeko za khalidwe la thanzi.
- Iwo avomereza kuvomereza mlingo wogwilitsika wogwilitsidwa ntchito zawo, mu malonda a voliyumu voliyumu omwe adzalandire mwa kukhala gawo la mapulani.
N'chifukwa Chiyani Nkhani Zanu Za Thanzi Lanu Zimagwira Ntchito?
Mudzabwezera ndalama zochepa komanso ndalama zothandizira pokhapokha mukapeza chisamaliro chanu kuchokera kwa wothandizira pa intaneti, poyerekeza ndi pamene mumasamalira kuchokera kwa wothandizira pa Intaneti . Ndipotu, ma HMO ambiri sangathe kulipira ngongole imene munalandira kuchokera kwa wothandizira ena kunja kupatula pansi pa zochitika zambiri . Ngakhale zochepa zoletsera PPO zimapereka ndalama 20 kapena 30 peresenti ya inshuwalansi kwa opa-intaneti komanso 50 kapena 60 peresenti ya inshuwalansi kwa ogwira ntchito pa Intaneti, ndipo amakhala ndi ndalama zowonjezera komanso zopanda malire pamene mukupita kunja kwa ukonde.
Ndalama zopezeka mu-network zimakhazikitsa dongosolo lanu labwino, kusonkhanitsa ndalama zokhazokha kapena zoperekedwa kuchokera kwa inu panthawi ya misonkhano (chifukwa cha ndalama zothandizira ndalama, yomwe ndi chiwerengero cha chiwerengero cha ndalama zonse - kuphatikizapo mlingo wokhala padera monga copay ndi deductible- Ndi bwino kufunsa wopereka ndalama kuti azilipiritsa inshuwalansi yoyamba, ndiyeno ndalama yanu idzayang'aniridwa malinga ndi chiwerengero chomwe wogulitsa ali nacho ndi wopereka).
Komabe, wotulutsira kunja-wotetezera sangapereke chigamulo cha inshuwalansi kwa inu. Ndipotu, ambiri amafuna kuti muthe kulipira ngongole yanu yonseyo ndiyeno perekani kalata ndi kampani yanu ya inshuwalansi kuti kampani ya inshuwalansi ikhoze kukubwezerani. Icho ndi ndalama zambiri kutsogolo kwa iwe, ndipo ngati pali vuto ndi malingaliro, ndiwe amene wataya ndalama.
Wothandizira mu-network samaloledwa kukhazikitsa malipiro . Ayenera kuvomereza mlingo umene wagwiridwa nawo, kuphatikizapo copay kapena ndalama zanu, monga malipiro anunthu kapena iwo akuphwanya mgwirizano wawo ndi kampani yanu ya inshuwalansi.
Koma popeza ogulitsa kunja-of-network alibe mgwirizano ndi kampani yanu ya inshuwalansi, malamulowo sagwiranso ntchito kwa iwo. M'madera ena, wogulitsa kunja kunja angakugulitseni chilichonse chimene akusankha, ziribe kanthu zomwe kampani ya inshuwalansi yanu imanena kuti ndi yololera komanso yowonjezera msonkho pa ntchitoyi. Popeza kampani yanu ya inshuwalansi idzangopereka ndalama zokhazokha zokhazokha, mudzakhala pa ngongole ya ndalama zonse zomwe muli nazo ndi omangotenga. Choncho, njira yopezeka mu-network ndi njira yabwino kwambiri.
Wogulitsa wothandizira akusintha pansi pa ACA
The Affordable Care Act, yomwe ikuyang'aniridwa ndikutsogoleredwa pansi pa Dipatimenti ya Utumiki , imapanga dongosolo laumoyo kuti liwonetsere ntchito zamagetsi zowonjezera zomwe zimagwiritsidwa ntchito ngati wothandizirayo atakhala pa intaneti.
Koma palibe chofunikira kuti chipinda chodzidzimutsa cha kunja-cha-network chivomereze dongosolo lanu la thanzi la malipiro a msinkhu monga malipiro. Izi zikutanthauza kuti chipatala chikuloledwa kubweza ngongole yanu pa gawo la chisamaliro chomwe mwalandira chomwe sichinalipidwe ndi ndondomeko yanu ya mgwirizano wa thanzi (mungathe kuona momwe izi zingachitikire, mutaganizira kuti mapulani azaumoyo akukambirana milandu ndi zipatala zawo, ndi chipatala cha kunja kwachinsinsi sichiyenera kuganiza kuti zifukwa zochepazo ndizokwanira).
Pamsika waumwini (inshuwalansi ya umoyo mukudzigulira nokha, osati kupeza kuchokera kwa abwana kapena pulogalamu ya boma monga Medicare kapena Medicaid ), opereka ma intaneti akhala ochepa pazaka zingapo zapitazi.
Pali zifukwa zosiyanasiyana izi, monga:
- Othandizira inshuwalansi zaumoyo ayang'ana kufunafuna opereka omwe amapereka phindu lofunika kwambiri
- Mabungwe ang'onoang'ono amapereka othandizira mphamvu zambiri zogwirizana ndi mitengo.
- Zowonjezera-network PPO zimakopeka odwala odwala, ndipo ndalama zomwe zimanena kuti ndalamazo ndizoposa.
- Ma HMO omwe ali ndi zofuna zapakhomo amathandizira inshuwalansi kusunga ndalama, mosiyana ndi ma PPO komwe odwala angasankhe kupita kwachinsinsi kwambiri.
Ogulitsa inshuwalansi pamsika pawokha sangathe kugwiritsanso ntchito kulembedwa kwachipatala kukana kulengeza kwa anthu omwe alipo kale (pomwepo, izi zingasinthe pansi pa Dipatimenti Yoyendetsa Boma), ndipo kufotokozera kumene akuyenera kupereka kumakhala kofananirana ndikwanira, chifukwa cha ACA zofunika zaumoyo zofunika. Zinyamuliro zimakhalanso zochepa potsata peresenti ya madola oyambirira omwe angathe kugwiritsira ntchito ndalama zothandizira.
Zonsezi zawasiya ndi zosankha zochepa zokhudzana ndi mtengo. Njira ina yomwe iwo adakali nayo ikusintha kuchoka pamagetsi otchuka kwambiri PPO ikukonzekera kuchepa kwa intaneti ma HMOs. Izi zakhala zikuchitika m'mayiko ambiri m'zaka zingapo zapitazi, ndipo ena amati palibebenso ogwira ntchito yaikulu omwe amapereka mapulani a PPO pamsika. Kwa olembera oyenera, izi sizovuta, chifukwa sakufuna kukhala ndi mndandanda wambiri wa omwe akufuna kuti agwiritse ntchito. Koma mapulogalamu otetezeka a PPO amatha kukopa olembetsa odwala-ngakhale apamwamba kwambiri-chifukwa amalola kuti athandize akatswiri osiyanasiyana ndi zipatala. Popeza malingaliro azaumoyo sangathe kusankhira olembetsa odwala powakana, azinyamula ambiri asankha kuchepetsa malonda awo m'malo mwake.
M'madera ena, ma-tiered networks tsopano alipo, ndi kugawana mtengo wochepa kwa odwala omwe amagwiritsa ntchito othandizira mu gawo lachitsulo chothandizira.
Zonsezi zikutanthauza kuti ndizofunikira kwambiri kuposa kale lonse kuti muwone zomwe zadongosolo la thanzi lanu, makamaka musanayambe kugwiritsa ntchito chithunzi chanu. Onetsetsani kuti mukumvetsa ngati dongosolo lanu lidzasamalira chisamaliro chatsopano (ambiri samatero) ndipo ngati angatero, zingakuwonongereni. Onetsetsani kuti mukudziwa ngati ndondomeko yanu ikufuna kuti mutumizidwe kuchokera kuchipatala chanu choyamba musanayambe katswiri, ndipo ndi chithandizo chiti chomwe chisanayambe chilolezo . Mukamadziwa zambiri za mapulogalamu anu, sizidzakhala zovuta kwambiri pamene mukuyenera kugwiritsa ntchito chithandizo chanu cha mankhwala.
Kusinthidwa ndi Louise Norris.
> Zotsatira:
> Housedocs.house.gov. Kuwunikira Chitetezo cha Odwala ndi Zopanda Thandizo Labwino . Monga momwe zasinthidwa pa May 1, 2010.
> Kaiser Family Foundation. Kufotokozera za Kusintha kwa Thanzi la Zaumoyo: Njira Yoperekera Kuchiza Mankhwala (MLR). February 29, 2012.