Apo Utano Inishuwarensi Inoramba Kuvhara ER ER
Kana iwe uchangobva kubvisa umunwe wako mutafura wakaona, zvakajeka kuti imba yekukurumidzira inofanira kunge iri yega inotevera. Asi kwete zvose zvinokurumidzira ndezvokuti zvakajeka-zvakatemwa.
Emergency rooms ndiyo nzvimbo dzinodhura zvikuru dzekugamuchira kurapwa, saka nokuda kwekusava nemamiriro ezvinhu ekukurumidzira, vatsigiri vanoda kuti nhengo dzavo dzishandise dzimwe, nzvimbo dzisingabatsiri, kusanganisira nzvimbo dzekuchengetedza dzinokurumidza kana hofisi yekuchengeta vana.
Apo vashandi vanoshandisa kusina ER zvivako, zvisingadhuri zvakanyanya kune inshuwarisi, uye izvo zvinoshandura pakuderedza kushandiswa kwehutano hwehutano-uye nemari yepisimusi shoma-yevanhu vose. Asi munyaya yehupenyu-kana chikwata-chinotyisa, mukamuri inokurumidzira ingangove iyo nzvimbo bedzi yakagadzirirwa zvakakwana kuita mamwe mamiriro ezvinhu.
Uye iyo conundrum ndeyokuti vanhu vakawanda havakwanisi kurovedzwa mune mushonga unoshamisika, naizvozvo kana vasina mubvunzo pamusoro pekuoma kwemamiriro ezvinhu ehutano, kukanganisa kune rumwe rutivi rwekuchenjerera (kureva, kuenda kuchivanze chekukurumidzira) kazhinji kunoratidzika sechinhu chinonyanya kuchenjera.
Nhema Inogadzira Kurwisana NeNew ER Rules
Kune chikamu chikuru, vatsigiri vanobhadhara iyo mafambi kuenda kune imwe nzvimbo yekukurumidzira. Asi Anthem yakakonzera kukakavara nemitemo mitsva muGeorgia, Indiana, Missouri, neKentucky (inoshanda munaJuly 1, 2017), iyo inoshandura mari yeE ER inoshanyira murwere kana kuongorora kwekutsvaga kunoratidza kuti mamiriro acho akanga asina kuitika shure zvose.
Mumwe murwere akafuridzirwa naVox akapinda mukamuri rekukurumidzira muKentucky nekunetseka kwepamuviri uye fever. Amai vake, aimbova mukoti, vakanga vamuudza kuti aende kuimba yepamhanho, sezvo zviratidzo zvake zvaibatanidza ne appendicitis , iyo inonzi inofanirwa mune zvehutano. Asi zvakazoitika kuti iye ane mavhisi emapurisa pane chimwe chinhu, chimwe chinhu chakanga chinyorwa chete mushure mekurapa kwaive kuchipiwa muE ER.
Anthem ndokubva amutumira chikwereti chemadhora anodarika $ 12,000, achitaura kuti kuda kwake kwakange kwarambwa nokuti akanga ashandisa nzvimbo yekukurumidzira kwekutarisirwa kwekutambudzika. Murwere wacho akakumbira, achicherechedza kuti akanga asina nzira yekuziva kuti kurwadziwa kwake kwakanga kusiri kwekukurumidzira kusvikira ER vanakwanisa kumuwana. Pakupedzisira, mushure mechipiri yechikumbiro chake (uye mushure mekunge murwere achikurukura nyaya yake naVox), Anthem akabhadhara chikwereti.
ER Zvikwereti Kazhinji Zvinoita Musoro wemusoro
Mitemo mitsva yeAnthem inogona kuitika kune vamwe vakawanda varwere kune dzimwe nyika ina. Asi zvikwereti zvinoshamisa zvechiremba zvakakonzerwa nerwendo kuenda kuE ER haisi itsva.
Dzimwe nyika dzine mitemo yakafanana yeMedicaid inorlees, ine mapepa akawanda ekushandiswa kwekusava kwekutsvaga kwemukana wekutsvaga (kunyange zvazvo mukuchengeta neMedicaid mitemo, ma copays achiri kushandiswa kana achienzaniswa nemari yekutarisira inowanikwa muEER).
Uye vanhu vanozviwana pachavo paE ER vari kunze kwehutano hwavo hwehutano hwemashumo vanogona kuguma nemari yakawanda yemishonga, pasinei nokuti ACA inoda zvirongwa zvehutano zvisingaverengeki kuvhara kunze kwe-network kushungurudzwa kwepamusoro sekunge kuti network.
Izvozvi zvave zvichiri kuongororwa, pamwe nevanishuwarenzi kaviri-kutarisa kuti vaone kuti kuchengetedza kwaive kwakangoerekana kwaitika kare vasati vabhadhara kunze kwe-network ER zvikwereti.
Uye kunyange kana bhizimisi ichibhadhara kudai kana iri mu-network, kunze kwe-network ER haafaniri kubvumirwa kubvuma mubhadharo wemubhizimisi sebhadharo yakakwana, sezvo ER isina chikamu nemu inshurenzi, uye inogona kuenzanirana bvisa murwere kuti chikamu chemutemo chinosara mushure mekunge mubhadhadzi aripa. Kana iyo yaiva mu-network nzvimbo, ER yaizofanira kunyora chikamu chebhadharo, pasi pemitemo yesungano neye inshuwarisi. Asi hapana chikonzero chakadai chekunze kwe-network nzvimbo.
Mamiriro ekuchengetedzwa kwekukurumidzira anoita kuti zvive zvakaoma kuvaridzi kuti vauye kuburikidza nehushuwarisi hoops izvo zvingave zvisinganzwisisiki.
Mune mamiriro ezvinhu asingashamisi, vanhu vanowanzofonera kambani yavo yveshuwarenzi kuti vabvunze nezvemvumo yekare kana kuti chengeta nechiremba mukuru wekuchengeta kana mukoti hotline kuti aone kuti chii chinodiwa. Asi mune dambudziko-kana kuti chii chinoratidzika sechiitiko chinotyisa, kubva pamarangariro evarwere-izvo zvinhu zvingakanganwa.
Uye nokuda kwechikamu chikuru, ndiyo nzira iyo inofanirwa kuva. Kana mumwe wako aine chirwere, iwe haufaniri kunetseka nekutumira kambani yako yveshuwarenzi-iwe unofanirwa kudana 911 kana kusvika kuE ER nokukurumidza sezvaunogona.
Asi kana vatengi vanonzwa nhau dzevanishuwarenzi vachiramba ER mabhizimisi nokuti inshurenzi akazoona sechiitiko chisina kuitika, zvinonzwisisika zvinetseka. Murwere munyaya yeVox akataura kuti mushure mechiitiko chaaiva nacho neE ER Bill uye Anthem kuda kuramba, munguva yemberi iye "achaenda kunonyanya kutarisirwa, uye ivo vachafanira kumumanikidza [kuenda] mu ambulensi kuenda kuenda kunzvimbo yekukurumidzira. "
Kunzwisisa Purogiramu Yenyu-Isati Yakaitika
Kana iwe uchiwedzera kuziva nezvehutano hwehutano hwehutano hwako huri nani, huri nani hwakagadzirira iwe uchava mamiriro ezvinhu apo iwe unoguma uchida kushandisa shanduro yako. Saka, danho rokutanga nderokuverenga nekunyatsoongorora mutemo wako. Vanhu vanowanzoisungirira muidhi uye vanokanganwa nezvazvo kusvikira vachida kuishandisa, asi hapana nguva yeiyo mumamiriro ekukurumidzira. Saka, panguva yausina kutarisana nechido chekuda kwehutano, gara pasi nepurogiramu yako uye iva nechokwadi chokuti unonzwisisa:
- Izvo zvinokonzerwa uye zvisingabhadharwi zvehomwe zvepurogiramu yako, uye chero ipi zvayo inoshanda kune ER ekushanyira (nheyo yokuti mamwe maitiro achabvisa copay kana ukazoguma uchibvumirwa kuchipatara uchishandisa ER, uye mhaka dzacho dzinogona kushandiswa yako yakagadziriswa-idzi ndidzo zvinhu zvaunoda kunzwisisa mberi kwemazuva, saka itaidza inshuwarisi yako yekambani uye mubvunze mibvunzo kana usina chokwadi kuti chirongwa chako chinoshanda sei).
- Pasinei nokuti urongwa hwako hunobatsira kunze kwe-network , uye kana zvakadaro, pasinei nehomwe pamari yako yekuti kunze kwe-network. Mukuwedzera, kana pane dzakawanda ER munharaunda yako, iwe unoda kuziva kuti ndezvipi zviri muurongwa hwepurogiramu yako uye izvo zvisiri, sezvo izvo zvisiri iwe chinhu chaunoda kuva nekufunganya pamusoro pemamiriro ekukurumidzira.
- Zvingangodaro hurongwa hwako huri nemitemo iyo inoguma mukurambidza kubvuma kwekusashandiswa kwekukurumidza kweE ER. Kana zvakadaro, zvizivikanise nemubhizimisi wako tsanangudzo yekukurumidzira kusati yaitika. Kana iyo mirayiridzo isingaoneki yakajeka, dana iwe inshuwarisi kuti ukurukure izvi navo, kuitira kuti unzwisise zvaunotarisirwa kwauri maererano neshoko renzvimbo yaunofanira kushandisa mumamiriro akasiyana-siyana (Anthem yakarondedzera mirayiridzo mune tsamba yavakatumira kune nhengo muna 2017, apo mitemo yavo itsva muGeorgia, Indiana, Missouri, neKentucky yakatanga kushanda).
- Izvo zvinoshandiswa nemubatsiri wako zvinowanikwa maererano nemvumo yekutanga yezvipatara zvinotevera zvinotangira kuE ER kushanyira.
Chii Chinofanira Kuita Kana Iwe Uchiwana Bhiri Risingatarisirwi ER?
Kana iwe ukawana mushoma-kupfuura-wakatarisirwa mushure mushure mokushanyira ER, svika kune ako inshuwarisi uye ona kuti unonzwisisa zvose pamusoro pebhadharo. Icho chikwereti chemari kubva kune-kunze-network ER? Kana kuti ndeyekuda kubvuma nokuti wako inshuwaridzi akafunga kuti mamiriro ako haasi epfungwa? Iyo yekare inowanzowedzera kuva yakawanda, asi zvakare, zvinosuruvarisa, mamiriro ezvinhu apo murwere ane zvishoma mukugadzirisa.
Kana iwe wakagamuchira bhadha yemari kubva kune-kunze-network ER (kureva, wako insurer akaripa chikamu chekutsvaga, asi ER inokubhadharira zvimwe zvacho, uye kwete kunyora chero zvipi zvadzo nokuti hauna chibvumirano nemubhizimisi wako), pane zvinhu zvishoma zvaunoda kuita:
- Tarisa nehurumende yehurumende yehu inshuwarisi kuti uone kana pane mitemo yekuchengetedza vatengi kana mitemo iri munyika yako iyo inotarisa kuenzanisa kubhadhara mumamiriro ezvinhu akaoma. Hapana hurumende yepamutemo inodzivisa kubhadharisa kubhadhara kubva kune-kunze-network providers, asi vamwe vanoti vakataura nyaya yacho .
- Kana pasina chinhu icho nyika yako inogona kuita, svika kunze kwe-network ER zvakananga uye ona kana vachizobvumirana newe. Vanogona kunge vanoda kugamuchira chikamu chiduku sekubhadhara zvakakwana.
Kana iwe wakagamuchira chiziviso chako chokuti chibvumirano chako chakarambidzwa nokuti wako insurer akafunga kuti mamiriro ako haasi ehutukutu (uye iwe unofunga kuti zvaiva, zvechokwadi, mamiriro ezvinhu akaoma kana kuti imwechete iyo munhu akangwara angaiona dambudziko), iwe unowedzera ruzivo maererano nemitoo yekukumbira:
- Kana chirongwa chako chisina kuberekwa, ACA inokutenderera kodzero yekuita dare rekukumbira, uye kana iyo inshurensi ichiri kukaramba kubvuma kwako, iwewo unokwanisa kubvunzurudzwa kwekunze nemumwe munhu akazvimiririra (heino chidimbu chekuti sei chikumbiro matanho emabasa).
- Iwe unogona kutanga nokutanga chirongwa chemukati chekukumbira nemubhizimisi wako, uyewo nekusvika kune imwe yenyika yehu inshuwarisi yedhipatimendi kuti uone kana vane nhungamiro kwauri.
- Chengetedza zvazvinoitika panguva yekukumbira, kusanganisira mazita evanhu watinotaura navo uye chero hutano hunosimbisa kubva kune wako inshuwarisi. Iwewo unoda kuchengetedza chipatara muchirongwa, sezvavanenge vachida kutumira mamwe mashoko kune kambani yveshuwarenzi kuitira kuratidzira kuti mamiriro ako akafanirwa nerwendo kuenda kuE ER.
- Kana zvikumbiro zvemukati nekunze zvisingabudiriri, iwe unoda kugadzirisa mamiriro acho nechipatara. Vanogona kunge vachida kuderedza mari yavo kana kuti kugadzira chirongwa chekubhadhara chinokwanisika.
Mhirizhonga Yakashamisika ER Mipiro
Nhau dzeEnthem itsva ER mazano muGeorgia, Indiana, Missouri, neKentucky zvakasangana nekuchema kubva kune varwere nevatengi vevatengi. IAmerican College of Emergency Physicians yakasundira shure nevhidhiyo yakagadzirwa kuti iise pachena zvikanganiso muhurongwa hunonyanya kushanda nevarwere vanonzwisisa chii uye kwete dambudziko, kana mamwe mamiriro ezvinhu asingagoni kuongororwa pasina kuedza miedzo.
Nhema inotaura kuti nzira dzavo dzinobva mumutauro waive uri muzvibvumirano zvavo, uye kuti "munhu akangwara" akagara achishandiswa asi iye zvino anenge achisimudzirwa (kureva, kana "munhu akangwara" aizotaridzika kuti inokurumidza, ipapo iri dambudziko). Asi zvakajeka, uku ndiko kukakavhiringidza. Varwere, vashandi vezvokurapa, uye vatsigiri vevatengi vanoshushikana kuti tsika yacho inogona kupararira kune vamwe vatsigiri, vachisiya varwere vane chisarudzo (panguva isina nguva) pamusoro pekuda kutsvaga muEER, zvichiguma nemigumisiro yehutano hwakashata. Asi Anthem, uye zvichida vamwe vatsigiri vekutevera, inofunga nezvekugadzirisa mune zvekutengesa kwehutano-basa iro anenge munhu wese anobvumirana rinodiwa, asi vashomanana vanobvumirana nezvekuita.
Uye kunyange kuda kuramba kwekutsvaga kwekushandiswa kwekusava nekushamisika kweE ER kunokonzera kuvhiringidzika uye kunetseka, nyaya yekushamiswa kwezvikwereti zvekurapa mushure mekushanya kweE ER yakange iri dambudziko rinoramba riripo zvisati rasvika purogiramu itsva yeAnthem. Mamiriro ega ega ave achishanda kugadzirisa nyaya mune dzimwe nguva, asi inoramba iri dambudziko munzvimbo dzakawanda dzenyika.
Kunyange zvazvo mhinduro dzacho dzichioneka pachena kana dzichitarisa kubva pane zvinoonekwa nemurwere kana mutengi wevatengi, zvakaoma kuwana vose vanobatana vari pabhodhi. Nokuti nguva iripo, vatengi vanofanira kunzwisisa zvose zvavanogona pamusoro pekushanda kwavo nekushanda uye sei izvo kodzero dzavo dzekutsvaga dziripo kana vakazviwana ivo nemutemo usingatarisiri mushure mokushanyira ER.
> Sources:
> American College of Emergency Physicians. Emergency Physicians Expose Anthem Harmful Emergency Care Policy NeVhidhiyo Idzva. January 17, 2018.
> Centers for Medicare neMedicaid Services. Zvikwereti zveMukati neMakumbirano uye Kuongorora Kunze kweNyaya yeKurongwa. April 12, 2017.
> National Association of Insurance Commissioner, Mepu: Nyika neMitemo.
> Pollitz, Karen. Kaiser Family Foundation. Zvikwereti zveMari Bhizimusi. March 17, 2016.