Zvaunotarisira Paunosangana neHealth Maintenance Organization
Kunzwisisa kuti HMO chii uye kuti vanoshanda sei zvakakosha pakusarudza chirongwa chehutano panguva yekunyora kusununguka uye kana uchishandisa HMO yako mushure mokunge wakanyoresa.
Chii chinonzi HMO?
HMO inomirira utano hwehutano sangano , rudzi rwehutano hwehutano hwehutano hwakachengetedzwa. Sezvo zita rinoreva, imwe yezvinangwa zveHMO ndeyokuchengetedza nhengo dzayo hutano. HMO yako inoda kupedza mari shoma mberi pakudzivisa chirwere pane mari yakawanda gare gare pakuedza kuchibata.
Kana uchitova nechirwere chisingaperi , HMO yako ichaedza kutarisira chirwere ichocho kuti chichengetedze iwe soutano sezvaunokwanisa.
Kubva muna 2016, vanhu vanopfuura mamiriyoni 92 veAmerica vakanga vaine huwandu mune imwe HMO. Izvo zvaisanganisira vanhu vari mubasa rekushandira pamwe nemagadziro emisika, pamwe chete nevanhu vari mu Medicare Advantage HMOs uye Medicaid vakachengetedzwa HMOs.
Chinoshanda sei?
1. Iwe unofanirwa kuva nechiremba wekutanga.
Chiremba wako mukuru wekutarisira , kazhinji mushandi wemhuri, mudzidzi wepamusoro kana chiremba wevana, achava chiremba wako mukuru uye achagadzirisa zvose zvaunotarisira. Ukama hwenyu nechiremba wako wekunyanya kukosha zvakakosha mune imwe HMO. Iva nechokwadi chekuti unonzwa wakasununguka naye kana kuti ita shanduko. Iwe une kodzero yekuzvisarudzira chiremba wako wekunyanya kutarisira chero bedzi iye ari munhare yeHMO. Kana iwe usasarudze iwe pachako, yako insurer ichakupa imwe.
2. Chiremba wako mukuru wekutarisira anofanira kukutaridzira iwe chero kupi zvako kwakakosha.
Chiremba wako wepfungwa huru ndiye achasarudza kana iwe haudi mamwe mhando dzekutarisira uye unofanira kuita kuti utumire iwe kuti uugamuchire. Mienzaniso iri kuona nyanzvi, kuwana chirwere chepanyama kana kuwana mishonga yezvokurapa sechigaro chevasimba. Kuda kutumirwa kunovimbisa kuti kurapwa, kuongororwa uye kutarisirwa kwaunogamuchira iwe kwakakosha.
Pasina kutumirwa, hauna mvumo yezvibato izvo uye HMO hazvizobhadhara.
Kubatsirwa kwegadziriro iyi ndeyekuti varwere vanowana mashoma mashoma asingabatsiri. Asi kukanganisa ndechokuti varwere vanofanira kuona vatengesi vakawanda (chiremba mukuru wekuchengetedza uyewo nyanzvi) uye kubhadhara copays kana kumwe kugovana-mari kune imwe nguva yekushanyira.
3. Unofanira kushandisa in-network providers.
HMO imwe neimwe ine mutsara wevashandi vehutano avo vari munharaunda yavo. Vaya vanopa mazano vanofukidza hutano hwakasiyana-siyana hwehutano hunosanganisira vanachiremba, nyanzvi, ma pharmacy, zvipatara, mabhii, x-ray zvivako, uye kutaura marapa. Kana iwe uchitarisira kunze-kwe-network , HMO haichabhadhara; iwe unenge wakaramba uchingobhadhara mari yose iwe pachako .
Kungoerekana kubuda kunze kwe-network kuchengetedza kunogona kunge iko kukanganisa kukuru paunenge uine HMO. Zadzai chiremba mune imwe nzvimbo ye-out-of-network pharmacy kana kuwana ropa rako rekuedzwa rinoshandiswa nebazi risina kunaka uye iwe unogona kubatirwa nemutemo wemazana kana kunyange zviuru zvemadhora.
Ndiro mutoro wako kuziva kuti ndeupi vatapi vari mu-network neHMO yako. Izvi hazvisi zvakaoma zvikuru neHMO saKaiser Permanente apo vateereri vese vese vari muchivako chakafanana uye havaoni munhu asi Kaiser varwere.
Asi, kana iwe uine HMO ine inshuwarheni seUnited Healthcare, Aetna, kana WellPoint, in-network network providers haisi kuzogara panzvimbo imwe chete uye kazhinji vanoona varwere vasiri nhengo dzeHMO. Iwe haugoni kufungidzira izvozvo, nekuda kwekuti tepi iri pasi pasi kubva kuhofisi yechiremba, kuti lab iri mu-network neHMO yako. Iwe unofanira kutarisa.
Kune zvikamu zvitatu kubva kune zvinodiwa kuti ugare mu-network:
- Zvechokwadi nokukurumidza.
- IHMO haina in-network kupa kune yekushumira basa raunoda. Izvi hazvisi nyore. Asi, kana zvikaitika kwauri, tanga kugadzirisa utano hwekunze -hwe-network hunoenderana neHMO-chengetedza HMO yako.
- Iwe uri pakati penzira yakaoma yehutano hwehutano paunova nhengo yeHMO, uye unyanzvi wako hausi chikamu cheHMO. HMO dzakawanda dzinosarudza kana iwe ungapedza chirongwa chekurapa nechiremba wako iye zvino pane imwe nyaya-ne-kesi.
4. Zvido zvako zvekugovana zvinotengeswa muHMO kazhinji zvishoma.
Kugovana- kudhura kwakadai sekubviswa , kubhadharwa mari , uye kubhadhara mari inochengeterwa huwandu neHMO. Vamwe vanoshandira-HMO vanobatsirwa havatsvaki chero kupi zvayo (kana kuti vane zvishoma kuderedza) uye vanongoda kubhadhara mari shoma kune mamwe mabasa. Nokuda kwekugovana kwavo kudhura-kugovana uye pasi pepumisikiti , HMO inofananidzwa seimwe yezvinhu zvakasarudzwa zvehutano yveshuwarenzi yehutano.
Zvisinei, muhutano hwehutano inshuwarheni, pane inenge 7 kubva muzana yevanhu veUnited States vakawana kugoverwa muna 2016, HMOs inowanzova nemari yakawanda yakanyanya kubviswa uye kunze kwemari. Mune dzimwe nyika, zvirongwa chete zvinowanikwa mumusika mumwe chete ndezveHMO, uye zvinodhakwa zvinosvika zvakakwirira sezviuru zvemadhora madhora. Munyika dzakawanda, pane zvinowanzoita sarudzo shoma inowanika mumusika mumwechete maererano nemitambo yemhando ( HMO, PPO, EPO, kana POS ), zvichienderana nemusika unobhadharwa nevashandirwi, uko kushandiswa kwemagetsi kusarudzwa kunoramba kwakasimba.
HMO vs. Zvimwe Mishonga Inishuwarenzi yehutano
Mhando dzose dzehutano hwehutano hwehutano hwehutano hwakachengetedzwa (iyo inosanganisira zvinenge zvese kugoverwa pachedu muUnited States) zvine zvimwe zvinhu zvakafanana. Somuenzaniso, hapana hurongwa hwehutano hwekutarisira hunoita huchabhadhara hutano husati huri hwemishonga hunokosha, uye zvirongwa zvose zvekutarisira zvakachengetwa zvine maitiro aripo kuti avabatsire kuziva kuti kuchengetedza kunoda kudii, uye chii chisingaiti.
Kugadziriswa zvirongwa zvakadai sePPOs, EPOs, uye zvirongwa zvePOS zvakasiyana neHMO nenzira dzakawanda. Vamwe vachabhadhara kune-out-network-kutarisira, uye vamwe havazo (ivo vose vanofanira, kana zviri zvechokwadi zvekukurumidzira). Vamwe vane mari shoma-kugoverana zvinodiwa apo vamwe vane zvikwereti zvakanyanya uye vanoda kubhadhara mari inokosha. Vamwe vanoda chiremba wokutanga, asi vamwe havaiti.
Iwe unogona kudzidza zvakawanda pamusoro pekusiyana pakati pehutano zvirongwa mukati, HMO, PPO, EPO & POS-Chii chakasiyana Uye Ndezvipi Zvakanakisisa?
> Sources:
> Kaiser Family Foundation. Utano Inishuwarenzi Inoshandiswa yeVanhu Vose. 2016.
> K aiser Family Foundation. Zvose HMO Inyoresa. January 2016.