Kunzwisisa Mafambisi Akasarudzirwa Anoda
Uri kutarisa kusayina kwePPO inshuwarano yehutano hurongwa here? Iva nechokwadi chokuti zvichaenderana nezvido zvako nekuziva kuti zvinoshanda sei. Watove wakanyoresa PPO? Kunzwisisa kuti zvinoshanda sei kuchakubatsira kushandisa inshuwalano yehutano yako zvakanaka uye kudzivisa kukanganisa kunodhura.
Kunzwisisa PPOs
PPO inomirira musarudzo waidiwa. PPOs ine zita iri nokuti vane mazita evarapi vehutano avo vanosarudza kuti iwe uwane hutano hwako kubva.
Kana iwe ukawana hutano hwako kubva kune avo vanogadziriswa, iwe unobhadhara zvishoma.
PPOs chirongwa chekuchengetedza utano hwehutano inshuwarano sevabereki vavo vari kure, masangano ekuchengetedza utano, kana HMOs. Zvose zvinotarisirwa kugadziriswa zvirongwa zvehutano zvine mitemo pamusoro pekuti iwe unotora sei utano hwako hwehutano. Kana iwe usingatevedzeri mitemo yegadziriro yekuchengetedza, iwe haungabhadhari nokuda kwehanya kwako, kana iwe uchatongerwa nekufanirwa kuisa chikamu chakakura chemari yekuchengetedza kunze kwehomwe rako.
Maitiro Anotungamirirwa Nehutano Hwokuchengeta Zvirongwa Chengetedza Zvinoderedza
Zvose zvinotarisirwa kutarisira zvirongwa zvehutano zvine izvi zvinotungamirira kuitira kuchengetedza hutano hwehutano mukutarisa. Mitemo inowanzoita izvi nenzira mbiri huru:
- Vanogadzirisa mabasa enyu ezvehutano kune zvinhu zvese zvinoda kurapwa kana izvo zvinoita kuti utano hwako hwehutano huderedze munguva refu, sekuchengetedzwa kwekuchengetedza .
- Vanogadzirisa kuti ndiani kana kupi iwe unogona kuwana rubatsiro rwehutano, uye vanotaurirana nezvezvikwereti kubva kune avo vanopa utano hwehutano unobvumirwa kuwana rubatsiro rweutano kubva.
Nzira iyo PPO inoshanda
PPOs inoshanda nenzira dzinotevera:
- Iwe unobhadhara chikamu; iyo PPO inopa chikamu.
A PPO inoshandisa kugovana-mari kunobatsira kuchengeta mari mukutarisa. Paunoona chiremba kana kushandisa sangano rehutano, unobhadhara chikamu chemari yezvibasa iwe pachako nenzira yekudhura , kubhadhara , uye kubhadharwa .
Kugovana-kudhura chikamu chepurogiramu yePPO yekuve nechokwadi kuti unonyatsoda rubatsiro rwehutano huri kuwana. Paunofanirwa kubhadhara chimwe chinhu chekutarisira kwako, kunyange chekubhadhara maduku, iwe hausi pfupi kushandisa zvisizvo zvisingabhadharwi zvebasa. Asi zvakadaro, nokuda kweAne Affordable Care Act , PPOs haigoni kubhadhara mari yekugoverana kwemabasa ekudzivirira.
Kugovana-kudhura kunobatsira kubvisa mari yekutarisira kwako. Kana iwe unowedzera kubhadhara kune mari yekutarisira kwako, pasi pePPO yako inopa uye pasi inogona kuchengetedza mwedzi wepamusoro premium mhosva.
- Kana ukashandisa PPO's network of providers, iwe unobhadhara zvishoma.
A PPO inogadzirisa kubva kune uyo kana kubva kwaunogona kuwana rubatsiro rwehutano kuburikidza nekushandiswa kwehutano hwevashandi vehutano avo vataurirana navo zvikwereti. A network yePPO haisanganisi chete vanachiremba, asi mhando yese inofungidzirwa yehutano hwehutano yakadai semabhati, x-ray zvivako, varapi vemaviri, vashandi vezvipatara, zvipatara, uye zvipatara zvekurapa kunze.
IPPO inopa kukurudzira iwe kuti uwane kutarisirwa kwako kubva kunhandare yevashandi nekukubhadhara iwe wepamusoro makopa kana mari yekutendesa kana iwe ukawana kutarisira kwako kunze kwe-network . Somuenzaniso, iwe unogona kunge uine $ 40 copay kuti uone chiremba we -in-network , asi 50 muzana mari yekubhadhara mari yekuona chiremba kunze kwe-network. Kana chiremba kunze-che-network achikwereta $ 250 kuti atarisire iyo office, iwe uchabhadhara $ 125 panzvimbo ye $ 40 copay waizodai waita mhosva kana waizoshandisa mushandi we-in-network.
Kunyange zvakadaro, kunyange iwe uchibhadhara zvakanyanya paunoshandisa kunze kwe-network-carecare providers , chimwe chezvinhu zvePPO ndeyokuti, paunoshandisa kunze-we-network providers, PPO inowedzera ichipa chimwe chinhu kune mari yevhisi. Iyi ndeimwe yenzira dzePPO dzakasiyana neHMO. HMO haingabhadhara chero kana iwe ukawana kutarisira kwako kunze kwe-network.
- Iwe unofanirwa kuwana maitirwo akafanirwa kutenderwa nePPO.
Imwe yenzira dzePPO dzinova nechokwadi kuti zviri kungobhadhara mabasa ehutano anonyanya kukosha ndekukukumbira kuti uwane mvumo yekutangira usati wava nemari yakawanda, miitiro, kana kurapwa. Kana iwe usingakwanisi kuwana mvumo kubva kuPPO yako usati waita mabasa aya akaitwa, PPO haingabhadhari.
PPOs yakasiyana nedzipi, maitiro, maitiro, uye marapirwo avanoda kutangirwa kushandiswa, asi iwe unofungidzira kuti uchada kugadziriswa kwechipi nechipi chinodhura kana chipi zvacho chinogona kuitwa zvakaderera nenzira yakasiyana. Semuenzaniso, unogona kuwana mitsara yemishonga yakakura yakazadza pasina yekutumirwa kodzero asi inofanira kuwana chibvumirano chako chePPO chechirwere chinodhura chinodhaka kuti utore mamiriro akafanana.
Kana iwe kana chiremba wako achikumbira PPO kuti isati yapiwa mvumo, PPO ichada kuziva kuti nei uchida kuedzwa, kushanda, kana kurapwa. Zviri kuedza kuve nechokwadi chokuti iwe unonyatsoda kutarisirwa kwakadaro, uye kuti hapana imwe nzira inoparadzaniswa yekuita chinangwa chimwe chete. Somuenzaniso, kana chiremba wako wemapfupa achikumbira kugadzirira kusati kwapiwa mvumo yekuvhiya kwako kwebvi, PPO yako inogona kuti iwe uedze kurapa kwepanyama kutanga. Kana iwe ukaedza chirwere chepanyama uye hachigadziri dambudziko racho, saka PPO inogona kuenda mberi uye inotendera mvumo yekuvhiya kwako.
Kusiyana pakati pePPO uye Mamwe Marudzi eUtano Inishuwarenzi
Zvirongwa zvekuchengetedza zvakadai seHMO, hurumende kupa mishandisirwo (EPOs) uye purogiramu-yebasa (POS) zvirongwa zvakasiyana kubva kune PPOs uye kubva kune mumwe nemumwe nenzira dzakasiyana. Vamwe vanobhadhara kune-out-network-kutarisira; vamwe havaiti . Vamwe vane mari shoma-kugovana; vamwe vane zvikwereti zvakakura uye zvinoda kubhadhara mari yakawanda. Zvimwe zvinoda chiremba wekuchirapa (PCP) kuti ave sechirindiro chemukova, kungokubvumira kuwana rubatsiro rwehutano nekutumira kubva ku PCP yako; vamwe havaiti. Mukuwedzera, PPOs kazhinji dzinodhura nokuti dzinokupa rusununguko rwunosarudza.
> Kwakabva:
> Humana. HMO vs. PPO: Ndeupi Wakakodzera Kwauri? 2017.