Exclusive Provider Organization (EPO)
Wakafunga here kunyora muurongwa hwehutano hweEEPO? Kana zvakadaro, zvinokosha kuti unzwisise kuti zvirongwa izvi ndezvipi uye kuti dzinoshanda sei, kuve nechokwadi kuti chirongwa chichasangana nezvido zvako.
Ko kana iwe uine EPO yehutano yehutano? Kunzwisisa ins uye kunze kwekuti EPO yako inoshanda sei ichakubatsira kushandisa hurongwa hwako hwehutano zvakanaka uye udzivise kukanganisa kwakawandisa.
Chii chinonzi EPO (Exclusive Provider Organization)?
Mhando yehutano hwehutano hwehutano hwekutarisira, EPO inomirira oga anopa sangano . EPO inshuwarano yehutano yakatora zita iri nokuti unofanirwa kuwana hutano hwako chete kubva kune vehutano vanopa hutano EPO mikataba, kana EPO haichabhadhari kutarisira.
Kufanana nehanzvadzi dzavo, PPOs uye HMOs, zvirongwa zvehutano zveEEP zvine mitengo yekutengesa mari yekuti unowana sei utano hwako. Kana iwe usingatevedzeri mitemo yako EPO apo iwe unowana rubatsiro rwehutano, hahuzobhadhara nokuda kwekutarisira.
Mirairo yePO yehutano yehutano inopoteredza maitiro maviri ezvokudya-maitiro:
- Ndekupi uye kubva kunaani waunowana rubatsiro rwekuchengetedza utano huwandu kune avo vanopa iyo iyo EPO yakurukura zvikwereti.
- Utano hwehutano hwakakosha kune zvinhu zvinoda kurapwa kana izvo zvinoita kuti utano hwako hunotapudza munguva refu, sekuchengetedzwa kwekuchengetedza .
Sei EPO Health Insurance Work?
Chii chaunoda kuziva pamusoro pekushandisa inshuwarano yako yehutano hweEEPT?
Ita chokwadi chekuverenga yako inshuwarano yehutano hurongwa hwakanyatsonaka. Kuramba mu-network nekuwana ma-kugadziriswa kana zvichidiwa zvinogona kukuchengetedza mari yakawanda. Ngatitarisei pfungwa dzinonyanya kukosha kuti tinzwisise.
Zvinodhura-kugovera zvinodikanwa mu EPO zvakaderera
Kugovana kugoverana mutsika umo iwe neyekambani yako ye inshuwarheni kuribhadharira chikamu chebasa uye inowanzochengetwa kusvika pachidiki ne EPO.
Izvi zvinosanganisira kuderedza , kubhadharwa , uye kubhadhara mari . Ichokwadi, mamwe maPOs haadi chero kubhadhara kana kubhadhara mari, uye kungobhadhara chikwereti chiduku panguva yebasa. Nemhaka yehuwandu hwekugovana-kugovana-kugovana uye pasi-pasi, EPO ndiyo imwe yezvinhu zvakasarudzwa zvehutano yveshuwarenzi yehutano.
Unofanira Kushandisa In-Network Provider
Zvose EPO dzine runyora rwevashandi vehutano vanonzi mupiro network. Iyi nhandare inopa imwe neimwe inofungidzirwa yehutano hwehutano hwakabatanidza vanachiremba, nyanzvi, ma pharmacy, zvipatara, mabhii, x-ray zvivako, vatambi vekutaura, imba ye oxygen, nezvimwewo.
Mune chirongwa chehutano hweEEPO, unogona kungowana rubatsiro rwehutano kubva kune-network network providers . Kana iwe uchitarisira kunze-kwe-network , EPO haichabhadhara; iwe unenge wakaramba uchingobhadhara mari yose iwe pachako. Kungoerekana kubuda kunze-kwe-network kutarisira kunogona kunge iko kukanganisa kukuru paunenge uri EPO.
Pakupedzisira basa rako rekuziva kuti ndiani anopa-network pamwe ne EPO yako. Semuenzaniso, haugoni kufunga kuti nekuda kwekuti bhorosi iri pasi pasi kubva kuhofisi yako yePO doctor, iri mu-network ne EPO yako. Iwe unofanira kutarisa. Saizvozvowo, usafungidzira kuti nzvimbo yekufungidzira iyo yakaita mammogram yako gore rapera ichiri mu-network ne EPO yako gore rino.
Mupi wehutano hunochinja. Kana iwe uchiita izvozvi uye iwe uri kukanganisa, iwe unofanira kubhadhara yose mammogram iwe pachako.
Pane zvikamu zvitatu zvakasiyana kune zvinodiwa mu-network:
- Kana iyo EPO isina in-network inopa wehutano hunodiwa iwe unoda. Kana izvi zvikaitika kwamuri, gadzirirai kunze kwe-network tsananguro yehutano ne EPO. Chengetedza EPO yako mumutambo.
- Kana iwe uri pakati penzira yakaoma yehutano hwehutano paunova nhengo ye EPO, uye iwe nyanzvi haisi chikamu che EPO. Ezvo EPO yako ichasarudza kana iwe usingakwanisi kupedza nguva yekurapa newachiremba wako iye zvino pane imwe nyaya-ne-kesi.
- Nokuda kwezvinoitika zvinoitika. Kana uine chirwere chepfungwa, chirwere chepfungwa, kana chimwe chekukurumidzira kwechokwadi iwe unofanira kuenda kune imwe nzvimbo yepamhanho yepamhanho kana iwe uri mu-network ne EPO yako. Zvizhinji zvePOs zvichavhara mari yekuchengetedzwa kwekukurumidzira kwakagamuchirwa kune imwe nzvimbo iri pedyo ye-network nzvimbo sezvinenge iri mu-network. Kana uchida kubvumirwa kuenda kuchipatara kubva kuE ER, zvisinei, EPO yako inogona kukumbira kunze kwe-network ER kukuendesa kuchipatara che-in-network kuti chigamuchirwe.
Iwe Haufaniri Kuva Nechiremba Wokutanga Kunyanya
Purogiramu yako yehutano yePO haizodi kuti iwe uve nechiremba wokutanga wekuchengeta (PCP) , kunyange kuwana PCP kuchiri pfungwa yakanaka.
Iwe Haudi Kuti Uve Nekutsvaga Kuona Muongorori
Uine EPO haugoni kudiwa kuti utumire mberi usati wamboona nyanzvi. Izvi zvinoita kuti zvive nyore kuona nyanzvi kubvira iwe uri kuita sarudzo iwe pachako, asi unofanirwa kuchenjerera kuti uri kuona nyanzvi chete dziri mu-network ne EPO yako. Nzira yekuva nePPP ndeyekuti inowanzozivikanwa neyanyanzvi munharaunda yako, uye nyanzvi dzakawanda dzinofarira zvakanakira mukati mehutano hwavo, somuenzaniso, vamwe vese vezvemagariro evecologists vanogona kunge vane hanya zvikuru nekenza yepamu asi imwe inogona kuva nechido chaicho mumukenza wemapapu.
Iwe Uchave Uchidiwa Kuti Utange Kutenderera Mberi KweMari Inodhura
Ezvo EPO yako inoda kuti iwe uwane mvumo yemamwe mabasa, kunyanya ayo anonyanya kukosha. Kana imwe sangano inoda kusati-mvumo (kubvumirwa kare) uye kana iwe usingakuiti, EPO yako inogona kuramba kubhadhara. Kazhinji yenguva iyo mazano anoda kupiwa mvumo inosarudza uye kwete hurongwa hwekukurumidzira, saka nguva shomanana kunonoka haisi kutyisa upenyu.
Pre-authorization inobatsira EPO yako kuchengetedza mari pasi nekuita chokwadi kuti unoda chaizvo zvese zvaunowana. Muzvirongwa zvakaita seHMO dzinoda kuti iwe uve nechiremba wekutanga, PCP yako inotarisira kuve nechokwadi kuti iwe unoda chaizvo zvese zvaunowana. Sezvo EPO yako isingada kuti iwe uve nePPP, inoshandisa chigadziro chekugadza sechirongwa chekuita chinangwa chimwechete: EPO inongorayira zvinhu zvinonyatsodiwa.
EPO zvirongwa zvakasiyana maererano nemhando dzipi dzebasa rinofanira kunge risati ragadzwa. Yakawanda inoda kutenderwa kwezvinhu zvakadai seMRI neT CT scans, zvinodhaka zvinodhaka zvinodhaka, kuvhiyiwa, zvipatara, uye mishonga yezvokurapa semusha weokisijeni. Yako EPO's Summary of Benefits uye Coverage inofanira kukuudza zvakawanda pamusoro pezvinodiwa kare, asi iwe unofanirwa kutarisira kuti chero mari inobhadhara inoda kuve yakagadzirirwa.
Kunyange zvazvo chiremba wako achizvipira kuti atange kutumirwa, iwe pakupedzisira iwe unotarisira kuti uve nechokwadi chekutora hutano hwakagara hugadzwa usati wawana rubatsiro rweutano. Kana iwe usingaiti, EPO yako ine kodzero yekuramba kubhadhara kutarisira, kunyange kana kutarisirwa kwaive kuchidikanwa uye iwe wakabva kune in-network provider.
Pre-authorization inotora nguva. Dzimwe nguva, iwe uchava nemvumo usati waenda kuhofisi yechiremba. Kazhinji, zvinotora mazuva mashoma. Mumamiriro ezvinhu akaipa, kana kana pane dambudziko nemvumo, inogona kutora mavhiki. Tarisa mazano edu ekuti tingagamuchira sei chikumbiro chekupa mvumo yakagamuchirwa .
Iwe Haufaniri Kuisa Mafambiro
Iwe haufaniri kufambidzana nemitemo uye kutora mafomu apo une EPO yehutano yehutano sezvo yese yaunotarisira inopiwa mu-network. Yenyu ye-inetano yehutano yehutano inopa zvikwereti hurongwa hwako hwehutano hweEpyo zvakanakira kuchengetwa kwaunogamuchira. Iwe unongova wekodzero yekubhadhara yako zvakabviswa, kubhadharwa, uye coinsurance.
Pasi Pano pa EPO Health Insurance
EPOs ine humwe hutano hwakafanana neHMO uye zvimwe zviito zvakafanana nePPOs. Sezvo zvakadaro, iwe unogona kufunga kuti EPO inenge yakabatana pakati peHMO nePPO. Vanhu vazhinji vanoita sekusununguka kwekukwanisa kuronga nguva yekugadzirira nemumwe nyanzvi pasina kubvunzurudza chiremba wechiremba. Panguva imwecheteyo, izvi zvinogona dzimwe nguva kuva dambudziko pakuti iwe unongogumira kune dzimwe nyanzvi mukati memutambo wako. Kuva neEEPO kunoda kuti iwe ushingairire kubatanidzwa mukugadzira mabasa anodhura kana maitiro, uye iwe unokusiya iwe unonyanya kuve nechinangwa chekuzadzisa chero mvumo ipi zvayo inotanga kudiwa. Kakawanda, kusanganiswa kwepumumisi yakaderera uye kugovana-kudhura kugovera kunoita EPO chisarudzo chakanaka kune vanhu vazhinji. Kana uri kuifunga pfungwa-yakakosha sezvaunofanidza zvirongwa zvakasiyana, tarisa kuenzanisa kwedu kweHMOs, PPOs, EPOs. uye POS zvirongwa .
> Kwakabva:
> Healthcare.gov. Exclusive Provider Organization (EPO) Plan. https://www.healthcare.gov/glossary/exclusive-provider-organization-epo-plan/