Bhuku Rakatambirwa Nezvehutano Vanopa Vatengi
Ihutano hwehutano inshuwarheni network ndiyo boka rehutano hwehutano vakabvumirana nehutano hwehutano inshu (kuburikidza neHMO, EPO, kana PPO ) kuti vawane rubatsiro pane zvisingabatsiri.
Urongwa hwehutano hwehutano hunosanganisira vatsigiri vehutano vakadai sevanotarisira vanachiremba , vanachiremba vanonyanya kukosha, mabhii, X-ray zvivako, makambani ekuchengetedza hutano pamusha, hospice , vashandi vezvipatara, zvipatara, chiropractors, podiatrists, uyewo masikati anovhiyiwa nzvimbo.
Inishuwarenzi yehutano makambani anoda kuti iwe ushandise vapeji mumutambo wavo nekuda kwezvikonzero zviviri zvinokosha:
- Ava vagova vakagadzirisa zvirongwa zvehutano hwehutano.
- Vabvumirana kugamuchira kubvunzurudzwa kwekutengesa kwehutano hwemashumiro avo, mukutengeswa kwemuviri wevarwere ivo vachagashira kuburikidza nekuve chikamu cheurongwa hwepurogiramu.
Chikonzero nei Utano Hwako HweMagariro Ezvinhu
Iwe uchabhadhara mari shoma uye coinsurance kana iwe ukawana kutarisira kwako kubva kune-innet network, kana uchienzanisa kana iwe uchitarisira kwako kubva kune -kunze-network . Ichokwadi, maHMO mazhinji haazobhadhara kunyange nehanya iwe wawakagamuchira kubva kune-kunze-network-wekupa kunze kunze kwezvakawandisa mamiriro ezvinhu . Kunyange zvishoma zvishoma zvinogadziriswa PPOs zvinowanzobhadhara 20 kana 30 muzana ye-inshuwarisi ye-inshuwarheni ye-in-network providers uye 50 kana 60 muzana ye-inshuwarisi ye-out-of-network providers, uye inowanzove yakanyanya kubhadhara uye kunze kwe-pocket maximums paunenge uchienda kunze kwekambani.
In-network kupa zvikwereti chirongwa chako chehutano zvakananga, kuunganidza chete copay kana mari yakabhadharwa kubva kwauri panguva yebasa (nokuda kwekubhadharwa mari, iyo inenge muzana yemari yakawanda - inosvika purogiramu yakadzika seyo copay uye yakabviswa-iyo kazhinji zviri nani kukumbira mubatsiri kuti ape mari yehushuwarisi pakutanga, uye ipapo bhiri yako ichagadziriswa zvichienderana nekutarisana kwekutengesa iyo mutakuri aneye nemupiki).
Kunyange zvakadaro, kunze kwe-network mutapi angasaisa faira ye inshuwarisi yako. Chaizvoizvo, vazhinji vanoda kuti iwe ubhadhara mari yako yose uye wozopa mvumo nekambani yako ye inshuwarisi kuitira kuti kambani ye inshuwarisi inogona kukubhadhara iwe. Ndiyo mari yakawanda mberi pamberi pako, uye kana pane dambudziko nemhosva, iwe ndiwe wakarashika mari.
An in-network provider haabvumirwi kuenzanisa-bhiri iwe. Vanofanira kubvuma chibvumirano chakabvumirana, kusanganisira copay kana coinsurance yako, sekubhadhara zvakakwana kana ivo vachipesana nesangano ravo nekambani yehutano yehutano.
Asi sezvo kunze-kwe-network providers vasina chikamu nekambani yenyu ye inshuwarisi, iyo mitemo haishandisi kwavari. Mune dzimwe nyika, an-out-network-mvumo anogona kukubhadhara chero chavanosarudza, pasinei nokuti kambani yehutano yehutano yehutano inoti ndeyechokwadi uye tsika yemitambo yebasa iroro. Kubvira sezvo kambani yako ye inshuwarisi ichangobhadhara chikamu chemari yakananga uye yekodzero yemitambo, iwe unenge uri pachikwereti chezororo rose rebhadhiro nekunze kwe-network. Nokudaro, in-network network inowanzova yakanakisisa sarudzo.
Mupi wehutano unochinja pasi pe ACA
Iko Inogadziriswa Care Act, iyo inotarisana nayo inogona kubviswa uye inogadziriswa pasi peHurumende Inotungamirira , inoda zvirongwa zvehutano kuvhara kunze-kwe-network dharuvhisi zvinoenderana nekugoverana kwezvikwereti zvavanoshandisa kana mupi weve ari mu-network.
Asi hapana chikonzero chekuti kunze kwe-network kamuri inokurumidzira inogamuchira hurongwa hwehutano hwehutano hwehutano-sekubhadhara-muzere. Izvozvo zvinoreva kuti chipatara ichiri kubvumidzwa kuenzanisa mari yako yezvikamu zvekuchengetedzwa kwekukurumidzira iwe wakagamuchira kusina kubhadharwa nehutano hwako hwehutano hwehutano hwemagetsi (unogona kuona kuti izvi zvinogona kuitika sei, iwe uchifunga kuti zvirongwa zvehutano zvinotaurirana zvakaderera zvikwereti pamwe ne-in-network zvipatara, uye chipatara chekunze-chengetara chingave chisingafungi kuti mhosva dzakaderera dzinokwana).
Mumutengo wega wega (inshuwarhu yehutano iwe unotenga iwe pachako, panzvimbo yekuwana kubva kumushandi kana kubva purogiramu yehurumende yakadai seMedareria kana Medicaid ), anopa mishandisirwo akawandisa mumakore mashomanana apfuura.
Kune zvikonzero zvakasiyana-siyana izvi, kusanganisira:
- Inishuwarenzi yehutano vatakuri vakaisa pfungwa pakutsvaga vatsigiri vanopa zvakanakisisa kukosha
- Zviduku zvitanhatu zvinopa vatakuri nhare simba rekutaurirana maererano nemitengo.
- Broad-network PPO zvirongwa zvinowanzokwezva varwere vanorwara, uye zvinokonzerwa kuti zvinodhura zvinodhura.
- HMO nevanopinda musuo vamasuwo vanobatsira inshuwarisi kuchengeta mari pasi, kunze kwePPOs apo varwere vanogona kusarudza kuenda zvakananga kune imwe nyanzvi yemari.
Inishuwarenzi inotakura mumusika mumwe nomumwe haagoni kushandiswa nekunyorwa kwezvokurapa kuti arambe kuparidzirwa kune vanhu vane mamiriro ezvinhu akambovapo (zvakare, izvi zvinogona kuchinja pasi peHurumende Inotungamirira), uye kugoverwa kwavanofanira kupa kwakakodzera kufanana uye kwakadzika, nokuda kweAACA's zvakakosha hutano hunodiwa. Zvinotakura zvinorehwawo maererano nehuwandu hwemari yepuraimari iyo inogona kushandisa pahutungamiri mari.
Zvose izvi zvakasiya nemasana mashoma ekukwikwidza pamutengo. Imwe nzira yavanoita ichiri kuchinja kubva kune inodhura yakawanda yakawanda network PPO inoronga kuderedza mitambo yeHMOs. Icho chave chichiitwa mumatunhu akawanda pamusoro pemakore mashomanana apfuura, uye vamwe vanoti havasisina chero vatakuri vakuru vanopa PPO zvirongwa mumusika mumwe nomumwe. Kune vanyori vane hutano hwakanaka, izvi hazvirevi dambudziko, sezvo vasingadi kuva neruzhinji rwandu rwevarimi vemazuva ano vanoda kuramba vachishandisa. Asi yakawanda network network PPOs inowanzokwezva kune avo vanorwara vanorwara-pasinei nezvikwereti zvakakwirira-nokuti vanobvumira kuwana ruzhinji rwevadzidzisi uye zvipatara. Sezvo zvirongwa zvehutano zvisingazogoni kusarura kune avo vanorwara vanorwara nekuvasiya kuvapa, vazhinji vanotakura vakasarudza kupedza mitambo yavo pane.
Mune dzimwe nyika, mitambo yakasungirirwa ikozvino inowanikwa, nekudhura-kugovana-kugovana kwevarwere vanoshandisa vashandi mumutakuri wevanotakura.
Zvose izvi zvinoreva kuti zvakakosha kudarika kare kuti uongororore ruzivo rwehutano hwako hwehutano, zvakanakisisa iwe usati watoda kushandisa chinyorwa chako. Iva nechokwadi kuti unonzwisisa kana hurongwa hwako huchavhara kunze kwe-network (vazhinji havaiti) uye kana vachida, mari yako ichaita sei. Iva nechokwadi kuti unoziva kana chirongwa chako chichikuda kuti uwane kutumirwa kubva kuchiremba wako wekuchirapa usati waona nyanzvi, uye ndezvipi zvinotarisirwa kushandiswa kwemvumo . Kunyanya iwe uchiziva pamusoro peurongwa hwako hwepurogiramu, zvisinganyanyi kudzvinyirira zvichave apo iwe pakupedzisira unoda kushandisa kugovera kwako kwechiremba chikuru chekurapa.
Yakarongwa naLouise Norris.
> Sources:
> Housedocs.house.gov. Kuumbwa kweMurwere Kuchengetedzwa uye Kutengeswa Kwezvokuchengetedza Mutemo . Sezvakagadziriswa musi waMay 1, 2010.
> Kaiser Family Foundation. Kutsanangura Utano Hwakachinja Kuchinja: Kurapa Kwekurapa (MLR). February 29, 2012.