Rubatsiro rwekuti kana pasina avo vari pedyo kana vanogona mune-network providers
A network gap exception ndeye chikwata chemishonga inshuwarisi yehutano inoshandisa kubhadhara zvikwereti mumusangano wavo wevashandi vehutano hwehutano. Apo bhizimisi rako rehutano rinokupa iwe unyanzvi hwekutsvaga, uye unozivikanwa sechirwere chechipatara chisipo, kuri kukubvumira kuwana rubatsiro rweutano kubva kune kunze kwe-network kupa apo uchibhadhara mari yakaderera mu-network inodhura mari yekugovana .
Iko Inonzi Gap Kubviswa Kunaka
Pasina kambani yakasarudzwa, kana iwe ukaona kunze kwe-network, iwe uchabhadhara kupfuura iwe waizobhadhara dai waive uchishandisa mu-network. Kana uine HMO kana EPO , chirongwa chako chehutano hachizobhadhara imwe dime yemari yekutora kwako kunze kwekunamata kunze kwekunge iwe uchinge uwane rusununguko rwenhare. Kana uine chirongwa chePPO kana chirongwa chePOS, hurongwa hwako hwehutano huchakubatsira iwe kubhadhara kutarisira kwaunowana kunze kwe-network. Zvisinei, yako yakabviswa , coinsurance, uye zvikwereti zvichave zvakakura apo iwe uchishandisa kunze kwe-network kupa kune apo iwe unoshandisa in-network provider.
Kukumbira sangano rekutsvaga ruzhinji kubva kune wako wehutano wehutano inokumbira zvakakwana inshuwarisi kuti uchengetedze rubatsiro rwaunowana kubva kune-kunze-network wekupa kune in-network rate . Kana bhizimisi yako ichipa ruzivo rwomukati, iwe unobhadhara chikamu chiri pasi-network deductible, copay, kana kuti kubhadhara kune imwe nzvimbo kunze kwe-network.
Sei Kushandiswa Kwemagetsi Kunogona Kubatsira
Chokutanga, cherechedza kuti hurongwa hwako hwehutano hahuzove huchida kupa mutezo wepakati. Iri basa rakawedzerwa kwavari, uye rinogona kuguma rave riine mari kune avo zvakare. Zvisinei, kana hurongwa hwehutano husina mu-network hupi huri munharaunda yako kana kana uyo anopa mvumo asina kukwanisa kupa hutano hwehutano hwaunoda iwe, hazvina kunaka kukuita iwe kubhadhara mari yakakura-kugovana chete nokuti chirongwa chehutano hachina mukana wakakwana wekupa mutezo.
Saka, vatsigiri vese vanogona kupa mvumo yekunamatira yekutengeserana kukubvumira kuwana rubatsiro rwaunoda kune wekunze-we-network kupa pasina kubhadhara kupfuura iwe unofanirwa kubhadhara.
Zvikonzero Zvaungaita Kuti Uwane Indaneti Gap Kubva
Iwe haunzwisisike kuti uwane kambani yemapurisa kunze kwekutevera kwechokwadi:
- Kuchengetedza kwaunenge uchikumbira ndeyekubatsira kwakavharidzirwa uye kunoda kurapa .
- Hakuchina mu-network kupa uyo anokwanisa kupa rubatsiro rwaunoda mukati memakiromita akaenzana. Chirongwa chega chega chehutano chinozvitsanangurira icho chakanaka chikamu chakanaka. Mune dzimwe zvirongwa zvehutano, zvingava maira makumi mashanu. Mune vamwe, inogona kunge yakakura kana yakakura.
Kana mamiriro ako akafanana neainoda pamusoro apa uye iwe wakaziva kunze kwe-network muteveri unosangana nezvose zvaunoda, unogona kutumira chikumbiro kune kambani yako yehutano inshuwarheni kune imwe nzvimbo yepasiti gap. Mune zvimwe zviitiko, kunze kwe-network mupiki angave achida kuita izvi kwauri; mune dzimwe nguva, iwe unofanira kuzviita iwe pachako.
Iwe unofanirwa kukumbira kushandiswa kwepaketani kwepabonde asati awana kutarisirwa . Kana iwe ukamirira kusvikira iwe wawana kutarisirwa, urongwa hwako hwehutano huchagadzirisa kudai sekunze kwe-network uye iwe uchabhadhara zvakawanda.
A Network Gap Kubvumirana chete Kunovhara Rimwe Nyaya Inoshanda
A network gap exception haisi kukupa kadi blanche kuti uone kunze kwe-network kupa kune chero basa raunoda, chero nguva yaunoda.
Pane kudaro, apo inshuwarheni inopa ruzivo rwemapuraneti, kunze kwekuti inowanzovhara imwechete yebasa rinopiwa nemumwe munhu kunze kwe-network inopa nguva shoma.
Zvamunoda Nekudavira Kwako Kusaita
Izvo zvaunoda iwe zvaunoda paunenge uchikumbira mukana wekutsvaga ruzhinji unosanganisira:
- Iyo code CPT kana HCPCS inotsanangura basa rehutano hwehutano kana nzira inoda iwe.
- Ikhodi ye ICD-10 inotsanangura kuongorora kwako.
- Izvo-kunze-network-mutezi wekutsvaga mashoko.
- Zuva rinotarisa panguva yaunotarisira kugamuchira basa rakakumbirwa. Somuenzaniso, kubva paFebruary 1, 2018, kusvika panaJuly 31, 2018.
- Mazita e-in-network providers ezvimwe zvidimbu mukati memunharaunda yako pamwe nekutsanangura kuti sei iyo in-in-network provider isingakwanise kuita basa racho.
Kuti uone kuti nzvimbo yakasununguka yakasanganiswa inosanganisira maidiro aunoda, tora ma CPT codes, HCPCS codes, uye ICD-10 nhamba kubva kune wako kunze-we-network provider. Kana izvi zvakaoma nokuti iwe hauna kutarisana nemupiki iye zvino, chiremba akakuratidza iwe angakwanisa kukupa mazano ekurapa anodiwa.
Kutsanangura Chikonzero Nei Mugove Wako Wemutambo Asingaregi
Kana paine chero mu-network network vanoita zvimwechetezvo sevanenge vari kunze kwe-network mupi weurikukumbira kusarudzwa kwepaneti, iwe uchada kutsanangurira kambani yako yehutano inshuwarisi kuti sei iwe usingagoni kushandisa in-network mupi.
Heino muenzaniso. Ngatiti iwe unoda kuvhiyiwa nzeve uye uri kukumbira rutivi rwepabheti rusina kukwanisa kubvisa kunze kwe-network otolaryngologist kuita chirwere. Zvisinei, pane in-network otolaryngologist mukati memunharaunda yako. Iyo in-network otolaryngologist yakwegura, ine kudengenyeka kwemaoko, uye naizvozvo haisisiri kuita chirwere. Kana iwe usingafambidzani mukutsanangurira hurongwa hwako hwehutano nei iyo-network otolaryngologist isingakwanisi kugovera basa raunoda, chikumbiro chako chinogona kukanganwa.
Zvaunofanira Kuita Kana Chikumbiro Chako Chakarambwa
Usarega kunyange kana chikumbiro chako chakarambidzwa. Dana kambani yako yehutano inshuwarano kuti uone kuti nei. Dzimwe nguva, kukumbira kunorambwa nokuda kwechikonzero chakajeka chakadai:
- Iyo inshuwarisi yakashaya kutaura nehofisi ye-out-of-network provider.
- Iyo inshuwarisi inofunga kuti pane-inhare vapeji vanogona kupa sangano rimwe chete.
- Iyo inshuwarisi haina kero yako yakarurama uye saka inofunga kuti iwe unogara uri pedyo ne--network providers kupfuura iwe.
Zvose izvi zvinokanganisa zvinogona kubviswa. Kana ukangonzwisisa nei chikumbiro chacho chakarambidzwa, unogona kukumbira chisarudzo ichocho kana kutumira chikumbiro chitsva chinosanganisira mamwe mashoko ekusimbisa chikumbiro chako.