Iko Kunogona Kuva Ipo Nguva Ipo Izvo Zvisizvo Zvekugadzira Nheyo Ndezvakosha
An out-of-network provider ndeye asina kubvumirana nekambani yako ye inshuwarisi yekubhadhara pamutengo wekutaurirana. Zvimwe zvirongwa zvehutano, saHMO , hazvibhadhari kunze kwevashandi vese pane zvose, izvo zvinoreva kuti semurwere, iwe unenge uine mutoro wemari yakazara yakapomerwa nachiremba wako. Zvimwe zvirongwa zvehutano zvinopa kugoverwa kwekunze kwe-network providers, asi mutoro wako une chirwere unenge wakakwirira pane zvaizova iwe kana uri kuona mu-network network.
Zvikonzero zvekusarudza kunze kwe-Network Health Care
Kunyange zvazvo pakutanga zvingakubhadhara mari yakawanda, pangave pane dzimwe nguva apo iwe ungaona zvichidikanwa, kana kunyange kutarisirwa, kushandisa kunze kwe-network.
Dzimwe nguva hauna chaunosarudza, kana kuti zvinongonzwisisika kusarudza munhu asiri we-network networkcare provider. Pasi pane urongwa hwezviitiko umo iwe ungakwanisa kukwidza mu--network coverage, kana inogona kugoverwa:
Dambudziko: Mamiriro ekukurumidzira, unofanira kutsvaga rubatsiro rwakapedzisira rwawanikwa. Iko Inotengeswa Care Care Act inoda inshuwarisi kuvhara kuchengetedzwa kwekukurumidzira sekunge iri mu-network, pasinei nokuti kuchengetedzwa kwekukurumidzira kunowanikwa kune imwe mu-network kana kunze kwe-network nzvimbo. Asi zvakadaro, kunze kwe-network makamuri ekukurumidzira uye vanachiremba vanogona kukutumirai mari yebhadharo , uye mari yekubhadhara haina kuvharirwa neAACA (kunyange zvazvo mamwe maitiro akadzivisa ). Kana zvisiri zvechokwadi zvekukurumidzira, kushanyira kwako hakuzogadziriswa se-in-network treatment; iwe unofanirwa kuenda kumunhu anenge akafukidzira panzvimbo.
Kunyatsotarisirwa: Kana iwe uine chirwere chisina kujairika icho pasina nyanzvi inowanikwa muurongwa hwako, kunze kwe-network kutarisira kungave kwakakosha.
Kuchinja vachengeti vangaisa pangozi utano hwako: Kana iwe uri pakati pekurapwa kwemashoko makuru kana ekuguma-e-hupenyu, uye iwe unopa mupiro anobva mumusangano, zvingave zviri mukanakisisa iwe kuramba uchichengetedza kuburikidza nekubuda kunze kwekutengesa.
Iwe unogona kukumbira kuti uenderere mberi--kubatanidza ruzivo, kana kwenguva imwe chete kana nhamba yakatarwa yekushanyira.
Kunze kwekuchengetedzwa kweguta: Kana uchida kurapwa paunenge uri kure nemusha, unogona kubuda kunze kwekutengesa, asi vamwe vambisi vehurumende vachabata kushanyira kwako kune uyo asingatori mubatsiri kunze kwekunge uri mumutambo. Zvisinei, in-network providers inogona kuwanikwa. Kana zvisiri zvekukurumidzira, zvakanakisisa kuti utaure neshuwarenzi yako kutanga kuti uwane.
Nharaunda yepamusoro: IAACA inoda vatsigiri vekuchengetedza kuti varambe vakagadzirisa mitambo yakakwana zvichienderana nechokuita uye nguva iyo nhengo dzinofanirwa kufamba nadzo kusvika kune mutevedzeri wezvokurapa, asi mirayiridzo maererano nezvakakwana yakasiyana kubva kune imwe nyika kuenda kune imwe. Kana iwe uchigara kumaruwa uye pasina kuwanikwa kwechokwadi kune-in-network provider munharaunda yako, hutano hwako hwakaramba hunogona kuvimba nekushandisa chiremba asingabatsiri. Mune zviitiko izvi, unogona kukwidza kuti uwane ruzivo rwekunze kwe-network inopa munharaunda yako.
Njodzi dzinongoitika dzoga: Mafashamo, moto wakapararira, dutu, uye mhirizhonga zvinogona kuparadza zvipatara uye kusunga vanhu kuti vaende kune dzimwe nzvimbo dzavanofanira kutsvaga kutarisira utano. Dzimwe nguva, varwere ava vanogona kunge vakakodzera ku-mumatare ehurumende sechikamu chekuzivisa kwekukurumidzira nehurumende kana hurumende yehurumende.
Izvo-kunze-network mupiki angangokutumira iwe mushumo
Zvakakosha kuziva kuti kunyange kana kambani yako ye inshuwarisi ichibata iwe kunze kwe-network kutarisira sekunge iri mu-network, mutemo wezvematongerwo enyika haudi kuti kunze kwe-network mvumo kubvuma mari yako yekambani yveshuwarisi sekubhadhara kwakakwana.
Somuenzaniso, ngatitaurei kambani yenyu yveshuwarenzi ine " inonzwisisika uye tsika " yepamhanho ye $ 500 kune imwe nzira, uye iwe watosangana newe in-network deductible. Zvino unopedzisira uri mumamiriro ezvinhu apo an-out-of-network anogadzira nzira yacho, asi ndeimwe yemamiriro ezvinhu akarondedzerwa pamusoro apa uye wako insurer anobvumirana kubhadhara $ 500.
Asi kana kunze kwe-network mutengesi kuripa $ 800, vanogona kukutumirai mari yeimwe $ 300.
Izvi zvinonzi kuenzanisa kubhadhara , uye zvinowanzotenderwa kana mutapi asiri muurongwa hwehutano hwako.
Dzimwe hurumende dzakagadzirisa nyaya iyi kune zvimwe zviitiko, kusanganisira Florida (kunze kwe-network providers vanoshanda mu-network network zvipatara) uye kuNew York (mamiriro ezvinhu ekukurumidzira). Asi kazhinji, kuenzanisa kubhadhara kuchiri nharo apo varwere vanowana kutarisirwa kunze kwekunishuwarenzi.
> Sources:
> Centers for Medicare neMedicaid Services, Center for Consumer Information and Insurance Oversight. Affordable Care Act Kushanda FAQs, Set 1. Out-of-Network Emergency Services.
> Commonwealth Fund. Kuenzanisa Kubhadhara Nevanopa: Kuongorora Vatengi Kudzivirirwa Munyika Yose . 2017.
> Urban Institute. Robert Wood Johnson Foundation. Kuvimbiswa Kutevedzana neMatare ekugadzirisa Mitemo: Zvidzidzo Kubva kuNyika Dzose . March 2017.