Pasina Kugamuchirwa, Mufambisi Wako Haangabatsiri
Kugamuchirwa ishoko rinodiwa kuti chiremba wako agamuchire chibvumirano kubva kune waunopa utano wehutano asati agadzirira kutarisira. Pasina izvi zvinotenderwa kare, mushandi wehutano wehutano wehutano haagoni kugovera, kana kubhadhara, mishonga yako kana kushanda, achikusiya iwe kuti uvhare zvimwe, kana kuti zvose, zvezvinodhura kubva muhomwe.
Vamwe vatsigiri vezvehutano vanoda kusati kugamuchirwa, uye vanozivikanwa sepamberi-certification, kune mamwe marudzi ehutano hwehutano, zvakadai sekuvhiyiwa kana kushanyira kuchipatara .
Izvi zvinoreva kuti iwe kana chiremba wako unofanira kutumira inshuwarisi yako kuti uwane kugamuchirwa kwavo vasati vatarisira, kana zvisinei kuti inshuwarisi ingasaifukidza. Hasi masevhisi ose achada kutanga kugamuchirwa, asi kana iwe usina mubvunzo, zvakanakisisa kusangana nekambani yako ye inshuwarisi musati wawana chero mararamiro ehutano.
Uyewo Anozivikanwa Se: Pre-certification. Iko pfungwa yekugashira isati yakakodzana yakafanana neyeYe Prior Authorization .
Pane zvikonzero zvakasiyana siyana zvekuti utano hwehutano hwehutano huchada kubvumidzwa.
1. Basa kana chirwere chaunenge uchikumbira chinonyanya kukosha .
2. Basa kana chirwere zvinotevera zvinokurudzirwa kusvika kunezvino zvinoratidzira nezvehutano hwehutano hwauri kuita.
3. Mishonga iyi ndiyo inonyanya kukoshesa kurapa inowanikwa pamamiriro ako. Semuenzaniso, Drug C (inodhura) uye Drug E (inodhura) zvose zvinoshandisa chirwere chako. Kana chiremba wako akaraira Drug E, chirongwa chako chehutano chingada kuziva kuti nei Drug C isingashandisi zvakafanana. Kana uchikwanisa kuratidza kuti Drug E ndiyo nzira yakanakisisa, inogona kunge yakagadzirirwa. Kana pasina chikonzero chekurapa chikonzero nei Drug E yakasarudzwa pamusoro pemiti inodhura Drug C, hurongwa hwako hwehutano hunogona kuramba kugamuchira Drug E.
4. Basa racho harisi kudzokororwa. Izvi zvinoshungurudza apo nyanzvi dzakawanda dzinobatanidzwa mukutarisira kwako. Somuenzaniso, chirwere chako chemapapu chinogona kuraira chifukidzo CT scan , kwete kuziva kuti, mavhiki masere apfuura, iwe wakanga uine chifu che CT chakarayirwa nechiremba wako wekenza. Muchiitiko ichi, wako insurer haazogoni kutendera chikamu chechipiri kusvikira ichiita kuti chirwere chepamupa chako chione kuve iwe waive nemavhiki maviri apfuura uye unotenda kuti kumwe kuwedzerwa kunokosha.
5. Basa rinoenderera mberi kana rakadzokorora rinokubatsira. Somuenzaniso, kana wakanga uine kurapwa kwemwedzi kwemwedzi mitatu uye uri kukumbira mvumo yeimwe mwedzi mitatu, ingano yekurapa inobatsira zvechokwadi here? Kana uri kuita zvishoma nezvishoma, kufambira mberi kunogona kuenzaniswa, mwedzi mitatu yakawanda inogona kunge yakagadzwa kare. Kana iwe usiri kuita chimwe chinhu mberi, kana kana PT ichikuita kuti uwedzere kunzwa zvakanyanya, urongwa hwako hwehutano hahugoni kupa mimwe zvirongwa zveP PT kusvikira uchitaura nachiremba wako kuti anzwisise kuti nei achifunga imwe mwedzi mitatu PT ichakubatsira.