Pane zvikonzero zvakawanda zvingaita kuti uende kunze kwehutano hwehutano hupiwe network kuti uchengetedze. Zvisinei, kutarisira kunze-kwe-network kunowedzera mari yako yehupfumi uyewo njodzi yako yekuve nehutano hwakanaka nehutano hwehutano hwaunogamuchira. Kunyange iwe usingakwanisi kubvisa zvachose njodzi yako yakawedzerwa, unogona kuderedza iyo kana ukaita basa rako rechikoro.
Usati waenda kunze-ye-network, wana kunzwisisa zvakajeka nezvezvipingamupinyi zvinosanganiswa uye zvaunogona kuita kuti uzvigadzirise. Tanga nekuziva kuti sei kuwana hutano kunze kwe-network kunowedzera ngozi.
Sei Kuwana Kuchengetedza Kunze Kwemagetsi Ndekukuvadza Kwemari
Iwe unorasikirwa nehutano hwehutano huripo
Apo kambani yako yehutano inshuwarisi inogamuchira chiremba, kliniki, chipatara, kana imwe mhando yekupa mupiki wayo wehutano, iyo inotauridza kutengesa mitengo yevhisi iyo. Paunoenda kunze kwe-network, hauna kudzivirirwa nehutano hwehutano hwako. Iyo chete inokurukurwa kutora iwe waunowana ndiyo inotora iwe unotaurirana iwe pachako. Sezvo usina hutano hukuru hwevashandi paunoita kuti uve nechokwadi chekutora chikamu chakanaka, iwe unowedzera dambudziko rokutengesa zvakanyanya kuti iwe utarisire.
Chikamu chako chemari chakakwirira
Mari yako yekutengeswa ndiyo yakabviswa , copay , kana coinsurance iwe unofanira kubhadhara chero ipi zvayo inopiwa.
Paunoenda kunze-kwe-network, yako chikamu chemari yakakwirira. Iyo yakareba zvakadini inobva kune rudzi rwehutano hwehutano uhunahwo.
Kana hurongwa hwako hwehutano huri HMO kana EPO , hunogona kunge husingafambi kunze kwe-network kutarisira zvachose. Izvi zvinoreva kuti iwe uchava nemhosva yekubhadhara 100% yebhadharo yako yekubuda kwe-network.
Kana chirongwa chako chehutano chiri chirongwa chePPO kana chirongwa chePOS, icho chinogona kupa chimwe chezvinhu kutarisa kwekunze kwe-network. Kunyange zvakadaro, hazvizobhadhara sehombe yepamusoro yebhadharo sezvo ingadai yakabhadhara dai wakagara mumutambo. Somuenzaniso, iwe unogona kuva ne20% coinsurance ye-in-network kutarisira uye 50% coinsurance yekunze kwe-network.
Kunyange yako yakabviswa ingave yakakanganiswa. Kana hurongwa hwako hwehutano hunoita kuti uwane mari yekunze kwe-network, unogona kuona kuti iwe unobviswa chimwe chekuchengetedzwa kwe-network uye imwe, yakakwirira, inobviswa nokuda kwekunze kwe-network .
Iwe unogona kuenzaniswa-kukweretwa.
Paunoshandisa in-network provider nokuda kwehutano hwehutano hwehutano, uyo anopa mvumo akabvumirana kukubhadhara iwe pane chimwe chinhu kunze kweiyo yakabviswa, copay, uye coinsurance iyo hurongwa hwako hwehutano huri kutaurirana.
Paunoshandisa kunze kwe-network, haasi chete uyo anogona kukupa chero zvaanoda, anogona kukubhadharai pane zvakasara mushure mokunge inshuwarisi yehutano yehutano ibhadhara chikamu chayo. Inonzi bhajiro yekubhadhara, izvi zvingakwanisa kutengesa zviuru zvemadhora.
Heino nzira iyo inoshanda. Iwe unosarudza kushandisa kunze kwe-network mupiro wemoyo wako catheterization. PPO yako ine 50% kubhadhara kwekunze kwe-network, saka iwe unofunga kuti urongwa hwako hwehutano huchabhadhara hafu yemari yekutora kwako kunze kwenyika, uye iwe uchabhadhara imwe hafu.
Mwoyo catheterization inouya nemutemo we $ 15,000, saka iwe unofunga kuti iwe unokwereta $ 7,500, zvakarurama? Zvakashata!
PPO yako inotarisa iyo $ 15,000 bhiri uye inotaura chimwe chinhu kumigumisiro ye "Izvozvo zvakawandisa. Imhosva inonzwisisika yekutarisira kwakadaro ye $ 6,000, saka tiri kungobvumira $ 6,000 kutengesa. Tichabhadhara hafu yedu ye $ 6,000 inonzwisisika. "PPO inopa $ 3,000.
Izvo-kunze-network mupiro haatarisi kuti chirongwa chako chehutano chinofunga ndechepi inonzwisisika. Iko kunofanirwa kubhadhara mari yako yePPO ye $ 3,000 kune $ 15,000 mushamba uye inokutumira iwe mushumo wekuenzanisa (ndicho chikonzero ichi chinonzi kutengesa kubhadhara ). Iwe zvino unokwereta $ 12,000 panzvimbo ye $ 7,500 waunofunga kuti iwe unenge uine chikwereti.
Iwe unopedza kudzivirira kuchengetedza kwako kwepamusoro pehomwe.
Utano hwako hwehutano inshuwarheni huri kunze kwehombodo yakagadzirirwa kuti hudzivirire kubva kune mari isingagumi yekurapa. Inoisa kapu, kana kuti yakakwirira, pamutengo wese waunofanira kubhadhara gore roga rega muzvikwereti, copays, uye coinsurance. Somuenzaniso, kana chirongwa chako chehutano chiri kunze kwehomwe ye $ 6 600, kana iwe wakabhadhara mari inosvika madhora 6 600 mumadhokoni, mapepa, uye coinsurance gore iroro, unogona kurega kubhadhara mari iyo yekugovana mari. Urongwa hwako hwehutano hunotora 100% yebhuku rehutano hwehutano hwehutano hwakakosha kwegore rose.
Zvisinei, zvirongwa zvakawanda zvehutano hazvikweretesi iwe unowana kunze-kwe-network kusvika kune yako yepamusoro-yepamusoro pehomwe. Sezvo kubuda kwepasi kwehomwe yepamusoro kungangova chinhu chimwe chete chakamira pakati pako uye zvachose chekushaya mari kana iwe ukakurira mamiriro ekurapa anorema, kusarudza kuchengeta kunze kunze kwekuchengetedza kuti kunze kwehomwe muhomwe kuchawedzera mungozi yako yemari.
Unhu Hwokutarisira Nheyo Nekunze-Nheyo Utano
Vanhu vazhinji vanotsvaga kutarisira kunze-kwe-network nokuti vanofunga kuti vanogona kuwana hutano hwepamusoro hwekutarisira kupfuura hurongwa hwehutano hwavo mu-network providers huchapa. Kunyange zvazvo izvi zvingave zvichiitika kana zvisingasvike, ziva kuti iwe unogona kurasikirwa nezvimwe zvidziviriro zvepamusoro apo iwe unoenda kunze kwe-network.
Iwe unogona kunge uine matambudziko nekubatana kwekutarisira kwako.
Kunyanya muhutano hwehutano husingazobhadhara chero chinhu chekunze-che-network kutarisira, hapana mamiriro ezvinhu akanaka ekunyatsogadziriswa kwekutarisira kunopiwa nekunze kwe-network kupa nekutarisirwa kunopiwa ne-in-network providers.
Pakupedzisira, onus is on you to make sure that in-network doctors do know what your out-of-network doctor is doing, and vice versa. Iwe uchava mutevedzeri uye murondedzero wemashoko pakati pako nguva dzose mune-network providers uye yako kunze kwe-network.
Usati wanyanyisa kubvuma kuti bhuru inomira newe ... ona kuti buck haizombomira. Iwe haufaniri kupindira kamwe chete kuti uzadze gwaro iri rekukurukurirana. Iwe unotofanira kuzviita nguva dzose nguva yaunenge wakatarisana, kuedza, kuchinja mune hutano hwako, kana kuchinja mune chirongwa chako chekurapa.
Iwe hausi kungovhara musiyano wekukurukura pakati pevanachiremba, zvimwe; iwe uri kuzozviita pakati pekunze kwe-network yako uye nehutano hwako, zvakare. Semuenzaniso, kana wako kunze-we-network cardiologist anoda kuronga kuedzwa kana kurapwa kunoda kusati kwapiwa mvumo kubva kune yako inshuwarisi kambani, iwe ndiwe unofanirwa kuve nechokwadi chokuti iwe unotora iyo yekutenderwa. Kana iwe usingawani mvumo yekutangira, urongwa hwako hwehutano hunogona kuramba kubhadhara .
Iwe ucharasikirwa nehutano hwehutano kuongororwa kwevateresi.
Usati wabvumira mutarisiri wehutano kuti atore chikamu munharaunda yaanopa mutevedzeri, chirongwa chako cheutano chinomuponesa. Izvi zvingava zvakajeka sekutarisa kuti mabhizimisi emubatsiri ari mumamiriro akanaka kana kuti zvivako zvakagamuchirwa nemasangano ekubvumira kwehutano anozivikanwa seJCAHCO. Zvisinei, kuburitswa kunogona kuva kwakaoma kunzwisisa uye kwakadzama kudarika izvozvo, kupa hurumende inogona kuva yakaoma iwe kuti uzviite iwe pachako. Uyezve, zvirongwa zvakawanda zvehutano zvine hurongwa hunopfuurira hunoona hutano hwehutano hupihwa kune nhengo dzavo ne-in-network providers. Vapi vasiri kuenzanisa nehuwandu hwehutano hwehutachiwana hunodonhedzwa kubva kunhare.
Paunoenda kunze kwe-network, iwe unorasikirwa netsika yekuchengeteka yehutano hwako hwehutano hwekuongorora nekutarisa zvirongwa.
Iwe ucharasikirwa nehutano hwako hwehutano hwehutano nevatapi.
Kana iwe uchinge uine dambudziko kana gakava ne-in-network provider, kambani yako yehutano inshuwarheni inogona kuva mutongi ane simba panzvimbo yako. Sezvo urongwa hwehutano hwako hunomiririra zviuru zvevatengi kune uyo anopa, uyo anopa mukana achaona kana chirongwa chehutano chinokanda simba rayo rakakosha shure kwekutaura kwako. Kana urongwa hwehutano husingafungi kuti mupiro ari kuzvibata zvakakodzera, zvinogona kumuburusa kubva mumutambo wayo. Kunyange zvazvo zvinhu zvisingawanzofambira mberi iri kure, zvakanaka kuti uzive kuti une mumwe munhu ane ruzivo parutivi rwako.
Kune rumwe rutivi, an-out-of-network provider haafaniri kutarisira zvishoma izvo kambani ye inshuwarisi yehutano inofunga. Uyezve, pasinei nokuti zvinoshamisa sei chiitiko chakakonzera kukakavadzana kwako, kambani yako yveshuwarhu yehutano haisi kuzokurumidza nguva yako kukurudzira iwe nekunze kwe-network kupa iyo isingagoni kuchinja.
Nzira Yokushandisa Nayo Ngozi Dzokuwedzera Dzakasangana Nekunze Kwekuchengetedza
Sezvo uchange uine basa rinokosha pakuita kuti iwe uwane kutarisirwa kwakanaka kubva kune wako kunze-we-network provider, dzidza. Aya mazano anogona kukubatsira:
Nzira Yokutsvakurudza Dhigirii Dhigirii .
Nzira Yokuwana Nayo Chiremba Nezvokurapa Zvisina Kurapa Rekodi .
Nzira Yokusarudza Yakanakisisa Chipatara .
Iva nechokwadi chokuti kunze kwe-network providers vane zvinyorwa zvinobva kune-in-network providers, uye kuti in-network network providers vane zvinyorwa kubva kunze kwe-network-providers. Vanhu vazhinji vachada kuwana marekheni avo ezvokurapa. Nzira Yokukumbira Marenda Ako Okurapa .
Kugadzirisa iwe pachako kunotora kunyatsocherechedza tsanangudzo. Iwe unofanirwa kuva nyanzvi yepasi rose mukurapa kwako. Iwe ndiwe mutungamiri weboka rako rehutano hwehutano, uye iwe unofanirwa kunge uchikurumidza kukurumidza pane izvo umwe wevadzidzi vako varikuita uye nei.
Mukuwedzera pakupa marekodhi emakiriniki, unoda kutora zvinyorwa zvako paunotarisira. Uchishandisa zvinyorwa zvako, iwe unogona kupa kukurumidza kutaura mazwi kune vapeereri vako nezvekuchinja mune dzimwe zvirongwa zvevashandi zvekutarisira kwako. Iwe unogona kukwanisa kutsanangura kuti nei mupiki akaita shanduko muurongwa hwako hwekutarisira hwaakaita, kwete chete izvo kuchinja kwaiva.
Sezvo uchange uri kubhadhara chikamu chikuru chekutarisira kwako paunenge uchitarisa kunze kwe-network, iwe unoda kuziva kuti mari yako ichave iwe usati wawana kutarisirwa. Ronga pakutaurirana chiyero chinoderedzwa nekunze kwekunze-network; haudi kubhadhara "rack rate". Kana urongwa hwako hwehutano hunobatsira kubhadhara kunze kwe-network, taura kuti chii chakanaka uye chemutambo wacho ndeyekutarisira kwaunoda. Izvi zvingabatsira:
Tora Indaneti Gap Kubvumirana kuti Ubhadhara In-Network Mitengo yeIri-Ye-Network Care .
Tsvaga Kuti Ndezvipi Zvakawanda Zvokurapa Kwako Kunofanira Kuda .