Kuendeswa kune imwe nzira yakagadzirira yekugashira iyo nhengo dzehutano hwehutano-kunyanya avo vane HMOs -kuwana kuwana kubva kuchiremba wavo wakasarudzwa wokurapa vasati vaona nyanzvi kana mumwe chiremba mune imwechete yehutano.
Zvimwe zvirongwa zvinoda kuti kutumirwa kunyore zvakananga kubva kunachiremba, asi vamwe vanobvuma foni kubva kuchiremba wako wekugadzirira.
Kuti uve nechokwadi chokuti zvinhu zvose zviri muhutano pamusoro pekuona nyanzvi , iwe unofanira kunge uchiita basa, uye iva nechokwadi chokuti insurer yako yakagamuchira kutumira mberi usati waita musangano neunyanzvi hwako. Izvozvo iwe uchaziva kuti kushanyira kwako kumudzidzisi kuchafukidzwa pasi peurongwa hwehutano hwako.
Zvinyorwa uye HMO
Masangano ekuchengetedza hutano, kana HMO, anoda munhu kuti asarudze chiremba wepamusoro . Chiremba mukuru wekuchengetedza ndiye anokwanisa kutarisira zvose zvehutano hwehutungamiri huri mberi. Chiremba mukuru wekuchengetedza anova nemhosva yekuita mazano kune zvidzidzo zvekurapa, nyanzvi yekushanyira, mishonga, nezvimwe. Chiremba mukuru wekuchirapa anopawo kutumira kune chero humwe humwe hunodiwa huripo kana kuti nyanzvi anoshanyira mukati memutambo. Izvi zvinokubvumira kuenda kuenda kuona imwe chiremba kana nyanzvi mukati mehutano hwehutano .
Kana iwe usina hurumende kubva kuchiremba wako wekutanga, kana iwe uchisarudza kuenda kune mumwe chiremba kunze kwehutano hwerongwa hwehutano hwako, iwe uchange uchida kubhadhara zvose kana kuti zvizhinji zvekutarisira kwekutarisira, sezvo zvisingagone ifukidzwe neHMO. IHMO inowanzovhara kushanyira mukati memaketani.
HMO yakave yakajairika pane imwe yehutano inshuwarisi yemisika pamakore mashomanana apfuura sezvo vashandi vanoita basa rokutarisira mari. Utano hwehutano wehutano inshumo mune dzimwe nyika hahuna humwe hutano hwePPO hunowanikwa.
Zviratidzo uye PPO
Zviratidzo hazvidiwi muPPO . Imwe sangano rinoda kugovera chirongwa chehutano chine zvibvumirano zvine unhu hwakawanda hwe "vasarudzo" vanopa. Iwe unokwanisa kusarudza kutarisira kwako kana kushanda kunze kwekambani. Kusiyana nesangano rekuchengetedza hutano, muPPO haufaniri kusarudza chiremba wekutanga uye iwe haufaniri kutumira kune vamwe vanopa mu network.
Nokuda kweizvi kushanduka, PPO inoronga yakawanda inodhura kupfuura HMO inoronga nezvimwe zvakafanana zvinobatsira. Uyewo vanowanzokwezva vanhu vanotora hutano nemamiriro ezvinhu ehutano, sezvo avo vari vanhu vanozove vachida kubhadhara zvikwereti zvepamusoro kuitira kuti vawane huwandu hwakawanda hwevashandi vehutano vanogona kuonekwa vasina kutumirwa. Ichi chikamu chechikonzero chikonzero kune vashandisi vemakethe vese vari kushanduka kubva kuPPOs mumakore achangopfuura.
Payment
Inishuwarenzi yekubhadhara kwemashoko mukati memutauro wakasarudzwa anosiyana pakati peHMO nePPOs.
In-Network:
HMO nePPO: Pasinei nokuti iwe une HMO kana PPO, ye -in-network services iwe uchava nemhosva yebhadharo uye iyo inobviswa , uye kubhadhara kana hurongwa hwako huchishandisa .
Out-of-Network:
HMO: Mune HMO, iwe hauna kuvharwa chero ani zvake kunze kwe-network services.
PPO: MuPPO, pane inowanzobudiswa kwekunze kwe-network kuchengetedza, asi uyo anopa mukana akasununguka kuenzanisa mari yako yechikamu icho mubhadhari wako haafaniri kuvhara kubvira apo mupiro asina kutora kontrakiti nemubhizimisi wako . Kana ukasarudza kubuda panze kwekweneteneni pakutarisira kwako, iwe kazhinji unoda kubhadhara mupiro pakutanga, uye wozobhadhara nePPO. Zvizhinji zvezvirongwa zvePPO zvinowedzera zvakakwana zvekugadziriswa kwegore negore uye kunze kwe-pocket maximums ye-out-of-network kuchengetedza, uye zviri kuwedzera kuonekwa kuona PPO inoronga pasina muganhu pane kunze kwehomwe mari yauchazoita kana ukaenda panze network.