Zvinorevei kuti 'kunze-kwe-network' zvinorevei?

Kambani Healthcare Yakatsanangurwa

Iwe unoenda kunowanzoitwa musangano kwachiremba mutsva uye-BAM! Unorohwa nemari yakakura kudarika inotarisirwa kunyangwe neinishuwarenzi yako yehutano. Iwe unoona kuti mutengo wakakwira uyu nekuti mupi wehutano wawakashandisa ari kunze kwenetiweki. Asi zvinorevei izvozvo? Ngationei!

Zvinorevei-zve-network zvinorevei?

Kunze-kwe-network kunotsanangura chiremba, chipatara, kana nzvimbo yehutano isiri iyo chikamu chehutano hwekambani yeinishuwarenzi. Izvi zvinoreva kuti yako inishuwarenzi haisati yatangisana netiweki mwero nachiremba iyeye, chipatara, kana chivakwa, uye iwe unozobhadhariswa chikamu chakakura chemutero wezvekurapa wese kana bhiri rese, zvichienderana nehurongwa hwako hwehutano.

Ese marongero ehutano akagadziriswa ane network, kusanganisira Medicaid uye Medicare .

Kumwe kurova kwekushandisa wekunze-kwe-network mupi ndeyekuti kazhinji izvi zvinodhura hazvishandiswe kune yako inobvisirwa kana chirongwa chako chisinga bude kunze-kwe-network mutengo. Ivo havazoverengera kune yako yekunze-kwehomwe yakanyanya kana.

Ngatitorei izvi pasi kana tichienzanisa kunze-kwe-network kune mu-network.

In-network vs. kunze-kwe-network

Paunosaina chirongwa chehutano, iyo inishuwarenzi inokupa runyorwa rwevanachiremba, zvipatara, uye zvivakwa zvehutano izvo mu-network . Kushanyira mu-network vanopa zvehutano mabasa zvinoreva huwandu hwakaderera kubva kune iyo inishuwarenzi kambani uye mupi vakataurirana mitengo. Kunze kwekunge kambani yako yeinishuwarenzi ichipa nerupo kunze-kwe-network kubatsirwa, kushanyira kunze-kwe-network vanopa zvinoreva kuti yako yekurapa mari ichawedzera sezvo yako inishuwarenzi kambani ichafukidza zvishoma kana kusatomboita zvachose.

Semuenzaniso, iwe unoona wako wekutanga wekutarisira nekuti ako zvivi zvinokuvadza. Anotarisa uye anokurudzira kuti iwe uone nyanzvi. Mari inobhadharwa parwendo irworwo rwechiremba iUS $ 100. Sezvo ari mu-network, dhisikaundi inoiswa kune iyo yakazara bhiri sezvo yako inishuwarenzi yakatangira kutaurirana chiyero nachiremba iyeye. Ngatitii, iyo yakaderedzwa yose yava madhora makumi masere. Iwe unogona kuve nemhosva kune iyo yasara yebhiri zvichienderana nemari yako yekusimbisa uye copay.

Nekudaro, mushure mekuita imwe ongororo, iwe unoona kuti iri nyore-inowanikwa nyanzvi iwe yaunoda kuti uone iri kunze-kwe-network. Iwe unosarudza kutora njodzi uye bhuku musangano. Mavhiki mashoma mushure mekushanya, unowana bhiri re $ 250. Sezvo iyo nyanzvi yakanga isiri mu-network, hapana dhisikaundi inoiswa kune iyo yakazara yehutano bhiri, uye yako inishuwarenzi kambani inovhara zvishoma, kana zvakanyanya, hapana kana zvachose kubvira mupi aive kunze-kwe-network uye macopay uye coinsurance haigone. shandisa.

Kuona in- uye kunze-kwe-network kudhura kuenzanisa munharaunda yako, karukureta aka inogona kubatsira. Zvinowanzova zvirinani kushandisa in-network hutano hwekupa, kana zvichibvira, nekuti mari yacho inenge iri shoma.

Izvo zvakakoshawo kuti uzive kuti pane zvakajairika mutsauko pamutengo pakati hurongwa hweinishuwarenzi yehutano kana uchibata ne-mu-network uye kunze-kwe-network fizi.

• PPO inomirira Sarudzo Inopa Mubatsiri. Aya marudzi ezvirongwa anowanzo kupa kunze-kwe-network mabhenefiti-kunyangwe, iwo asina kunyatsoita se-mu-network mabhenefiti. Iyo inishuwarenzi kambani inobatsira kubhadhara chikamu chemubhadharo uye iwe ungangobhadhara chikamu chakakura cheiyo coinsurance.
• HMO ipfupi kune Health Maintenance Organisation. Aya marudzi ehurongwa kazhinji haapi chero epanze-e-network mabhenefiti-zvinoreva kuti uchafanirwa kufukidza zvese kunze-kwe-network mutengo muhomwe.
• EPO (kana Exclusive Provider Organisation) imhando yehurongwa hwehutano iyo inongovhara mu-network masevhisi (kunze kwekukurumidza).
• Pos (aka Point of Service) chirongwa chinoda kuti varidzi vemitemo vawane kuendeswa kubva kuna chiremba wavo wekutanga kuitira kuti vaone nyanzvi. Iwe unozochengetedza mari nekushandisa mune-network vanopa, asi zvakasiyana neiyo HMO, unogona kugashira kutarisirwa kubva kune wekunze-kweneti mupi.

Imwe yekusiyanisa kune in-network vs. kunze-kwe-network mutengo ndeye emergency services. Makambani einishuwarenzi haakwanise kukuranga nemakopayment epamusoro uye hushamwari kana uchitsvaga rubatsiro rwechimbichimbi kubva kuchipatara chekunze. Iwe zvakare haufanire kuwana pre-kubvumidzwa kune ekukurumidzira kamuri masevhisi evari-ve-network vanachiremba nezvipatara. Nekudaro, Kana iyo yekunze-kwe-network imba yekukurumidzira isina kondirakiti nekambani yeinishuwarenzi, hazvisungirwe kubvuma kubhadhara kwavo semubhadharo wakazara. Kana ivo vachibhadhara mari isingasviki pane yekunze-kwe-network emergency imba yemabhiri, iyo emergency emergency inogona kutumira mutengi chikwereti chemari yemari isina kubhadharwa.

Chii chandinoita kana chiremba wangu ari kunze kwenetiweki?

Ngatitii wanga uchishanyira iye gynecologist mumwechete kwemakore gumi, asi mushure mekutanga basa idzva nekushandura inishuwarenzi, anova wekunze-we-network mupi. Unogona kunge usisakwanise kumushanyira nekuti haugone kubhadhara mari yekuwedzera yehutano.

Zvinogona kuve zvakachipa kuchinjira kune chiremba ari mu-network. Nekudaro, kana iwe usiri kuda kusiya chiremba wako wazvino, taura naye kana iye kuti uone kana paine sarudzo. Vamwe vanachiremba vanobvumidza varwere kubhadhara mari yemari, iyo inogona kunge yakachipa kupfuura iyo inopihwa nemakambani einishuwarenzi kana ichienzaniswa nemitengo yekunze- asi hazvizoverengere kune yako inobviswa kana kunze-kwehomwe yakakwira.

Iwe unogona zvakare kubvunza wako weinishuwarenzi wehutano kuti awedzere network gap kuwedzera, uko inishuwarenzi yako inovhara chiremba sekunge vari mu-network. Nekudaro, izvi zvinowanzo kupihwa chete kune akasarudzika mamiriro, senge pasina mumwe chiremba mune iyo yakasarudzika munzvimbo iyoyo, sezvo ichirasikirwa nemakambani einishuwarenzi ehutano 'mari.

Kunze-kwe-network dzimwe nzira

Kunze-kwe-network mabhenefiti mabhenefiti anodhura. Mune zvimwe zviitiko, zvingave zvirinani kuti utengese uchitsvaga chirongwa chitsva cheinishuwarenzi uine zvirinani mu-network kufukidzwa panguva kuvhura kunyoresa kana Nguva Yakakosha Yekunyoresa yezviitiko zvikuru zvehupenyu.

Imwe yedzakareruka nzira dzekudzikisa hutano hwekushandisa ndeye kushandisa SingleCare yekutsigira mari yemishonga iwe uchinge usiri underinshuwarenzi. Ingo tsvaga yako mushonga uye uwane iyo zvakachipa mitengo iripo , uine kana usina inishuwarenzi.