Chii chinonzi PPO?

Kambani Healthcare Yakatsanangurwa

Kana zvasvika kune inishuwarenzi yehutano, hapana kushomeka kwezvinyorwa uye mazwi asina kujairika anodikanwa kuti unzwisise mashandiro ehutano anoshanda. Iwe unayo kana iwe uri kufunga kusainira iyo PPO? Dzidza zvazviri, kana iri iyo sarudzo iwe, uye kuti ungaziva sei kana uinayo kare.

Chii chinonzi PPO?

PPO rudzi rwehurongwa hweinishuwarenzi yehutano. Inomiririra yakasarudzika mupi wesangano. NePPOs, iwe unobhadhara zvishoma paunoona mupi ari mukambani yako yeinishuwarenzi network - ndicho chikamu chinodiwa. Yako PPO yakatotaurirana imwe chiyero chehutano hwezvehutano hunopihwa neaya ari mu-network vanopa.

Iwe zvakare unokwanisa kuona vazhinji vanopa kunze kweiyo PPO network yekurapwa. Nekudaro, iwe unowanzo kubhadhara zvakanyanya kune vekunze-ve-network vanopa uye ekurapwa masevhisi. Izvi zvinodaro nekuti hapana chibvumirano chakatemwa chepamutemo pakati peiyo kunze-kwe-network mupi uye hurongwa hwako.

Nei munhu achizosarudza PPO pane HMO?

PPOs ndeimwe yemhando dzakakurumbira dzehurongwa hweinishuwarenzi yehutano nekuda kwekuchinja kwavo. Uine PPO, unogona kushanyira chero mupi wezvehutano waungade, kusanganisira nyanzvi, pasina kutanga waendeswa kubva kuna chiremba wekutanga (PCP) kutanga. Izvo zvinogona kubatsira kana usiri padyo nachiremba ari mune yako network network, senge paunenge uchifamba, kana kana iwe uchitova nechikwata chevashandi vehutano iwe unogadzikana navo, kunyangwe kana vari kunze kwenetiweki.

Zvakanakira iyo PPO zvinosanganisira iwo mukana wekugona kusarudza chiremba uye nyanzvi iwe yaunoda pasina kuenda kuburikidza nemukuru chiremba pakutanga, anotsanangura Yuna Rapoport , MD, MPH, ophthalmologist kuManhattan Eye muNew York City. Izvi zvinoisa murwere pachigaro chemutyairi.

PPO vs. HMO

PPOs haisi yako chete sarudzo, hongu. Imwe nzira yakajairika yehurongwa hweinishuwarenzi yehutano ndeye HMO, kana sangano rekuchengetedza hutano. HMO zvirongwa zvine mashoma misiyano yakakosha pamusoro pePPOs izvo zvinogona kukanganisa yako sarudzo yekambani yeinishuwarenzi yehutano.

Uine HMO, iwe unofanirwa kuenda kuburikidza nePCP yako kuti uendeswe kuitira kuti uone mu-network nyanzvi. HMO yako haizofukidze kunze-kwe-network mupi anoshanyira kunze kwekunge iri yechokwadi yekurapa emergency, uye kunyangwe ipapo, unogona kunge uchitsika chikamu chebhiri.

Nekudaro, Dr. Rapoport anoti panogona kuve nekukosha muzvirongwa zveHMO zvevarwere. Kubatsirwa kweHMOs kunobva pane-maitiro-akavakirwa maonero, anodaro. Nekuchengetedza hukama hwepedyo nachiremba wekutanga, kune vashoma vasingakoshi kushanya kune nyanzvi, kushomeka kwekufungidzira, uye mashoma kuongororwa bvunzo. Mhedzisiro inofananidzwa kana zvirinani pane iyo PPO, uye varwere vanachiremba vavo vese vakakurudzirwa nehurongwa.

Paunenge uchiwana kuendeswa usati waona nyanzvi inogona kuva kurwadziwa, zvinorevawo kuti PCP yako inobatanidzwa muhutano hwako nenzira iyo dzimwe nguva vanachiremba muPPO vasiri, vachikubatsira kuronga kutarisirwa nenzira kwayo.

Kuenzanisa kwemutengo

Uye zvechokwadi, haugone kutaura nezve hutano inishuwarenzi uye usingataure kunze-kwehomwe mari. PPO network inowanzo kuve yakakwira premiums , copayments , uye pagore rinobviswa kupfuura HMOs mukudzoka kwekuwedzera kuchinjika. Kana iwe ukaona wekunze-kwe-network mupi, iwe ungatofanira kubhadhara mutengo kumberi uye wozopa chikumbiro chekubhadharwa zvishoma. Kana iwe uchikoshesa kuchinjika uye usine hanya nekubhadhara zvakanyanya kune iyo, iyo PPO inogona kunge iri iyo chaiyo yehutano sarudzo iwe.

Mari yehutano yehutano neHMO network kazhinji haina kudhura zvakakwana. Iwe unenge uine madhiri epasi nepasi uye epopay mukuchinjana kushandisa PCP kurongedza hutano hwako. Zvisinei, iwe kazhinji haugone kuona kunze-kwe-network vanopa neHMO. Kana ukadaro, iwe unenge uine mutoro wemutengo wese.

RELATED: HMO vs. PPO

Pamusoro pezvo, iwe unogona kufunga nezve yakakwira deductible hutano chirongwa (HDHP), yakasarudzika mupi wesangano (EPO), kana poindi yehurongwa hwebasa (POS).

Ndinoziva sei kana ndine PPO?

Ndiri kufunga kuti ndeupi rudzi rwehurongwa hweinishuwarenzi yehutano hwauinahwo? Inowanzo taura zvakadaro iko kuseri kwekadhi rako reinishuwarenzi. Kadhi rako rinogona kutotaridza kuti imarii yauchabhadhara mumacopay ekushanyirwa nachiremba. Kufona nekukurumidza kumupi wako kana kupinda muakaundi yako yepamhepo kunogona zvakare kupa kumwe kujekesa.

Kana iwe usati uine PPO uye uchida kuchinjira kune imwe, unofanirwa kuzviita panguva kuvhura kunyoresa - kazhinji, asi kwete nguva dzose, munaNovember kana Zvita- kunze kwekunge wawana chiitiko cheupenyu chinokodzera . Zviitiko zvekufanirwa zvinosanganisirakutamira kuzip code nyowani kana mudunhu, kuroora, kana kuita mwana.

PPO zvirongwa zvinogona kuwanikwa kuburikidza neako waunoshandira, yako yemusika musika (kana paine imwe), kana iyo federal musika. Nzvimbo yakanakira yekutanga sarudzo iyi iri pahutano hwehutano.gov.

Medicare inopawo a PPO sarudzo (pakati peHMO uye dzimwe sarudzo) pasi peMedicare Advantage (Chikamu C) kana iwe uine makore makumi matanhatu nemashanu kana kupfuura uye uchikodzera. Chinhu chekuchengeta mupfungwa kana uchifunga chirongwa chePPO ichocho nhoroondo dzekuchengetedza hutano (HSAs) uye akaomarara ekuchengetedza maakaundi (FSAs) , pamwe nezvinhu zvakaita seSingleCare kadhi rako, zvinogona zvakare kubatsira kudzikisa mutengo wekurapwa kwako uye kupihwa mishonga.