Ndezvipi Zvakajairika, Tsika & Zvinonzwisisika (UCR)?

Kambani Healthcare Yakatsanangurwa

Kana iwe wakamboshamiswa nechikwereti chekurapa, hausi wega. Dzimwe nguva kushamisika ikoko kunoitika nekuti yako inishuwarenzi kambani haina kuvhara zvimwe kana zvese izvo zvakabhadharwa nachiremba wako pakurapwa nekuti hazvina kusangana neUCR yavo, kana zvakajairwa, zvetsika, uye zvine mwero chiyero.

Makambani einishuwarenzi anoshandisa nzira yeUCR kusarudza kuti vangabhadhara zvakadii kunze-kwe-network sevhisi yekurapa zvichibva pane izvo vazhinji vevamwe vanachiremba munzvimbo yechaji vanobhadharisa. Kana chiremba wako achibhadhara pamusoro pekambani yeinishuwarenzi UCR mwero, vangangotadza kubvuma kufukidza zvese, vachikubhadharisa mari yeUCR yekubhadhara iyo yasara.

Kana iwe ukashandisa in-network Provider, uye iwe uine chirongwa chekuchengetedza chakachengetedzwa kunge HMO, PPO, kana POS, haufanire kunetseka nezve mari yeUCR. Izvi zvinodaro nekuti avo vanopa vakatotaurirana nekambani yeinishuwarenzi uye vakabvuma kugamuchira mwero weUCR semubhadharo wavo uzere. Dzimwe nguva, zvakadaro, iwe ungangoda kushandisa wekunze-kwe-network mubatsiri, kana iwe unogona kunge uine chirongwa chekuregererwa (zvinova zvishoma). Ndosaka zvakanaka kuziva kuti mari yeUCR inoshanda sei uye kuti ungadzivise sei kana uchikwanisa.

UCR inomirirei?

UCR inomiririra zvakajairwa, zvechinyakare, uye zvine musoro, uye inotsanangura kuti makambani einishuwarenzi anosarudza sei kana izvo zvinopihwa nemupi wezvekurapa maitiro zvikaenzana kana zvishoma pane yakanyanya mari yavanofunga kuti inofanira kubhadhariswa

Heano marondedzero anoita makambani einishuwarenzi izvo zvakajairwa, zvechinyakare, uye zvine musoro maitiro:

Zvakajairika: Mari inobhadharwa inoonekwa seyakajairwa kana ichienderana nezvinowanikwa nevarapi vezvekurapa munguva yakapfuura yemaitiro akafanana kana akafanana.

Tsika: Kubhadharisa kunoitwa mutsika kana iri mukati meyakawanda mari yemubhadharo inowanzoitirwa nevamwe vezvekurapa munzvimbo inobhadharisa nzira imwechete kana yakafanana kana masevhisi.

Zvinonzwisisika: Mari inobhadharwa inoonekwa seinonzwisisika kana ikasangana nezvose zvakajairwa uye zvetsika maitiro kana iri mamiriro akakosha. Izvo zvinogona kusanganisira isingawanzo kana yakaoma nzira.

Zvinorevei, zvechivanhu, uye zvinonzwisisika zvinorevei?

Kuti makambani einishuwarenzi anouya sei nemitero yawo yeUCR inogona kunge iri isinganzwisisike, asi vazhinji vanoisa yavo UCR mhosva pa 80th percentile . Izvi zvinoreva kuti makumi masere muzana evanopa zvekurapa munzvimbo yakapihwa yakaenzana kana pasi peiyo kambani yeinishuwarenzi UCR mwero.

Heano maitiro anoshanda kana zvasvika kune akawanda avhara. Ngatiti iwe unobvarura yako meniscus paunenge uchimhanya uye uine chirwere kuti uigadzirise. Iwe unoshandisa kunze-kwe-network chiremba wekuvhiya uyo anokwereta $ 6,000 yeiyo maitiro. Asi yako inishuwarenzi yekambani yeinishuwarenzi UCR inobhadharisa iyo nzira ndeye $ 5,000. Kana yako inishuwarenzi kambani inowanzo kubhadhara makumi masere muzana emari yako yekurapa usati wasangana neyako inobviswa , ivo vaizovhara makumi masere muzana emabhiri ako anosvika kumadhora zviuru zvishanu. Ivo havanga vhara madhora chiuru pamusoro peiyo UCR mwero, zvinoreva kuti ungangoda kubhadhara iyo $ 1 000 yemari yeUCR, kuwedzera kune yako 20% yemari yemari yeUS $ 5,000 UCR mwero.

Muzviitiko zvakawanda, makambani einishuwarenzi haaverenge mari yaunobhadhara pamusoro peiyo UCR mwero yakanangana neyako yaunobvisa kana kunze-kwehomwe kunonyanyisa . Izvi zvinoreva, kana iwe uchigara uchishandisa vekunze-kwe-network vanachiremba, unogona kusimudzira kubhadhara yakawanda hefty mune zvekurapa zvikwereti.

Nhau dzakanaka ndedzekuti marongero mazhinji einishuwarenzi, akadai seHMO kana maPPO, anouya netiweki hombe yevanopa, kusanganisira vanachiremba, zvipatara, marabhoritari, uye varapi. Kana iwe ukagara mune iyo network, haubhadhare mari yeUCR.

Medicare ine yayo vhezheni yeUCR mitengo inozivikanwa se Medicare inobvumidzwa mhosva . Chero mupi anobvuma kutora chikamu muMedicare anobvumawo kugamuchira iyo Medicare inobvumidzwa mutero wechaji semubhadharo wavo uzere kubva kune inishuwarenzi. Asi vamwe vanachiremba avo vasiri-vanotora rubatsiro vanogona kutendeuka vokubhadharira mutsauko. Kubatsira kudzivirira izvo kuti zvirege kuitika, bvunza vanachiremba kana vachibvuma Medicare kupihwa, zvinoreva kuti havazokukumbira iwe kuti ubhadhare bhalansi yemubhadharo. Iwe unozo, zvakadaro, uchiri kufanira kubhadhara yako inobvisirwa uye coinsurance .

Mamwe maMedigap, kana kuti maMedare ekuwedzera marongero, anogona zvakare kubatsira kubhadhara kune vakawandisa varapi mhosva.

Chii chinonzi mari yeUCR?

Iko hakuna yakawanda kwazvo mirau inosarudza kuti makambani einishuwarenzi anosarudza sei avo akajairwa, echinyakare, uye ane mwero mareti. Vazhinji vanoshandisa yavo yega data kuona kuti varapi vemuno varikupija maitirwo. Pamutemo, zvakadaro, makambani einishuwarenzi anofanira kukuudza kuti vakauya sei nechiyero kana iwe ukabvunza.

Kune mimwe mitemo yakakosha, zvakadaro, kuti makambani einishuwarenzi anoteera kusarudza kana kubhadharisa kwakajairwa, kwetsika, uye zvine musoro. Iko kubhadharisa kunoenderana nezvakapihwa mupi wezvekurapa munguva yakapfuura (yakajairwa), inokwana marange ari kubhadhariswa nevamwe varapi vechivanhu (zvechivanhu), uye inogona kusangana zvese zvakajairwa uye zvechinyakare maitiro kana iri mamiriro akakosha (zvine musoro) . Kana iyo kambani yeinishuwarenzi ichifunga kuti muripo wemubatsiri wako wezvehutano hausvike pane izvo zvinodiwa, ivo vanozongobvuma kubhadhara iyo UCR mwero, uye iwe ungatofanira kubhadhara iyo yasara, inova iyo UCR fizi.

Unogona here kudzivisa kubhadhara UCR mari?

Nzira yakanakisa yekudzivirira kubhadhara UCR mari ndeye kushandisa mune-network vanopa. Dzimwe nguva, zvakadaro, izvo hazvidzivisike. Kana iwe uchiziva pamberi pekuti iwe unenge uchishandisa iyo kunze-kwe-network mupi , bvunza chiremba kuti vangabhadhare marii pakuita kana sevhisi. Wobva wabvunza yako inishuwarenzi kambani kuti yavo UCR muripo ndeyeiwo maitiro. Unogona kukwanisa kutora chiremba wako kuti abvume kubvuma inishuwarenzi yeUCR muripo semubhadharo wakazara.

Iwe zvakare unokwanisa kukwanisa yako kambani yeinishuwarenzi kuti ibhadhare zvinopfuura iyo UCR mwero kana chiremba vakanyora tsamba vachitsanangura kuti nei vaifanira kubhadharisa zvimwe zveimwe nzira. Zvinogonekawo kuti inishuwarenzi yako kambani inogona kubvuma kugadzirisa yako bhiri post-maitiro kana iwe uchikwanisa kuratidza kuti vamwe vakawanda vanachiremba munzvimbo iyi vanobhadharisa huwandu hwakaenzana kune zvakabhadharwa nachiremba wako

Mari yeUCR inoshanda here kumishonga yekunyorera?

Neraki, kana zvasvika pamishonga yekunyorera, hazvisi zvakajairika kuti unetseke nezvemari yeUCR. Izvi zvinodaro nekuti iyo UCR yekuchaja yemishonga yekunyorera ndiyo mari iyo munhu asina inishuwarenzi angabhadhara mushonga. Izvi zvinonziwo mutengo wemari.

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