Kodi HMO ndi chiyani?

Kampani Healthcare Yafotokozedwa

Kudziwa dongosolo la inshuwaransi yomwe mungasankhe kungakhale chisankho chovuta. Sikuti mumangofunika kuwerengera mtengo ndi zosowa zanu zathanzi, koma nthawi zina mawu ndi zopereka zimangokhala zosokoneza. Wathu Zowonetseratu zaumoyo , timayesetsa kuthetsa chilankhulo chovuta kwambiri. Apa, timakambirana zaumoyo womwe umadziwika kuti HMO.

Kodi HMO imayimira chiyani? Zikutanthauza chiyani?

HMO ndichidule cha bungwe lokonza zaumoyo. Ndi mtundu wa mapulani a inshuwaransi yazaumoyo omwe amafuna kuti muzigwiritsa ntchito okhawo omwe ali ndi intaneti. Awa ndi madotolo (komanso ntchito zina zamankhwala monga ma lab ndi zipatala) zomwe zili ndi mgwirizano ndi inshuwaransi yanu. Inu angathe pitani kwa omwe amapereka kunja kwa netiweki yanu kuti akalandire chithandizo chamankhwala, koma dongosolo la HMO nthawi zambiri silimalipira ndalamazo pokhapokha ngati zili zachipatala.

Ndikofunika kuzindikira kuti ngati mukukumana ndi zachipatala, muyenera kupita kuchipatala chapafupi - mosasamala kanthu kuti HMO yanu ikugwirizana nayo kapena ayi. Malinga ndi chipatala.gov , mapulani onse akuyenera kukuthandizani kulipira chithandizo chadzidzidzi, ngakhale mutapita kwa dokotala kapena chipatala mkati mwa netiweki ya HMO kapena ayi.

Ma HMO amagwira ntchito ngati mapulani a inshuwaransi yazaumoyo kuti:

• perekani mwezi uliwonse umafunika (zolipiritsa mobwerezabwereza kukhala ndi inshuwaransi yazaumoyo), ndi
• kulipira amakopera (ikani ndalama zomwe mumalipira pantchito ngati ulendo wa dokotala kapena X-ray), deductibles (ndalama zomwe mumayenera kulipira chaka chilichonse inshuwaransi yaumoyo yanu isanachitike), ndi chitsimikizo cha ndalama (kuchuluka kwa mtengo wonse wosamalira mumalipira mutakumana ndi deductible).

Malinga ndi makupalat.fi, Ma HMO adatchuka kwambiri kuposa mapulani ena ambiri azaumoyo ku United States kuyambira pomwe boma la feduro la Affordable Care Act (ACA) lidayamba kugwira ntchito mu 2014. The California Ofesi Yoyimira Wodwala amanenanso kuti pafupifupi 50% ya nzika zaku California zaphimbidwa ndi ma HMO.

Kodi ma HMO amagwira ntchito bwanji?

Mukasankha HMO ya inshuwaransi yazaumoyo wanu, muyenera kusankha dokotala woyang'anira chisamaliro (PCP) mkati mwa netiweki yomwe imayang'anira chithandizo chonse chamankhwala. (Ngati dokotala yemwe mwakhala mukumugwiritsa ntchito sali mu netiweki ya HMO, mungafunikire kusankha ina yatsopano.) Dotoloyu azikusamalirani pazithandizo zanu zodzitetezera, monga kupimidwa kwanu pachaka, katemera, komanso zina zamankhwala kusamalira.

Ngati muli ndi Medicare, mutha kusankha kupeza pulogalamu ya inshuwaransi ya HMO kudzera mu pulogalamu ya Medicare Advantage (yomwe imadziwikanso kuti Medicare Part C) - motsutsana ndi Original Medicare, yomwe sigwiritsa ntchito gulu la madotolo.

Ngati mukufuna kuwona katswiri pamavuto azachipatala-mwachitsanzo, ndinu othamanga omwe anang'amba ACL-muyenera kupeza kutumizidwa kuchokera ku PCP yanu kwa wothandizira pa intaneti. Mukapita osatumizidwa, kapena sankhani zokumana ndi wina kunja kwa netiweki zikakhala kuti sizadzidzidzi, mutha kukhala ndi udindo pazolipira zonse zomwe dokotala amakupatsani. Kuphatikiza apo, azimayi amatha kupita kwa azachipatala / azimayi azachipatala kuti azisamalidwa asanabadwe komanso azimayi azimayi osatumizidwa ndipo amathandizidwa. Komabe, kuti musamangokhalira kusamalidwa komwe mumaganizira kuti munakonzedwa ndi inshuwaransi yanu yazaumoyo, ndikofunikira kuti muwerenge zambiri za mapulani a HMO ndikumvetsetsa ndendende ntchito zomwe mungakakamizidwe mutachoka pa netiweki.

Chifukwa chiyani wina angasankhe HMO?

HMO ndi njira yoletsa kwambiri ya inshuwaransi yazaumoyo chifukwa imalepheretsa madokotala omwe amalipira kudzera mu inshuwaransi. Ngati mungasankhe kuchoka pa netiweki, mutha kukakamira kulipira ndalama zonse zakusamalirako. Koma, mbali yabwino, chifukwa mumakhala ochepa, mumalipira ndalama zochepa za inshuwaransi yazaumoyo za ma HMO motsutsana ndi mapulani ena azaumoyo. Izi zitha kukhala zabwino kwa wachichepere, wathanzi yemwe amangopeza chithandizo chamankhwala, monga kupimidwa chaka chilichonse. Kuphatikiza pamitengo yotsika yothandizira zaumoyo, Kaiser Permanente amanenanso kuti maubwino ena a HMO ndi awa:

• Kutsika mtengo kwa mankhwala akuchipatala, ndi
• Kukhala ndi dokotala m'modzi yemwe amadziwa zosowa zanu zamankhwala ndikuwongolera chisamaliro chanu chonse.

Mtengo ukakhala wofunikira pakusinthasintha, HMO itha kukhala inshuwaransi yoyenera kwa inu.

Kodi pali kusiyana kotani pakati pa HMO ndi PPO?

PPO ndichizindikiro china - ichi chimayimira bungwe lokonda kupereka. Mapulani a PPO amasiyana ndi a HMO chifukwa amakulolani kutuluka pa netiweki kuti mukasamalire osatumizidwa ndipo osalipira zonse mukamachita izi. Simufunikanso kusankha dokotala woyang'anira chisamaliro choyambirira. Ngakhale mutasunga ndalama zokhala ndi othandizira ma netiweki, PPO nthawi zambiri imalipira zina mwazosamalira zomwe mumalandira. Mwachitsanzo, PPO yanu ikhoza kulipira 80% ya ndalama zanu zachipatala mukamayendera wothandizira pa intaneti (ndipo mudzalipira 20%). Koma mukatuluka pa netiweki, imangotenga 60% ya mtengo wake - kukusiyani kuti mupange mtengo wa 40%. PPO ndi njira yosangalatsa kwa anthu omwe amakonda gulu lawo la madotolo ndipo samadandaula kulipira zowonjezera kuti athe kuwapeza akafunika. Ngati muli ndi Medicare, ma PPO amapezekanso pansi pa pulogalamu ya Medicare Advantage.

Kuti mumve zambiri, werengani nkhani yathu pa HMO vs. PPO .