PPO ndi chiyani?

Kampani Healthcare Yafotokozedwa

Pankhani ya inshuwaransi yazaumoyo, palibe kusowa kwa zilembo ndi mawu osadziwika omwe amafunikira kuti mumvetsetse momwe kufotokozera zaumoyo kumagwirira ntchito. Kodi muli nawo kapena mukuganiza zosainira PPO? Phunzirani zomwe zili, ngati ndi njira yoyenera kwa inu, ndi momwe mungadziwire ngati muli nayo kale.

PPO ndi chiyani?

PPO ndi mtundu wa mapulani a inshuwaransi yazaumoyo. Imayimira bungwe lomwe amakonda. Ndi ma PPO, mumalipira ndalama zochepa mukawona wothandizira yemwe ali mu netiweki ya kampani yanu ya inshuwaransi-ndiye gawo lomwe mumakonda. PPO yanu yakambitsirana kale za kuchuluka kwakanthawi kantchito zamankhwala zomwe opereka ma netiweki amapereka.

Muthanso kuwona othandizira ambiri kunja kwa netiweki ya PPO yothandizira zamankhwala. Komabe, nthawi zambiri mumalipira zambiri kwa omwe akutuluka pa intaneti komanso ntchito zamankhwala. Izi ndichifukwa choti palibe mgwirizano wovomerezeka pakati pa otuluka kunja kwa netiweki ndi dongosolo lanu.

Chifukwa chiyani munthu angasankhe PPO kuposa HMO?

Ma PPO ndi amodzi mwamitundu yodziwika bwino yamaphunziro a inshuwaransi yazaumoyo chifukwa chosinthasintha. Ndi PPO, mutha kuyendera aliyense wothandizira zaumoyo omwe mungafune, kuphatikiza akatswiri, osafunikira kutumiza kwa dokotala woyamba (PCP) kaye. Izi zitha kukhala zothandiza ngati simukuyandikira dokotala yemwe ali mu netiweki yanu, monga ngati mukuyenda, kapena ngati muli ndi gulu la akatswiri azaumoyo omwe mumakhala nawo bwino, ngakhale atachoka pa netiweki.

Ubwino wa PPO umaphatikizapo mwayi wokhoza kusankha dokotala ndi katswiri yemwe mukufuna popanda kupita kwa dokotala woyambirira, akufotokoza Yuna Rapoport , MD, MPH, katswiri wa maso ku Manhattan Eye ku New York City. Izi zimayika wodwalayo pampando wa driver.

PPO vs. HMO

Ma PPO si njira yanu yokhayo, inde. Mtundu wina wamba wa inshuwaransi yazaumoyo ndi HMO, kapena bungwe lokonza zaumoyo. Mapulani a HMO ali ndi zovuta zingapo pamalingaliro a PPO zomwe zingakhudze kusankha kwanu kampani ya inshuwaransi yazaumoyo.

Ndi HMO, mumayenera kudutsa PCP yanu kuti mutumizidwe kuti muwone katswiri wapaintaneti. HMO yanu siyikuphimba maulendo opita kunja kwa intaneti pokhapokha ngati pali zoopsa zachipatala zenizeni, ndipo ngakhale zitatero, mutha kukhala kuti mukutsata ndalama.

Komabe, Dr. Rapoport akuti pakhoza kukhala phindu mu mapulani a HMO kwa odwala. Ubwino wa ma HMO amachokera pamawonekedwe ofunikira, akutero. Mwa kukhala paubwenzi wapamtima ndi dokotala woyambira, pali maulendo ochepa osafunikira kwa akatswiri, kulingalira pang'ono, komanso kuyesa mayeso ochepa. Zotsatira ndizofanana kapena zabwinoko kuposa PPO, ndipo odwala amapatsidwa madokotala awo ndi dongosololi.

Pomwe kutumizidwa musanawone katswiri kungakhale kowawa, zimatanthauzanso kuti PCP yanu imakhudzidwa ndi thanzi lanu mwanjira yomwe nthawi zina madokotala a PPO sali, kukuthandizani kuti mugwirizane bwino.

Kuyerekeza mtengo

Ndipo zachidziwikire, simungalankhule za inshuwaransi yazaumoyo ndipo osanenapo zotuluka mthumba. Ma neti a PPO nthawi zambiri amakhala okwera malipiro , zokopa , ndi deductibles pachaka kuposa ma HMO pobwezera kusinthasintha. Ngati muwona omwe akutuluka pa netiweki, mungafunike kulipira mtengo patsogolo kenako ndikupereka fomu yoti mubwezeretsedwe pang'ono. Ngati mumayang'ana kusinthasintha ndipo simusamala kulipira zochulukirapo, PPO ikhoza kukhala njira yoyenera yosamalirira zaumoyo yanu.

Ndalama zothandizira zaumoyo ndi ma network a HMO nthawi zambiri zimakhala zotsika mtengo. Mudzakhala ndi malipiro apansi pamwezi komanso ma copay posinthana ndi PCP yolumikizira chisamaliro chanu. Komabe, nthawi zambiri mumalephera kuwona omwe ali kunja kwa ma netiweki ndi HMO. Mukatero, mudzakhala ndi udindo pamtengo wonsewo.

ZOKHUDZA: HMO vs. PPO

Kuphatikiza apo, mutha kulingalira za pulani yayikulu yodulira ndalama (HDHP), bungwe lokhalo lokhalo (EPO), kapena pulani yantchito (POS).

Ndingadziwe bwanji ngati ndili ndi PPO?

Mukuganiza kuti muli ndi mtundu wanji wa inshuwaransi yazaumoyo? Nthawi zambiri imanena kumbuyo kwa khadi lanu la inshuwaransi. Khadi lanu likhoza ngakhale kufotokoza momwe mudzalipire ndalama zambiri pamakopayi mukapita kukaonana ndi dokotala. Kuyimbira mwachangu wothandizira wanu kapena kulowa muakaunti yanu yapaintaneti kungaperekenso kumveka.

Ngati mulibe PPO kale ndipo mukufuna kusinthana ndi imodzi, muyenera kutero nthawi imeneyi kulembetsa kutseguka - kawirikawiri, koma osati nthawi zonse, mu Novembala kapena Disembala - pokhapokha mutakhala ndi chochitika chofunikira pamoyo . Zochitika zoyenera kuphatikizakusamukira ku zip code yatsopano kapena boma, kukwatira, kapena kukhala ndi mwana.

Mapulani a PPO atha kupezeka kudzera kwa owalemba ntchito, msika wadziko lanu (ngati alipo), kapena msika wamsonkho. Malo abwino kwambiri oyambira njirayi ndi kuchipatala.gov.

Medicare imaperekanso fayilo ya Njira ya PPO (pakati pa HMO ndi njira zina) pansi pa Medicare Advantage (Gawo C) ngati muli ndi zaka 65 kapena kupitilira apo ndipo mukuyenera. China choyenera kukumbukira mukamaganizira dongosolo la PPO ndichakuti maakaunti osungira azaumoyo (HSAs) ndi maakaunti osunga ndalama (FSAs) , pamodzi ndi zinthu monga khadi yanu ya SingleCare, zitha kuthandizanso kutsitsa mtengo wamankhwala ndi mankhwala.