Mtengo Wosasintha

Malipiro osamalira

Monga chipatala chopanda phindu, Shepherd Center ilibe eni eni ake, ndipo palibe ndalama zomwe zimapita kwa anthu wamba monga momwe zingachitikire m'makampani opeza phindu, omwe ali ndi masheya kapena mabungwe omwe ali ndi anthu wamba. M'malo mwake, ku Shepherd, ndalama zonse zimabwereranso kuchipatala, kuti titha kukupatsani chithandizo chamankhwala chochulukirapo komanso chabwinoko kwa inu ndi banja lanu.

Ndi gawo la ntchito ya Shepherd Center yopereka chithandizochi mosasamala kanthu za kuthekera kwa wodwala kulipira. Timapereka thandizo lazachuma m'njira zambiri, kuyambira pogwira ntchito ndi odwala ndi mabanja omwe ali oyenerera kulandira Medicaid kapena Medicare, kupereka chithandizo chachifundo, komanso kupereka kuchotsera kodzilipirira tokha kwa odwala omwe angathe kulipira, koma opanda inshuwaransi.

Woyezera mtengo wa odwala

Monga gawo la kudziperekaku, tapereka a Chida choyezera mtengo wa Patient kuti ndikupatseni chiŵerengero cha mtengo umene mungagule pazithandizo zina zomwe zimaperekedwa ku Shepherd Center. Chonde dziwani kuti mndandandawu sunaphatikizepo zonse, chifukwa ntchito zoperekedwa kwa odwala zimasiyana mosiyanasiyana malinga ndi momwe zinthu zilili komanso momwe chisamaliro chimachitika.

Udindo wanu wolipira udzasiyana malinga ndi mtundu wa inshuwaransi ndi zopindulitsa zomwe muli nazo. Ngati muli ndi mafunso owonjezera, tili ndi oyimilira omwe angakuthandizeni kukupatsirani zongoyerekeza komanso kugwirizana pazachuma, kaya muli ndi inshuwaransi kapena ayi. Kuti mufikire m'modzi mwa oyimilirawa, chonde imbani 404-350-7323.

Mndandanda wa zolipiritsa wamba

Boma la federal likufuna kuti zipatala zonse zizipereka woyang'anira, kapena mndandanda wa zolipiritsa pazithandizo ndi zinthu za odwala, mu "mawonekedwe owerengeka pamakina". Mndandanda wa Shepherd Center ulipo ngati fayilo yotsitsa pansipa.

Komabe, ndikofunikira kuzindikira kuti zolipiritsa za Shepherd Center, ndi zipatala zina, zimasintha pakapita nthawi potengera njira ndi njira zolipirira zomwe zimaperekedwa ndi Medicare ndi Medicaid kapena kukambirana ndi inshuwaransi zamalonda. Zomwe Shepherd Center imalipidwa pamapeto pake zimasiyana kwambiri ndi wolipira ndipo zimachepetsedwa kwambiri pamitengo yomwe yalembedwa pafayilo yotsitsa ili pansipa. Nthawi zambiri, Shepherd Center imalipidwa mtengo wokhazikika patsiku ("per diem") mosasamala kanthu za zolipiritsa kapena mtengo wa chisamaliro. Ndi Medicare, Medicaid ndi ena inshuwaransi zamalonda, kubweza sikulipira mtengo wa chisamaliro.

Zipatala zimafunikanso kuyika mndandanda wamagulu awo a Diagnosis-Related Groups (DRGs), gulu lamagulu lomwe Medicare ndi Medicaid amagwiritsira ntchito kulipira zipatala malinga ndi kuopsa kwa matenda, mphamvu ya chithandizo, kutalika kwa kukhala ndi zosiyana zina. Chifukwa cha kuvulala koopsa ndi matenda a odwala Shepherd Center amachitira ndi kusiyana kwakukulu kwa zosowa zawo zachipatala, owerenga omwe akuwona fayilo yotsitsa ili m'munsiyi akhoza kuona kusiyana kwakukulu kwa ndalama zocheperako za Shepherd Center, zolipiritsa kwambiri komanso zolipiritsa zomwe zidachitika chaka chatha.

• Tsitsani fayilo ya DRG ya Shepherd Center mumtundu wa XML (Dinani kumanja kuti musunge tsambalo ngati fayilo ya XML)
• Tsitsani fayilo yokhazikika ya Shepherd Center (ZIP)
  • Dziwani kuti mndandandawu sumaphatikizapo mautumiki kapena zinthu zoperekedwa ndi madokotala omwe amagwira ntchito pawokha pa Shepherd Center. Izi zikuphatikiza madotolo achinsinsi, ma radiologist, ndi madotolo ofunsira. Komanso dziwani kuti sizinthu zonse za mgwirizano zomwe zilipo pa ndondomeko zofananitsa, zokhazokha zomwe zimafunidwa ndi lamulo

Ngati muli ndi mafunso, lemberani m'modzi mwa alangizi azachuma a Shepherd Center ku 404-350-7323.

Ufulu wanu ndi chitetezo kumabilu odabwitsa azachipatala

Mukalandira chithandizo chadzidzidzi kapena kulandira chithandizo ndi wothandizira kunja kwa intaneti pachipatala cha in-network kapena ambulatory chipatala, mumatetezedwa ku kulipira modzidzimutsa kapena kulipira ngongole.

Kodi "malipiro owerengera" (nthawi zina amatchedwa "bilu modzidzimutsa")?

Mukawonana ndi dokotala kapena wothandizira zaumoyo, mungakhale ndi ngongole zina zakunja, monga kubweza, coinsurance, ndi/kapena deductible. Mutha kukhala ndi ndalama zina kapena ngongole yonse ngati muwona wothandizira kapena kupita kumalo omwe mulibe netiweki ya mapulani anu azaumoyo.

“Out-of-network” amafotokoza za othandizira ndi malo omwe sanasaine mgwirizano ndi mapulani anu azaumoyo. Othandizira kunja kwa netiweki angaloledwe kukulipirani chifukwa cha kusiyana pakati pa zomwe dongosolo lanu lavomereza kulipira, ndi ndalama zonse zomwe zaperekedwa pa ntchito. Izi zimatchedwa "malipiro otsala. Ndalamazi ndi zochulukirapo kuposa mtengo wapaintaneti pa ntchito yomweyi ndipo mwina sizingawerengeredwe ku malire anu apachaka otuluka m'thumba.

"Kulipira modabwitsa" ndi ndalama zosayembekezereka. Izi zikhoza kuchitika pamene simungathe kulamulira omwe akukhudzidwa ndi chisamaliro chanu-monga pamene muli ndi vuto ladzidzidzi kapena pamene mukukonzekera ulendo wopita kumalo ochezera a pa Intaneti koma mwadzidzidzi mukuthandizidwa ndi wothandizira kunja kwa intaneti.

Kuwongolera chitetezo chamalipiro

ntchito Emergency

Ngati muli ndi vuto lazadzidzidzi ndikupeza chithandizo chadzidzidzi kuchokera kwa wothandizira kapena malo omwe ali kunja kwa intaneti, nthawi zambiri wothandizira kapena malo angakulipirireni ndi ndondomeko yanu yogawana mtengo wapaintaneti (malipiro ndi coinsurance). Simungakulipire ndalama zothandizira zadzidzidzi. Izi zikuphatikizapo mautumiki omwe mungapeze mukakhala pabwino pokhapokha mutapereka chilolezo cholemba ndikusiya chitetezo chanu kuti musamalipire ndalama zambiri pazithandizozi pambuyo pokhazikika.

Ntchito zina pachipatala cha in-network kapena malo opangira ma ambulatory

Mukalandira chithandizo kuchokera ku chipatala cha in-network kapena malo opangira ma ambulatory, othandizira ena akhoza kukhala opanda intaneti. Zochuluka zomwe operekawo angakulipireni ndi ndalama zomwe mumagawana pa intaneti. Izi zimagwira ntchito pamankhwala azadzidzidzi, opaleshoni, matenda, ma radiology, labotale, neonatology, othandizira opaleshoni, chipatala, kapena ntchito za intensivist. Othandizirawa sangathe kukulipirani ndalama ndipo sangakufunseni kuti musiye chitetezo chanu kuti musamalipire ndalama.

Ngati mupeza mautumiki ena pazida zapaintaneti izi, opereka kunja kwa intaneti sangathe kukulipirani ndalama, pokhapokha mutapereka chilolezo cholembedwa ndikusiya chitetezo chanu.

Ufulu wanu pansi pa malamulo aku Georgia

Simufunikanso kusiya chitetezo chanu kumalipiritsa. Simukufunikanso kupeza chisamaliro kunja kwa intaneti. Mutha kusankha wopereka kapena wothandizira pa netiweki ya dongosolo lanu.

Chilamulo cha Georgia chimaphatikizapo mapulani omwe ali ndi chilolezo ndi ofesi ya GA Commissioner of Inshuwalansi, kuphatikizapo mapulani osamalira inshuwaransi, ma HMO, mapulani oyenerera azaumoyo, Kusinthanitsa mapulani, mapulani otsika mtengo, komanso mapulani a mano ndi masomphenya, mapulani a zaumoyo a boma, kuphatikiza Mapulani a Zaumoyo ku Georgia State, aphunzitsi a sukulu zaboma ndi antchito ndi mapulani a Board of Regents. Lamulo la GA silikugwira ntchito ku mapulani osamalira a Medicaid kapena mabungwe oyang'anira chisamaliro, mapulani opindulitsa ochepa, inshuwaransi ya ambulansi ya ndege, mapulani owonjezera, mapulani a Medicare, chipukuta misozi kapena mapulani oyendetsedwa ndi Employee Retirement Income Security Act ya 1974, 29 USC Sec. 1001, ndi seq (ERISA). Ma inshuwaransi akuyenera kuzindikira pa upangiri wotumizira ngati chithandizo chili pansi pa ulamuliro wa ERISA.

Ntchito ndi mabilu omwe ali pansi pa lamulo la Georgia

• Ntchito zadzidzidzi: Ma inshuwaransi ayenera kulipira chithandizo chadzidzidzi chadzidzidzi kwa anthu omwe ali ndi vuto lililonse mosasamala kanthu za kukhudzidwa kwa netiweki ndi omwe amapereka chithandizo kapena malo ogwirira ntchito, popanda chilolezo choyambirira komanso kukanidwa kwanthawi yayitali ntchito zomwe akuwona kuti ndizofunikira pachipatala.
• Ntchito zosakhala zadzidzidzi: Ngati zolipiritsa zimachokera kwa munthu wophimbidwa yemwe akulandira chithandizo chadzidzidzi kuchokera kwa wothandizira kunja kwa intaneti pamalo ochezera pa intaneti, izi zimawonedwa ngati "bilu yodabwitsa," ndipo ma inshuwaransi ayenera kulipira ntchito zophimbidwa mosasamala kanthu za kutenga nawo gawo kwa maukonde.

Kutetezedwa kowonjezera pamene kulipira ndalama ndizoletsedwa

• Muli ndi udindo wolipira gawo lanu la mtengowo (monga ndalama zolipirira, coinsurance, ndi deductibles zomwe mungalipire ngati woperekayo kapena malo ali mu-network). Dongosolo lanu laumoyo lidzalipira omwe amapereka kunja kwa intaneti ndi malo mwachindunji.
• Dongosolo lanu laumoyo nthawi zambiri liyenera:
  • Limbikitsani chithandizo chadzidzidzi popanda kukupemphani kuti mulandire chilolezo chazithandizo pasadakhale (chilolezo choyambirira).
  • Limbikitsani chithandizo chadzidzidzi ndi opereka kunja kwa intaneti.
  • Tsimikizirani zomwe muli ndi ngongole kwa wothandizirayo kapena malo (kugawana mtengo) pazomwe zingakulipire wothandizira pa intaneti kapena malo ndikuwonetsa ndalamazo pofotokozera phindu.
  • Werengerani ndalama zilizonse zomwe mumalipira pazithandizo zadzidzidzi kapena ntchito zakunja kwa netiweki kutengera malire omwe mungachotsedwe komanso osatuluka m'thumba.

Zoyenera kuchita ngati mukukhulupirira kuti munalipiridwa molakwika

Ngati mukukhulupirira kuti mwakulipiritsidwa molakwika, mutha kulumikizana kaye [imelo ndiotetezedwa] kapena dongosolo lanu laumoyo kuti mufotokoze. Ngati sangathe kuthetsa nkhawa zanu, mutha kulumikizana ndi a Ofesi ya Georgia ya Commissioner of Insurance and Safety Fire kapena pafoni pa 404-656-2070.

kukaona Malo a Medicare ndi Medicaid Services kuti mudziwe zambiri zaufulu wanu pansi pa malamulo a federal. Pitani ku Georgia Office of Insurance and Safety Fire Commissioner kuti mudziwe zambiri zaufulu wanu pansi pa Georgia Law.