Các kế hoạch Medicare Advantage thường có giới hạn về việc nhận chăm sóc ngoài mạng (out-of-network care). Dưới đây là một số hạn chế phổ biến liên quan đến việc nhận chăm sóc ngoài mạng:
Xin lưu ý rằng các chi tiết cụ thể về bảo hiểm chăm sóc ngoài mạng lưới có thể khác nhau tùy thuộc vào chương trình Medicare Advantage mà bạn chọn. Điều cần thiết là phải xem xét cẩn thận tài liệu của chương trình và tham khảo ý kiến của nhà cung cấp chương trình để hiểu đầy đủ các hạn chế và phạm vi bảo hiểm cho dịch vụ chăm sóc ngoài mạng lưới.
What are the restrictions on out-of-network care with a Medicare Advantage plan? Medicare Advantage plans typically have restrictions on receiving out-of-network care. Here are some common limitations regarding out-of-network care: Network limitations: Medicare Advantage plans often have approved networks of doctors, hospitals, and healthcare providers. If you seek care from a provider outside of the plan’s network, you may face limitations or not be covered for that service. However, there are exceptions, such as in the case of emergency care or when there is no in-network provider available.Higher costs: Receiving out-of-network care can result in higher costs for you. When receiving care from an out-of-network provider, you may be responsible for higher out-of-pocket fees. This can include both co-payments and balance billing, in case the out-of-network provider charges more than the approved limit.Insurance limitations: Some Medicare Advantage plans do not cover out-of-network care at all or only partially. This means that if you receive care from an out-of-network provider, you may have to pay the entire or a portion of the cost for that service.Special regulations: Some Medicare Advantage plans have specific regulations regarding out-of-network care. This may include requirements for prior authorization or limitations on the time period for receiving out-of-network care. It’s important to review the specific regulations of your Medicare Advantage plan to understand the limitations and special provisions related to out-of-network care. Please note that the specifics of out-of-network care coverage can vary depending on the Medicare Advantage plan you choose. It’s essential to carefully review the plan’s documentation and consult with the plan provider to fully understand the restrictions and coverage for out-of-network care. |