T I TH N

CHM SC

Con ng dn
ti vic Chm
Sc Tt Hn
V Sng
Khe Mnh
Hn

Bc 4: Tm ngi chm sc

CH DN sc khe

Bt u
y
t sc khe ln
hng u

Sng khe mnh l iu quan trng cho

qu v v gia nh mnh.

Hiu r bo him sc khe

ca qu v
Hi chng trnh sc khe ca qu v
hay chng trnh Medicaid hoc chng
trnh CHIP ca tiu bang xem dch v
no c bao tr.

Duy tr li sng lnh mnh nh, ch lm,

v trong cng ng.
Khm thm d sc khe theo ngh v
iu qun nhng cn bnh mn tnh.
Gi tt c cc thng tin sc khe ca qu
v mt ch.

Lm quen vi cc chi ph ca qu v (bo

ph, tin ph tr, tin khu tr, ng bo
him).
Bit s khc bit gia trong h thng v
ngoi h thng.

3
Bit i u c chm sc
S dng phng cp cu cho tnh trng bnh e
da n tnh mng.
Nn s dng chm sc chnh khi khng phi l
trng hp khn cp.
Bit s khc bit gia chm sc chnh v chm
sc khn cp.

4
Tm ngi chm sc
Hi ngi qu v tin tng v/
hoc tm kim trn internet.
Kim tra danh sch ngi chm
sc ca chng trnh.
Lin lc vi chng trnh nu
mun thay i ngi chm sc
c ch nh cho qu v
Nu qu v c ghi danh vo
Medicaid hay CHIP, lin lc vi
chng trnh Medicaid hay
CHIP ca tiu bang c
gip .

Vo trang mng marketplace.cms.gov/c2c bit thm thng tin.

Ly hn
Cho bit qu v l bnh nhn mi hay
tng n trc .
Cho bit tn ca chng trnh bo him
vhi xem h c nhn bo him ca qu
vkhng.
Cho h bit tn ca ngi chm sc qu
v mun khm bnh v l do qu v mun
ly hn.
Hi ngy gi thch hp cho qu v.

Chun b khi n khm bnh

Mang theo th bo him.
Bit r bnh s gia nh v lp danh sch bt
c loi thuc no qu v dng.
Mang theo danh sch cc cu hi v nhng
iu cn bn tho, v ghi ch trong lc
khmbnh.
C ngi i cng gip nu qu v cn.

Nu mun i ngi
chm sc, tr li
Bc 4.

Xem ngi chm sc c

ph hp vi qu v khng
Qu v c thy thoi mi vi ngi
chm sc khm bnh mnh khng?
Qu v c th hiu v ni chuyn vi
ngi chm sc ca mnh khng?
Qu v c thy mnh v ngi chm sc
c th cng nhau ly quyt nh sng
sut khng?
Hy nh: Qu v c th i ngi chm
sc khc!

Nhng bc k tip sau bui hn

Lm theo ch dn ca ngi chm sc.
Ly thm thuc qu v c cp, v dng theo hng dn.
Sp xp bui hn nu qu v cn theo di bnh.
Duyt qua gii thch quyn li v tr ha n y t ca
qu v.
Lin lc vi ngi chm sc, chng trnh sc khe chng
trnh Medicaid hay CHIP ca tiu bang nu c thc mc.

4 Tm ngi chm sc.

Chn ngi chm sc ph hp l mt trong nhng quyt
nh quan trng ca qu v v chm sc sc khe, do tm
ngi ph hp c th phi cn cht cng sc.
Hy nh l qu v tm mt i tc mnh c th tin tng v hp tc vi
nhau ci tin sc khe, an sinh ca qu v do nn dnh thi gian
suy ngh v iu qu v cn. Ty theo nhu cu chm sc sc khe ca
mnh phc tp ra sao, qu v c th cn n gp nhiu ngi chm sc.
Di y l hai mu ngi chm sc thng thng.
Bc s chm sc chnh (Primary Care Provider) l ngi qu v n
khm bnh u tin cho phn ln cc vn v sc khe. H cng s
hp tc vi qu v khuyn khch khm thm d, gi h s sc khe,
gip qu v iu qun bnh mn tnh, v gii thiu qu v n nhng
ngi chm sc khc nu cn. Nu qu v l ngi ln th bc s chm
sc chnh c th c gi l bc s gia nh, bc s ni khoa, bc s tng
qut, y t hnh ngh, hay ph t bc s. Ngi chm sc con em cn nh
hay con v thnh nin ca qu v c th c gi l bc s nhi khoa. Nu
qu v l lo nin th ngi chm sc ca qu v c th c gi l bc s
lo khoa.
Trong mt s trng hp, chng trnh sc khe c th ch nh ngi
chm sc cho qu v. Thng thng qu v c th i ngi chm sc
nu mun. Lin lc vi chng trnh sc khe bit cch lm vic ny.
Bc s chuyn khoa (Specialist) s khm qu v cho mt s dch v hay
cha tr cc bnh c bit. Bc s chuyn khoa bao gm: bc s khoa
tim mch, bc s khoa ung bu, bc s khoa tm l, bc s khoa d ng,
bc s tr chn, v bc s khoa chnh hnh.
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Qu v c th cn Giy gii thiu (Referral) (hay mt ch dn c bit)

t bc s chm sc chnh trc khi n bc s chuyn khoa chng
trnh sc khe tr tin khm cho qu v. i vi mt s dch v, chng
trnh sc khe c th i hi qu v phi c Giy cho php trc
(Preauthorization)quyt nh ca chng trnh bo him hay
chng trnh sc khe rng dch v chm sc sc khe, k hoch cha
tr, thuc theo toa, hay thit b y t dng lu di l iu cn thit v y
t. Giy ny cn gi l cho php trc, chp thun trc, hay chng
nhntrc.

NGI CHM SC PH HP
Qu v c th khm hn mt ln mi bit ngi chm
sc c ph hp vi mnh hay khng.

Lm theo bn bc ny tm ngi chm sc qu v c

th tin tng v hp tc vi nhau sng lu di v khe
mnh.
1. Bit nhng ngi chm sc trong h thng.
Gi cho hng bo him hay chng trnh Medicaid hoc CHIP tiu
bang, xem mng li ca h, hoc s tay hi vin tm nhng
ngi chm sc trong h thng c nhn bo him sc khe ca qu
v khng.
Cho h bit qu v c nhu cu ring bit, nh ngi chm sc bit
ni mt ngn ng khc vi ting Anh, hay ngi c th gip qu
v vn ng hay tr mt chc nng khc b suy yu.
Nu qu v c ngi chm sc mnh thch v mun tip tc hp
tc vi v ny, gi cho vn phng h v hi xem h c nhn bo
him ca qu v hay khng.
Xin nh l thng thng, qu v s tr tin nhiu hn khi n khm
bnh vi ngi chm sc khng thuc h thng hn l ngi chm
sc thuc h thng ca mnh.

2. Thm d.
H
 i bn b hay gia nh xem h c thch ngi chm sc no
khng.
H
 i h xem ngi chm sc c chuyn mn no v h thch g
v ngi chm sc

 i khi qu v c th tm kim nhng ngi chm sc trn Internet

xem nhng ngi khc trong cng ng ni g v h.

3. Chn ngi chm sc.

Gi cho vn phng ngi chm sc v hi
h nhng cu hi gip qu v quyt nh ngi
no lm bc s chm sc chnh cho mnh. Sau y
l mt vi iu qu v cn suy ngh bao gm:
Ngi chm sc c nhn bnh nhn mi, hay bnh nhn c bo
him sc khe nh qu v khng? iu ny c th thay i trong
nm, do qu v lun nh hi.
Vn phng c gn nh hay ch lm ca qu v khng? Qu v i n
bng cch no?
Gi hn c thch hp vi thi kha biu ca qu v khng?
Ngi chm sc c ni ngn ng ca qu v hay h c sn ngi
thng ngn khng?
Nu b hn ch vn ng hay suy yu mt chc nng khc, qu v
c kh nng n vn phng ngi chm sc, ln bn khm v bc
ln cn, hoc ly nhng thng tin quan trng theo cch p ng
nhu cu ca qu v khng?
Ngi chm sc s gii thiu cho qu v n (cc) bnh vin no v
qu v c th n khng?
Nhn vin vn phng c tn trng v gip qu v khng?

4. Th xem sao!
i khi qu v c th khm nhiu ln mi bit ngi chm sc c
ph hp vi mnh hay khng.

CH DN V CHI PH
Hi chng trnh xem trc khi n khm ngi chm sc th qu v
c cn giy cho php trc hay khng. Nu khng c giy cho php
trc th qu v c th b tnh tin cho nhng dch v m chng trnh
sc khe ca qu v ng l phi tr.

Cc ngun ti liu
CH GII
Khiu Ni (Appeal)
Khiu ni l hnh ng qu v c th lm nu khng ng vi quyt nh v vic bao tr hay s
tin tr ca chng trnh sc khe. Qu v c th khiu ni nu chng trnh sc khe t chi mt
trong nhng iu sau y:
Yu cu dch v chm sc sc khe, tip tiu, hay thuc theo toa m qu v ngh rng mnh c
quyn nhn
Yu cu vic tr tin chm sc sc khe hay thuc theo toa m qu v ly
Yu cu thay i khon tin qu v phi tr cho thuc theo toa
Qu v cng c th khiu ni nu c bo him v chng trnh ngng tr tin.
Tin ng bo him (Co-insurance)
S tin qu v phi tr chia s chi ph cho cc dch v sau khi qu v tr bt c tin khu tr
no. Tin ng bo him thng l s phn trm (th d nh 20%).
Tin ph tr (Copayment)
S tin qu v phi tr chia s chi ph cho dch v y t hay tip liu, nh bc s khm bnh
bnh vin khm ngoi chn, hay ly thuc theo toa. Tin ph tr thng l khon tin c nh,
hn l s phn trm. Th d, qu v c th tr $10 hay $20 cho ln bc s khm bnh hay thuc
theo toa.
Tin khu tr (Deductible)
S tin qu v phi tr cho cc dch v chm sc y t trc khi bo him sc khe hay chng
trnh bt u tr ht phn cn li.
Dch v khn cp (Emergency Services)
nh gi bnh, thng tch, triu chng, hay tnh trng nghim trng n ni mt ngi hiu
bit s i chm sc ngay gi cho tnh trng khng xu i.
Cc dch v loi tr (Excluded Services)
Cc dch v chm sc sc khe m bo him sc khe hay chng trnh khng tr.

Gii thch quyn li (hay EOB) [Explanation of Benefits (EOB)]

Tm lc chi ph chm sc sc khe m hng bo him gi cho qu v sau khi qu v gp ngi
chm sc hay nhn c mt dch v. y khng phi l ha n. l h s chm sc sc khe
m qu v hay nhiu ngi khc c bao tr theo hp ng, cho bit ngi chm sc tnh bao
nhiu tin cho hng bo him ca qu v.
Danh sch thuc ngh (Formulary)
Danh sch thuc theo toa c chng trnh thuc theo toa hay chng trnh bo him khc i
th, cung cp cc quyn li thuc theo toa. Cng cn gi l danh sch thuc.
Bnh vin chm sc ngoi chn (Hospital Outpatient Care)
Chm sc ti bnh vin thng khng i hi phi qua m.
Tin ng bo him trong h thng (In-network Co-insurance)
Phn trm (th d nh 20%) ca s tin c n nh, m qu v tr cho ngi chm sc c hp
ng vi hng bo him sc khe hay chng trnh, cho cc dch v chm sc sc khe c i
th. Tin ng bo him trong h thng thng tnh qu v t hn tin ng bo him ngoi h
thng.
Tin ph tr trong h thng (In-network Copayment)
S tin c nh (th d nh $15) qu v tr cho cc dch v chm sc sc khe c i th cho
ngi chm sc c hp ng vi hng bo him sc khe hay chng trnh. Tin ph tr trong h
thng thng t hn tin ph tr ngoi h thng.
H thng (cn gi l trong h thng) (Network)
Cc c s, ngi chm sc, v nh cung cp m hng bo him hay chng trnh sc khe c k
hp ng cung cp dch v chm sc sc khe.
Ngoi h thng (Out-of-network)
Ngi chm sc khng c hp ng vi hng bo him hay chng trnh sc khe cung cp cc
dch v cho qu v. Qu v s tr tin nhiu hn khi s dng.

Cc ngun ti liu
Tin ng bo him ngoi h thng (Out-of-network
Co-insurance)
Phn trm (th d nh 40%) ca s tin c cho php cho cc dch v chm sc sc khe c
i th m qu v tr cho ngi chm sc khng c hp ng vi hng bo him hay chng
trnh sc khe. Tin ng bo him ngoi h thng thng tnh qu v nhiu hn tin ng bo
him trong h thng.
Tin ph tr ngoi h thng (Out-of-network Copayment)
S tin c nh (th d nh $30) qu v tr cho cc dch v chm sc sc khe c i th t
ngi chm sc khng c hp ng vi hng bo him hay chng trnh sc khe. Tin ph tr
ngoi h thng thng nhiu hn tin ph tr trong h thng.
Tin xut ti ti a (Out-of-pocket Maximum)
Khon tin nhiu nht qu v tr trong thi hn hp ng (thng l mt nm) trc khi bo
him hay chng trnh sc khe bt u tr 100% cho cc quyn li sc khe thit yu c i
th. Tin xut ti ti a bao gm tin khu tr hng nm v cng c th gm bt c chia s chi
ph no qu v c sau khi khu tr. i vi phn ln cc chng trnh sc khe cho 2014, tin
xut ti ti a cao nht cho mt ngi l $6,350 v $12,700 cho gia nh. Nhng con s ny s
tng trong nm 2015.
Cho php trc (Preauthorization)
y l quyt nh ca hng bo him hay chng trnh sc khe rng dch v chm sc y t, k
hoch cha tr, thuc theo toa, hay thit b y t lu di, c bit l cn thit v y t. i khi giy
ny c gi l cho php trc, chp thun trc, hay chng nhn trc. Bo him hay chng
trnh sc khe c th i hi giy cho php trc cho mt s dch v trc khi qu v c phc
v, ngoi tr trong trng hp khn cp. Cho php trc khng phi l li ha ca bo him hay
chng trnh sc khe s i th chi ph.

10

Bo ph (Premium)
Tin tr nh k cho hng bo him hay chng trnh chm sc sc khe hoc i th thuc
theotoa.
Dch v phng nga (Preventive Services)
Chm sc sc khe thng l bao gm khm thm d, khm sc khe, v c vn bnh nhn
phng nga bnh, bnh tt, hay nhng vn sc khe khc hoc pht hin bnh giai
on u, khi m vic cha tr c tc dng tt nht (chm sc ny c th bao gm cc dch v
nh chch nga cm v vim phi, chch nga, v chp hnh khm thm d nh ri king v,
khm thm d trm cm/sc khe hnh vi, hay th mu, ty theo nhng g c khuyn khch
cho qu v).
Ngi chm sc chnh (Primary Care Provider)
Bc s khm bnh qu v u tin cho phn ln cc vn sc khe. V ny s chm sc cho qu
v nhng th cn thit gi gn sc khe. V ny cng c th ni vi bc s v ngi chm sc
sc khe khc v vic chm sc ca qu v v gii thiu qu v n nhng ngi . Trong nhiu
chng trnh sc khe, qu v phi gp bc s chm sc chnh trc khi gp bt c ngi chm
sc sc khe no khc.
Bc s chuyn khoa (Specialist)
Bc s chuyn khoa tp trung vo lnh vc y khoa c bit hay mt nhm bnh nhn chn
on, iu qun, phng nga, hoc cha tr mt s triu chng v bnh trng. Chuyn khoa
vin khng phi l bc s, m l ngi chm sc c hun luyn nhiu hn lnh vc chm sc
y t c bit.

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THNG TIN C NHN

QUAN TRNG
Ch dn ny thuc v ________________________________________
Tn chng trnh sc khe____________________________________
S hp ng ________________________________________________
S nhm___________________________________________________
S in thoi ca chng trnh sc khe_______________________
Ngi chm sc chnh________________________________________

Nh thuc ty_______________________________________________
D ng______________________________________________________
Lin lc khn cp____________________________________________
Thuc men_________________________________________________
___________________________________________________________
Nhng vic khc____________________________________________
___________________________________________________________
Bo v danh tnh: Gi kn thng tin c nhn ca qu v, d l trn giy,
trc tuyn, hay trn my in ton v thit b di ng Lu tr v b
thng tin c nhn ni an ton, c bit l s An Sinh X Hi ca qu v.

12

Ct ti y

Nhng ngi chm sc khc__________________________________

Ghi ch

13

Ghi ch

14

Ghi ch

15

S sn phm CMS
11841-V thng 1 nm 2015

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