{"id":3085,"date":"2014-07-22T09:00:49","date_gmt":"2014-07-22T17:00:49","guid":{"rendered":"http:\/\/smartandresponsible.com\/blog\/?p=3085"},"modified":"2014-07-19T12:41:58","modified_gmt":"2014-07-19T20:41:58","slug":"eob","status":"publish","type":"post","link":"https:\/\/smartandresponsible.com\/blog\/eob\/","title":{"rendered":"\u305d\u306e\u30c9\u30af\u30bf\u30fc\u304b\u3089\u306e\u8acb\u6c42\u66f8\u3001\u672c\u5f53\u306b\u6b63\u3057\u3044\u3067\u3059\u304b\uff1f"},"content":{"rendered":"<p>\u30af\u30ec\u30c3\u30b8\u30c8\u30ab\u30fc\u30c9\u4f1a\u793e\u304b\u3089\u8acb\u6c42\u66f8\u304c\u304d\u305f\u3089\u3001\u9593\u9055\u3063\u305f\u8acb\u6c42\u304c\u306a\u3044\u304b\u30c1\u30a7\u30c3\u30af\u3059\u308b\u3067\u3057\u3087\u3046\uff1f\u3000\u96fb\u8a71\u4f1a\u793e\u304b\u3089\u306e\u8acb\u6c42\u3082\u30c1\u30a7\u30c3\u30af\u3057\u307e\u305b\u3093\u304b\uff1f\u3000\u3067\u306f\u3001\u304a\u533b\u8005\u3055\u3093\u3084\u75c5\u9662\u304b\u3089\u304d\u305f\u8acb\u6c42\u66f8\u306f\u3069\u3046\u3067\u3059\u304b\uff1f\u3000\u3061\u3083\u3093\u3068\u30c1\u30a7\u30c3\u30af\u3057\u3066\u3044\u307e\u3059\u304b\uff1f\u3000\u4fdd\u967a\u4f1a\u793e\u304c\u5165\u3063\u3066\u3044\u308b\u3057\u3001\u4fdd\u967a\u3067\u30ab\u30d0\u30fc\u3055\u308c\u306a\u3044\u3082\u306e\u306f\u4ed5\u65b9\u304c\u306a\u3044\u304b\u3089\u652f\u6255\u308f\u306d\u3070\u306a\u3089\u306a\u3044\u3068\u3001\u76f2\u76ee\u7684\u306b\u305d\u3046\u3059\u308b\u306e\u306f\u3069\u3046\u3082\u3088\u304f\u306a\u3044\u3088\u3046\u3067\u3059\u30022013\u5e74\u306eAmerican Medical Association\u306e\u8abf\u67fb\u3067\u306f\u3001\u533b\u7642\u8cbb\u8acb\u6c42\u3067\u306e\u30a8\u30e9\u30fc\u30fb\u9593\u9055\u3044\u306f\u5168\u4f53\u306e\uff17\uff05\u306b\u4e0a\u308b\u3068\u3044\u3046\u7d50\u679c\u3067\u3057\u305f\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>\u305f\u3068\u3048\u3070\u3053\u3093\u306a\u30b1\u30fc\u30b9\u304c\u3002\u3002<\/h2>\n<p>\u3042\u308b\u60a3\u8005\u3055\u3093\u306e\u3068\u3053\u308d\u306b\u3001\u304a\u533b\u8005\u3055\u3093\u304b\u3089\u8acb\u6c42\u66f8\u304c\u5c4a\u304d\u307e\u3057\u305f\u3002\u984d\u306f$38\u3002\u300c\u25cb\u25cb\u4fdd\u967a\u4f1a\u793e\u306f\u3053\u306e\u984d\u306e\u8acb\u6c42\u3092\u62d2\u5426\u3057\u305f\u306e\u3067\u3001\u3053\u306e\u984d\u306e\u652f\u6255\u3044\u306f\u3042\u306a\u305f\u306e\u8cac\u4efb\u306b\u306a\u308a\u307e\u3059\u300d\u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3057\u305f\u3002\u3053\u306e\u60a3\u8005\u3055\u3093\u306f\u4fdd\u967a\u4f1a\u793e\u306e\u9001\u3063\u3066\u304f\u308bEOB\uff08Explanation of Benefit\uff09\u3092\u3061\u3083\u3093\u3068\u4fdd\u7ba1\u3057\u3066\u3044\u305f\u306e\u3067\u898b\u3066\u307f\u305f\u3068\u3053\u308d\u3001\u300c\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc\uff08\u533b\u8005\u3084\u75c5\u9662\u306a\u3069\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc\uff09\u306f\u4fdd\u967a\u4f1a\u793e\u304b\u3089\u306e\u652f\u6255\u984d\u3092\u3001\u533b\u7642\u8cbb\u306e\u5168\u984d\u3068\u3057\u3066\u53d7\u3051\u5165\u308c\u307e\u3057\u305f\u306e\u3067\u3001\u5dee\u984d\u306b\u3064\u3044\u3066\u60a3\u8005\u3067\u3042\u308b\u3042\u306a\u305f\u306f\u652f\u6255\u3046\u5fc5\u8981\u306f\u3042\u308a\u307e\u305b\u3093\u300d\u3068\u66f8\u3044\u3066\u3042\u308a\u307e\u3057\u305f\u3002\u305d\u306e\u65e8\u304a\u533b\u8005\u3055\u3093\u306e\u8acb\u6c42\u62c5\u5f53\u306b\u8aac\u660e\u3057\u3001$38\u306f\u652f\u6255\u3046\u5fc5\u8981\u306f\u306a\u3057\u3068\u53d6\u308a\u6d88\u3055\u308c\u307e\u3057\u305f\u3002<\/p>\n<p>\u307e\u305f\u3001\u3042\u308b\u4eba\u304c\u5598\u606f\u3067ER\u306b\u884c\u304d\u307e\u3057\u305f\u3002\u5f8c\u65e5\u3001$1,500\u3082\u306e\u8acb\u6c42\u304cER\u304b\u3089\u5c4a\u304d\u307e\u3057\u305f\u3002\u8acb\u6c42\u66f8\u306b\u306f\u3001\u300c\u63d0\u4f9b\u3055\u308c\u305f\u533b\u7642\u63aa\u7f6e\u306f\u4fdd\u967a\u4f1a\u793e\u304b\u3089\u306e\u8acb\u6c42\u304c\u3046\u3051\u3089\u308c\u306a\u3044\u306e\u3067\u3001\u3042\u306a\u305f\u306e\u8cac\u4efb\u3067\u3059\u300d\u3068\u66f8\u3044\u3066\u3042\u308a\u307e\u3057\u305f\u3002\u3053\u306e\u4eba\u3082EOB\u3092\u3061\u3083\u3093\u3068\u3068\u3063\u3066\u3044\u305f\u306e\u3067\u3059\u3050\u306b\u30c1\u30a7\u30c3\u30af\u3057\u305f\u3068\u3053\u308d\u3001\u305f\u3057\u304b\u306b\u5598\u606f\u306e\u63aa\u7f6e\u304c\u62d2\u5426\u3055\u308c\u3066\u3044\u307e\u3057\u305f\u3002\u53d7\u3051\u305f\u63aa\u7f6e\u306f\u306a\u306b\u3082\u5909\u308f\u3063\u305f\u63aa\u7f6e\u3067\u306f\u306a\u304f\u3001\u5598\u606f\u306e\u767a\u4f5c\u304c\u3042\u3063\u305f\u5834\u5408\u3001\u5f53\u7136\u306e\u3088\u3046\u306b\u306a\u3055\u308c\u308b\u63aa\u7f6e\u306a\u306e\u3067\u304a\u304b\u3057\u3044\u3068\u601d\u3044\u3088\u304f\u3088\u304f\u898b\u3066\u307f\u305f\u3068\u3053\u308d\u3001\u8a3a\u65ad\u30b3\u30fc\u30c9\u304c\u9593\u9055\u3063\u3066\u5165\u529b\u3055\u308c\u3001\u672c\u6765\u306f\u300c\u5598\u606f(asthma)\u300d\u3067\u3042\u308b\u3079\u304d\u8a3a\u65ad\u304c\u300c\u5fc3\u914d\u6027\uff08anxiety\uff09\u300d\u3068\u306a\u3063\u3066\u3044\u305f\u306e\u304c\u308f\u304b\u308a\u307e\u3057\u305f\u3002\u8a3a\u65ad\u3068\u63aa\u7f6e\u306b\u6b63\u3057\u3044\u95a2\u4fc2\u304c\u306a\u304b\u3063\u305f\u305f\u3081\u3001\u4fdd\u967a\u4f1a\u793e\u304b\u3089\u652f\u6255\u3044\u62d2\u5426\u3092\u53d7\u3051\u305f\u308f\u3051\u3067\u3059\u3002\u3059\u3050\u306b\u4fdd\u967a\u4f1a\u793e\u3068\u533b\u8005\u306b\u9023\u7d61\u3057\u3001\u8a3a\u65ad\u30b3\u30fc\u30c9\u3092\u6b63\u3057\u3066\u3082\u3089\u3044\u3001\u9593\u9055\u3063\u305f\u8acb\u6c42\u304b\u3089\u9003\u308c\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3057\u305f\u3002<\/p>\n<p>\u3053\u306e\u3088\u3046\u306a\u8acb\u6c42\u9593\u9055\u3044\u3092\u898b\u3064\u3051\u305f\u308a\u3001\u60f3\u5b9a\u5916\u306e\u533b\u7642\u8cbb\u3092\u8acb\u6c42\u3055\u308c\u308b\u3053\u3068\u304c\u306a\u3044\u3088\u3046\u306b\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u78ba\u8a8d\u3059\u3079\u304d\u3075\u305f\u3064\u306e\u91cd\u8981\u306a\u66f8\u985e\u304c\u3042\u308a\u307e\u3059\u3002\u3072\u3068\u3064\u306fSummary of Benefits and Coverage\u3068\u547c\u3070\u308c\u308b\u3082\u306e\u3067\u3001\u3082\u3046\u3072\u3068\u3064\u304cEOB(Explanation of Benefits)\u3067\u3059\u3002\u524d\u8005\u306f\u4e8b\u524d\u30c1\u30a7\u30c3\u30af\u3001EOB\u306f\u4e8b\u5f8c\u30c1\u30a7\u30c3\u30af\u3067\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>\u307e\u305a\u306f\u81ea\u5206\u306e\u5065\u5eb7\u4fdd\u967a\u3092\u3088\u304f\u77e5\u308b<\/h2>\n<p>Medicare\u4ee5\u5916\u306e\u3059\u3079\u3066\u306e\u4fdd\u967a\u306b\u306f\u3001\u305d\u306e\u4fdd\u967a\u3067\u30ab\u30d0\u30fc\u3059\u308b\u533b\u7642\u63aa\u7f6e\u3001\u30ab\u30d0\u30fc\u306e\u6761\u4ef6\u3084\u30ab\u30d0\u30fc\u984d\u306b\u3064\u3044\u3066\u898f\u5b9a\u3057\u305f\u30d6\u30c3\u30af\u30ec\u30c3\u30c8\u304c\u3042\u308a\u307e\u3059\u3002\u4ee5\u524d\u306f\u305d\u306e\u3088\u3046\u306a\u30d6\u30c3\u30af\u30ec\u30c3\u30c8\u304c\u81ea\u52d5\u7684\u306b\u624b\u5143\u306b\u9001\u3089\u308c\u3066\u304f\u308b\u3053\u3068\u304c\u591a\u304b\u3063\u305f\u3067\u3059\u304c\u3001\u6700\u8fd1\u3067\u306f\u4f55\u3067\u3082Web\u30d9\u30fc\u30b9\u306b\u306a\u308a\u81ea\u5206\u3067\u30aa\u30f3\u30e9\u30a4\u30f3\u3067\u63a2\u3055\u306a\u3044\u3068\u305d\u306e\u307e\u307e\u77e5\u3089\u305a\u306b\u3044\u308b\u306a\u3069\u3068\u3044\u3046\u3053\u3068\u3082\u3042\u308a\u307e\u3059\u3002\u624b\u5143\u306b\u306a\u3051\u308c\u3070\u3001\u4fdd\u967a\u4f1a\u793e\u306e\u30aa\u30f3\u30e9\u30a4\u30f3\u30b5\u30a4\u30c8\u306b\u3044\u3063\u3066\u30d7\u30ea\u30f3\u30c8\u3059\u308b\u304b\u3001\u3042\u308b\u3044\u306f\u4fdd\u967a\u4f1a\u793e\u306b\u96fb\u8a71\u3057\u3066\u30d6\u30c3\u30af\u30ec\u30c3\u30c8\u3092\u9001\u3063\u3066\u304f\u308c\u308b\u3088\u3046\u30ea\u30af\u30a8\u30b9\u30c8\u3057\u307e\u3059\u3002Summary of Benefits and Coverage\u306a\u3069\u3068\u3044\u3046\u30bf\u30a4\u30c8\u30eb\uff08\u30bf\u30a4\u30c8\u30eb\u306f\u3044\u308d\u3044\u308d\u306a\u30d0\u30ea\u30a8\u30fc\u30b7\u30e7\u30f3\u304c\u3042\u308a\u307e\u3059\uff09\u3067\u3059\u3002\u624b\u5143\u306b\u3042\u3063\u3066\u3082\u3001\u305d\u308c\u304c\u6700\u65b0\u306e\u3082\u306e\u3067\u3042\u308b\u304b1\u5e74\u306b\u4e00\u5ea6\u306f\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002\u4fdd\u967a\u306e\u5185\u5bb9\u3084\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u533b\u5e2b\u306a\u3069\u306f\u3069\u3093\u3069\u3093\u5909\u66f4\u306b\u306a\u308a\u307e\u3059\u3002\u5165\u624b\u3057\u305f\u3089\u3001\u8aad\u3080\u3053\u3068\uff01\u3000\u3042\u307e\u308a\u8aad\u307f\u305f\u304f\u5185\u5bb9\u3067\u3057\u3087\u3046\u304c\u3001\u3061\u3083\u3093\u3068\u3057\u304f\u307f\u3092\u308f\u304b\u3063\u3066\u304a\u304f\u3053\u3068\u304c\u5fc5\u8981\u3067\u3059\u3002\u4f55\u304c\u3069\u308c\u3060\u3051\u30ab\u30d0\u30fc\u3055\u308c\u308b\u306e\u304b\u3001Preauthorization\u306a\u3069\u306e\u624b\u9806\u3082\u77e5\u3063\u3066\u304a\u304d\u307e\u3057\u3087\u3046\u3002\u3059\u3079\u3066\u8aad\u3080\u5fc5\u8981\u306f\u3042\u308a\u307e\u305b\u3093\u304c\u3001\u3069\u3093\u306a\u5185\u5bb9\u306e\u3053\u3068\u304c\u66f8\u3044\u3066\u3042\u308b\u306e\u304b\u898b\u51fa\u3057\u3050\u3089\u3044\u306f\u898b\u3066\u628a\u63e1\u3057\u3066\u304a\u304f\u306e\u304c\u5fc5\u8981\u3067\u3059\u3002\u305f\u3068\u3048\u3070\u7dca\u6025\u6642\u306e\u5bfe\u5fdc\u3068\u304b\u30a2\u30e1\u30ea\u30ab\u56fd\u5916\u3067\u306e\u5bfe\u5fdc\u306a\u3069\u306f\u3001\u3042\u3089\u304b\u3058\u3081\u8aad\u3080\u3053\u3068\u306f\u3057\u306a\u304f\u3066\u3082\u3001\u305d\u3046\u3044\u3046\u9805\u76ee\u304c\u30d6\u30c3\u30af\u30ec\u30c3\u30c8\u306e\u4e2d\u3067\u8aac\u660e\u3055\u308c\u3066\u3044\u308b\u3053\u3068\u3092\u77e5\u3063\u3066\u304a\u304f\u3068\u3001\u3044\u3056\u3068\u3044\u3046\u3068\u304d\u306b\u300c\u3042\uff5e\u3001\u3042\u305d\u3053\u3092\u8aad\u3081\u3070\u3044\u3044\u3093\u3060\u300d\u3068\u308f\u304b\u308a\u307e\u3059\u3002\u533b\u5e2b\u3084\u75c5\u9662\u306b\u3044\u304f\u3068\u304d\u306b\u306f\u3001\u305d\u306e\u533b\u5e2b\u3084\u75c5\u9662\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u306b\u5c5e\u3057\u3066\u3044\u308b\u304b\u306a\u3069\u3082\u78ba\u8a8d\u3059\u308b\u3053\u3068\u304c\u5fc5\u8981\u3067\u3059\u3002<\/p>\n<p>\u81ea\u5206\u306e\u5065\u5eb7\u4fdd\u967a\u306e\u4ed5\u7d44\u307f\u3092\u77e5\u3063\u3066\u304a\u304f\u3053\u3068\u306f\u3001\u8acb\u6c42\u9593\u9055\u3044\u3092\u4e8b\u524d\u306b\u9632\u3050\u3053\u3068\u306b\u5f79\u7acb\u3061\u307e\u3059\u3002\u79c1\u3082\u5b9f\u969b\u306b\u3001\u305d\u3093\u306a\u3053\u3068\u304c\u3042\u308a\u307e\u3057\u305f\u3002\u8840\u6db2\u691c\u67fb\u306e\u305f\u3081\u306b\u30d7\u30e9\u30a4\u30de\u30ea\u30fc\u30c9\u30af\u30bf\u30fc\u306e\u30aa\u30d5\u30a3\u30b9\u306b\u51fa\u304b\u3051\u305f\u3068\u304d\u3001\u53d7\u4ed8\u306e\u5973\u6027\u304c\u300cCopay\u306f\uff04\uff11\uff15\u3067\u3059\u300d\u3068\u3044\u3046\u306e\u3067\u3001\u300c\u3042\u308c\u3001\u79c1\u306e\u4fdd\u967a\u306f\u30e9\u30dc\u30ef\u30fc\u30af\uff08\u691c\u67fb\uff09\u306f\u5168\u984d\u30ab\u30d0\u30fc\u3059\u308b\u306f\u305a\u3067\u3059\u304c\u300d\u3068\u3044\u3063\u305f\u3089\u3001\u300c\u30aa\u30c3\u30b1\u30fc\u300d\u3068\u3044\u308f\u308c\uff04\uff11\uff15\u306f\u6255\u308f\u306a\u304f\u3066\u3088\u304f\u306a\u308a\u307e\u3057\u305f\u3002\u305f\u3063\u305f\u305d\u308c\u3060\u3051\u306e\u3053\u3068\u3002\u306f\u3063\u304d\u308a\u3044\u3063\u3066\u3001\u30a2\u30e1\u30ea\u30ab\u306e\u5065\u5eb7\u4fdd\u967a\u306f\u3001\u4fdd\u967a\u4f1a\u793e\u306e\u6570\u3082\u4fdd\u967a\u306e\u30d7\u30e9\u30f3\u306e\u7a2e\u985e\u3082\u3042\u307e\u308a\u306b\u591a\u3059\u304e\u3066\u3001\u304a\u533b\u8005\u3055\u3093\u306e\u307b\u3046\u3082\u3088\u304f\u308f\u3051\u304c\u308f\u304b\u3063\u3066\u3044\u306a\u3044\u3053\u3068\u3060\u3063\u3066\u3088\u304f\u3042\u308a\u307e\u3059\u3002\u60a3\u8005\u3067\u3042\u308b\u79c1\u305f\u3061\u306f\u3001\u3068\u308a\u3042\u3048\u305a\u305f\u3063\u305f\u3072\u3068\u3064\u81ea\u5206\u306e\u5065\u5eb7\u4fdd\u967a\u3060\u3051\u3092\u3088\u304f\u77e5\u3063\u3066\u304a\u3051\u3070\u3044\u3044\u308f\u3051\u3067\u3059\u3057\u3001\u305d\u308c\u306f\u4fdd\u967a\u4f1a\u793e\u3067\u3082\u533b\u8005\u3067\u3082\u306a\u304f\u4fdd\u967a\u306b\u5165\u3063\u3066\u3044\u308b\u79c1\u305f\u3061\u306e\u8cac\u4efb\u3067\u3059\u304b\u3089\u3001\u30d7\u30e9\u30f3\u306e\u5185\u5bb9\u306e\u628a\u63e1\u306f\u91cd\u8981\u306a\u7b2c\u4e00\u6b69\u3067\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #444444; font-size: 1.7em;\">EOB(Explanation of Benefit\uff09\u3092\u78ba\u8a8d\u3059\u308b<\/span><\/p>\n<p>\u533b\u7642\u63aa\u7f6e\u3092\u53d7\u3051\u3066\u304b\u3089\u5927\u5207\u306b\u306a\u308b\u306e\u306f\u3001EOB\u306e\u78ba\u8a8d\u3067\u3059\u3002EOB\u306f\u8acb\u6c42\u66f8\u3067\u306f\u306a\u304f\u3001\u4fdd\u967a\u4f1a\u793e\u304b\u3089\u79c1\u305f\u3061\u306e\u53d7\u3051\u305f\u533b\u7642\u63aa\u7f6e\u3068\u3001\u305d\u308c\u306b\u5bfe\u3057\u3066\u3069\u306e\u3088\u3046\u306a\u30b3\u30b9\u30c8\u304c\u304b\u304b\u308a\u3001\u8ab0\u304c\u652f\u6255\u3046\u306e\u304b\u3068\u3044\u3046\u3053\u3068\u3092\u307e\u3068\u3081\u305f\u3082\u306e\u3067\u3059\u3002\u3053\u306eEOB\u3092\u304d\u3061\u3093\u3068\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3068\u3001\u5225\u9014\u533b\u5e2b\u304b\u3089\u5c4a\u304f\u8acb\u6c42\u66f8\u304c\u3053\u306eEOB\u306b\u7167\u3089\u3057\u5408\u308f\u305b\u3066\u9593\u9055\u3044\u304c\u306a\u3044\u304b\u3092\u78ba\u8a8d\u3059\u308b\u3053\u3068\u304c\u5927\u5207\u3067\u3059\u3002<\/p>\n<p>\u533b\u5e2b\u306b\u304b\u304b\u3063\u3066\u3082EOB\u304c\u6765\u306a\u3044\u3053\u3068\u3082\u3042\u308a\u307e\u3059\u3002\u305d\u308c\u306f\u4fdd\u967a\u304cHMO\u3067\u3042\u308b\u5834\u5408\u306a\u3069\u3067\u3001\u533b\u5e2b\uff08\u30d7\u30e9\u30a4\u30de\u30ea\u30fc\u30b1\u30a2\u30c9\u30af\u30bf\u30fc\uff09\u304c\u3001HMO\u60a3\u8005\u3072\u3068\u308a\u306b\u5bfe\u3057\u5e74\u9593\u3044\u304f\u3089\u3068\u3044\u3046\u3088\u3046\u306b\u56fa\u5b9a\u984d\u3092\u3001\u3059\u3067\u306b\u4fdd\u967a\u4f1a\u793e\u304b\u3089\u53d7\u3051\u53d6\u3063\u3066\u3044\u308b\u306e\u3067\u3001\u500b\u3005\u306e\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3066\u306f\u4fdd\u967a\u4f1a\u793e\u306b\u8acb\u6c42\u3092\u3057\u306a\u3044\u304b\u3089\u3067\u3059\u3002HMO\u306f\u3001\u533b\u7642\u8cbb\u7406\u89e3\u3068\u7ba1\u7406\u3068\u3044\u3046\u9762\u3067\u306f\u3082\u3063\u3068\u3082\u7c21\u5358\u306a\u4fdd\u967a\u3068\u3044\u3063\u3066\u3088\u3044\u3067\u3057\u3087\u3046\u3002\u60a3\u8005\u5074\u306f\u6bce\u56de\u306eCopay\u3060\u3051\u652f\u6255\u3048\u3070\u3001\u3042\u3068\u306f\u8ca0\u62c5\u304c\u307b\u3068\u3093\u3069\u306a\u3044\u306e\u3067\u3001\u8acb\u6c42\u9762\u3067\u306e\u30c8\u30e9\u30d6\u30eb\u3082\u5c11\u306a\u3044\u3067\u3057\u3087\u3046\u3002<\/p>\n<p>\u4e0a\u8a18\u306e\u3088\u3046\u306a\u30b1\u30fc\u30b9\u3092\u9664\u304d\u3001\u533b\u5e2b\u304c\u4fdd\u967a\u4f1a\u793e\u306b\u8acb\u6c42\u3092\u3057\u305f\u5834\u5408\u306f\u3001\u5fc5\u305aEOB\u304c\u4f5c\u3089\u308c\u304a\u624b\u5143\u306b\u5c4a\u304f\u306f\u305a\u3067\u3059\u3002EOB\u304c\u5c4a\u304f\u524d\u306b\u533b\u5e2b\u304b\u3089\u8acb\u6c42\u66f8\u304c\u6765\u305f\u5834\u5408\u306f\u3001\u3067\u304d\u308b\u3060\u3051EOB\u304c\u6765\u308b\u307e\u3067\u652f\u6255\u3044\u3092\u5f85\u3064\u304b\u3001\u3069\u3046\u3057\u3066\u3082\u5fc5\u8981\u306a\u3089\u30df\u30cb\u30de\u30e0\u306e\u984d\u3060\u3051\u652f\u6255\u3046\u306e\u304c\u3088\u3044\u3067\u3057\u3087\u3046\u3002\u307e\u305f\u533b\u5e2b\u3078\u306e\u652f\u6255\u3044\u306f\u3001\u305f\u3068\u3048$10\u306eCopay\u3067\u3082\u3082\u3063\u3068\u984d\u306e\u5927\u304d\u3044Coinsurance\u3067\u3082\u3001\u30af\u30ec\u30b8\u30c3\u30c8\u30ab\u30fc\u30c9\u304b\u30c1\u30a7\u30c3\u30af\u3067\u652f\u6255\u3046\u306e\u304c\u3088\u3044\u3067\u3057\u3087\u3046\u3002\u7a93\u53e3\u3067\u73fe\u91d1\u3067\u652f\u6255\u3046\u306e\u306f\u3001\u60a3\u8005\u5074\u306b\u306f\u4f55\u306e\u8a18\u9332\u3082\u6b8b\u3089\u306a\u3044\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002\u533b\u5e2b\u5074\u306eCopay\u7ba1\u7406\u3082\u3069\u308c\u3060\u3051\u3055\u308c\u3066\u3044\u308b\u304b\u308f\u304b\u308a\u307e\u305b\u3093\u3002\u5f8c\u3067\u9593\u9055\u3044\u3092\u6b63\u3059\u3068\u304d\u3084\u8fd4\u91d1\u3092\u53d7\u3051\u308b\u3068\u304d\u306b\u3001\u652f\u6255\u3044\u306e\u8a3c\u62e0\u304c\u624b\u5143\u306b\u306a\u3044\u3068\u8fd4\u91d1\u3082\u304a\u307c\u3064\u304d\u307e\u305b\u3093\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>EOB\u306e\u3057\u304f\u307f<\/h2>\n<p>\u5404\u4fdd\u967a\u4f1a\u793e\u3067EOB\u306e\u30d5\u30a9\u30fc\u30de\u30c3\u30c8\u306f\u307e\u3061\u307e\u3061\u3067\u3059\u304c\u3001\u9805\u76ee\u306f\u5927\u4f53\u540c\u3058\u306f\u305a\u3067\u3059\u3002\u8a18\u8f09\u3055\u308c\u3066\u3044\u308b\u306e\u306f\u3001\u4e0b\u8a18\u306e\u3088\u3046\u306a\u30a2\u30a4\u30c6\u30e0\u3067\u3059\u3002<\/p>\n<ul>\n<li><strong>\u8acb\u6c42\u756a\u53f7\u3068\u8acb\u6c42\u306e\u65e5\u4ed8<\/strong><\/li>\n<li><strong>\u4fdd\u967a\u8acb\u6c42\u3092\u3057\u305f\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc<\/strong>\uff08\u533b\u5e2b\u30fb\u75c5\u9662\uff09<\/li>\n<li><strong>\u533b\u7642\u8cbb\u304c\u767a\u751f\u3057\u305f\u65e5\u4ed8<\/strong>\uff1a\u3000\u3053\u308c\u304c\u533b\u7642\u63aa\u7f6e\u3092\u53d7\u3051\u305f\u65e5\u3067\u3059\u3002<\/li>\n<li>\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc\u304c\u8acb\u6c42\u3059\u308b\u984d\uff08Full amount\uff09\uff1a\u3000\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc\u306f\u63d0\u4f9b\u3059\u308b\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3001\u305d\u308c\u305e\u308c\u7570\u306a\u308b\u5024\u6bb5\u3092\u3064\u3051\u3066\u3044\u307e\u3059\u3002Full amount\u3068\u3044\u3046\u306e\u306f\u30d7\u30ed\u30d0\u30a4\u30c0\u30fc\u8a2d\u5b9a\u306e\u5024\u6bb5\u3068\u3044\u3046\u3053\u3068\u3002<\/li>\n<li><strong>\u8acb\u6c42\u306b\u5bfe\u3057\u3066\u306e\u5224\u65ad<\/strong>\uff1a\u3000Covered Amount(\u4fdd\u967a\u4f1a\u793e\u3067\u30ab\u30d0\u30fc\u3059\u308b\u984d)\u3068\u305d\u3046\u3067\u306a\u3044\u984d\u304c\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002\u8acb\u6c42\u304c\u6b63\u3057\u304f\u306a\u3044\uff08\u305f\u3068\u3048\u3070\u3001\u5148\u307b\u3069\u306e\u8a3a\u65ad\u3068\u533b\u7642\u63aa\u7f6e\u304c\u30de\u30c3\u30c1\u3057\u306a\u3044\u306a\u3069\u306e\u7406\u7531\u3067\uff09Deny\uff08\u533b\u5e2b\u306e\u4fdd\u967a\u4f1a\u793e\u3078\u306e\u8acb\u6c42\u304c\u62d2\u5426\uff09\u3055\u308c\u305f\u308a\u3001Disallow\uff08\u8acb\u6c42\u984d\u306e\u4e00\u90e8\u304c\u5374\u4e0b\uff09\u3055\u308c\u305f\u5834\u5408\u306f\u3053\u3053\u3067\u78ba\u8a8d\u3057\u307e\u3059\u3002\u5148\u307b\u3069\u3082\u66f8\u3044\u305f\u3088\u3046\u306b\u3001\u30d7\u30ed\u30d0\u30a4\u30c0\u306f\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3066\u81ea\u5206\u306e\u597d\u304d\u306a\u984d\u3092Full Amount\u8acb\u6c42\u984d\u3068\u3057\u3066\u8a2d\u5b9a\u3057\u3066\u3044\u307e\u3059\u304c\u3001\u3053\u308c\u306b\u5bfe\u3057\u30d7\u30ed\u30d0\u30a4\u30c0\u3068\u4fdd\u967a\u4f1a\u793e\u306e\u9593\u3067\u3042\u3089\u304b\u3058\u3081\u305d\u308c\u305e\u308c\u306e\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3066\u540c\u610f\u3057\u305f\u984d\u3068\u3044\u3046\u3082\u306e\u304c\u3042\u308a\u307e\u3059\u3002\u3042\u308b\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3066\u3001\u3042\u308b\u30d7\u30ed\u30d0\u30a4\u30c0\u306f$300\u3068\u3044\u3046\u984d\u3092\u8a2d\u5b9a\u3057\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3057\u3001\u307b\u304b\u306e\u30d7\u30ed\u30d0\u30a4\u30c0\u306f$500\u3068\u3044\u3046\u984d\u3092\u3064\u3051\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u304c\u3001\u305d\u306e\u4fdd\u967a\u4f1a\u793e\u3092\u53d7\u3051\u5165\u308c\u3066\u3044\u308b\u533b\u5e2b\u304c\u305d\u306e\u533b\u7642\u63aa\u7f6e\u306b\u5bfe\u3057\u3066\u8acb\u6c42\u3067\u304d\u308b\u984d\u306f$280\u3068\u6c7a\u307e\u3063\u3066\u3044\u308c\u3070\u3001\u6700\u521d\u306e\u30d7\u30ed\u30d0\u30a4\u30c0\u306e\u5834\u5408\u306f$20\u304c\u4e8c\u756a\u76ee\u306e\u30d7\u30ed\u30d0\u30a4\u30c0\u306e\u5834\u5408\u306f$220\u304cDisallowed Amount\u3068\u306a\u308a\u3001\u4fdd\u967a\u4f1a\u793e\u306f$280\u306e\u307f\u3092\u652f\u6255\u3046\u3068\u3044\u3046\u3057\u304f\u307f\u3067\u3059\u3002\u307e\u305f\u3001\u4fdd\u967a\u4f1a\u793e\u3068\u30d7\u30ed\u30d0\u30a4\u30c0\u3068\u306e\u53d6\u308a\u6c7a\u3081\u3067\u3001\u3053\u306eDisallowed Amount\u306f\u30d7\u30ed\u30d0\u30a4\u30c0\u306f\u60a3\u8005\u306b\u8acb\u6c42\u3067\u304d\u306a\u3044\u3053\u3068\u304c\u591a\u3044\u306e\u3067\u3001\u305d\u306e\u5834\u5408\u306f\u60a3\u8005\u306fDisallowed Amount\u306b\u3064\u3044\u3066\u306f\u307e\u3063\u305f\u304f\u5fc3\u914d\u3057\u306a\u304f\u3066\u3044\u3044\u3053\u3068\u306b\u306a\u308a\u307e\u3059\uff08\u3053\u308c\u306f\u3001EOB\u81ea\u4f53\u306b\u660e\u8a18\u3057\u3066\u3042\u308b\u306f\u305a\u3067\u3059\u304c\u3001\u5148\u307b\u3069\u306eSummary of Benefits and Coverage\u306a\u3069\u3067\u3082\u78ba\u304b\u3081\u3089\u308c\u307e\u3059\uff09\u3002<\/li>\n<li><strong>\u60a3\u8005\u306e\u81ea\u5df1\u8ca0\u62c5\u984d<\/strong>\uff1a\u3000\u5e74\u9593Deductible\u307e\u3067\u306e\u533b\u7642\u8cbb\u3084Coinsurance\u306a\u3069\u3001\u60a3\u8005\u304c\u8ca0\u62c5\u3059\u308b\u984d\u304c\u3044\u304f\u3089\u304b\u304c\u660e\u8a18\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u3053\u306e\u9805\u76ee\u306b\u7d0d\u5f97\u304c\u3044\u304f\u3053\u3068\u3001\u30d7\u30ed\u30d0\u30a4\u30c0\u304b\u3089\u306e\u8acb\u6c42\u66f8\u304c\u3053\u306e\u984d\u3068\u540c\u4e00\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u304b\u3081\u3066\u304b\u3089\u533b\u7642\u8cbb\u3092\u652f\u6255\u3044\u307e\u3059\u3002<\/li>\n<li><strong>Deductible\u3078\u30ab\u30a6\u30f3\u30c8\u3055\u308c\u308b\u984d<\/strong>\uff1a\u3000\u5e74\u9593Deductible\u9054\u6210\u306e\u305f\u3081\u306b\u30ab\u30a6\u30f3\u30c8\u3055\u308c\u308b\u984d\u304c\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002Deductible\u3078\u306e\u30ab\u30a6\u30f3\u30c8\u3082\u308c\u304c\u3042\u3063\u305f\u3068\u3044\u3046\u8a71\u3082\u805e\u304d\u307e\u3059\u304b\u3089\u3001\u81ea\u5206\u3067\u3082\u652f\u6255\u3063\u305f\u533b\u7642\u8cbb\u306e\u8a18\u9332\u3092\u3068\u3063\u3066\u304a\u3044\u3066\u3001\u901a\u7b97Deductible\u3092\u7ba1\u7406\u3057\u3066\u304a\u304f\u3053\u3068\u3092\u304a\u52e7\u3081\u3057\u307e\u3059\u3002<\/li>\n<li><strong>Out-of-Pocket-Max\u3078\u30ab\u30a6\u30f3\u30c8\u3055\u308c\u308b\u984d<\/strong>\uff1a\u3000\u5e74\u9593\u306e\u533b\u7642\u8cbb\u8ca0\u62c5\u306e\u4e0a\u9650\u304c\u8a2d\u5b9a\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u306b\u306f\u3001\u6b63\u3057\u3044\u304b\u81ea\u5206\u306e\u8a18\u9332\u3068\u7167\u3089\u3057\u5408\u308f\u305b\u307e\u3057\u3087\u3046\u3002Deductible\u3084Out-of-Pocket-Max\u306e\u6b63\u3057\u3044\u7ba1\u7406\u306f\u3001\u7121\u99c4\u306a\u533b\u7642\u8cbb\u3092\u652f\u6255\u3046\u3053\u3068\u3092\u9632\u3044\u3060\u308a\u3001\u5e74\u5ea6\u672b\u306b\u306f\u307e\u3068\u3081\u3066\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u3066\u5168\u984d\u4fdd\u967a\u4f1a\u793e\u8ca0\u62c5\u3068\u3059\u308b\u306a\u3069\u306e\u8a08\u753b\u304c\u3067\u304d\u307e\u3059\u3002<\/li>\n<li><strong>Footnotes<\/strong>\uff1a\u3000\u305d\u306e\u4ed6\u30ce\u30fc\u30c8\u7684\u306a\u8aac\u660e\u304c\u30d7\u30ea\u30f3\u30c8\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u304c\u3042\u308a\u307e\u3059\u3002\u81ea\u5206\u306e\u30b1\u30fc\u30b9\u306b\u3064\u3044\u3066\u7406\u89e3\u3059\u308b\u305f\u3081\u306b\u91cd\u8981\u306a\u5834\u5408\u3082\u591a\u3044\u3067\u3059\u304b\u3089\u3001\u3088\u304f\u8aad\u3093\u3067\u7406\u89e3\u3057\u307e\u3059\u3002<\/li>\n<\/ul>\n<p align=\"left\">\u30a2\u30e1\u30ea\u30ab\u306e\u5065\u5eb7\u4fdd\u967a\u306f\u672c\u5f53\u306b\u982d\u304c\u75db\u3044\u3053\u3068\u304c\u591a\u3044\u3067\u3059\u304c\u3001\u9ad8\u3044\u4fdd\u967a\u6599\u3092\u6255\u3063\u3066\u3044\u308b\u306e\u3067\u3059\u304b\u3089\u3001\u6b63\u3057\u304f\u6700\u5927\u9650\u306b\u6d3b\u7528\u3057\u305f\u3044\u3082\u306e\u3067\u3059\u306d\u3002<\/p>\n<p><a href=\"http:\/\/smartandresponsible.com\/blog\/medical-cost-shop-aroun\/\"  rel=\"bookmark\">\u30a2\u30e1\u30ea\u30ab\u533b\u7642\u306e\u30df\u30b9\u30c6\u30ea\u30fc\u3000\u75c5\u9662\u306f\u30db\u30c6\u30eb\u3092\u63a2\u3059\u3088\u3046\u306b\u30fb\u30fb<\/a><\/p>\n<p><a href=\"http:\/\/smartandresponsible.com\/blog\/medical-cost-negotiation\/\"  rel=\"bookmark\">\u30a2\u30e1\u30ea\u30ab\u533b\u7642\u306e\u30df\u30b9\u30c6\u30ea\u30fc\u3000\u533b\u7642\u8cbb\u306f\u3001\u305c\u3072\u5024\u5207\u308a\u307e\u3057\u3087\u3046\uff1f<\/a><\/p>\n<p>\u306a\u3069\u3082\u3054\u53c2\u8003\u306b\u3002\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u30af\u30ec\u30c3\u30b8\u30c8\u30ab\u30fc\u30c9\u4f1a\u793e\u304b\u3089\u8acb\u6c42\u66f8\u304c\u304d\u305f\u3089\u3001\u9593\u9055\u3063\u305f\u8acb\u6c42\u304c\u306a\u3044\u304b\u30c1\u30a7\u30c3\u30af\u3059\u308b\u3067\u3057\u3087\u3046\uff1f\u3000\u96fb\u8a71\u4f1a\u793e\u304b\u3089\u306e\u8acb\u6c42\u3082\u30c1\u30a7\u30c3\u30af\u3057\u307e\u305b\u3093\u304b\uff1f\u3000\u3067\u306f\u3001\u304a\u533b\u8005\u3055\u3093\u3084\u75c5\u9662\u304b\u3089\u304d\u305f\u8acb\u6c42\u66f8\u306f\u3069\u3046\u3067\u3059\u304b\uff1f\u3000\u3061\u3083\u3093\u3068\u30c1\u30a7\u30c3\u30af\u3057\u3066\u3044\u307e\u3059\u304b\uff1f\u3000\u4fdd\u967a\u4f1a\u793e\u304c\u5165\u3063\u3066\u3044\u308b\u3057\u3001\u4fdd\u967a\u3067\u30ab\u30d0\u30fc\u3055\u308c\u306a\u3044\u3082\u306e\u306f\u4ed5\u65b9\u304c\u306a\u3044\u304b\u3089\u652f\u6255\u308f\u306d\u3070\u306a\u3089\u306a\u3044\u3068\u3001\u76f2\u76ee\u7684\u306b\u305d\u3046\u3059\u308b\u306e\u306f\u3069\u3046\u3082\u3088\u304f\u306a\u3044\u3088\u3046\u3067\u3059\u30022013\u5e74\u306eAmerican Medical Association\u306e\u8abf\u67fb\u3067\u306f\u3001\u533b\u7642\u8cbb\u8acb\u6c42\u3067\u306e\u30a8\u30e9\u30fc\u30fb\u9593\u9055\u3044\u306f\u5168\u4f53\u306e\uff17\uff05\u306b\u4e0a\u308b\u3068\u3044\u3046\u7d50\u679c\u3067\u3057\u305f\u3002 &nbsp; \u305f\u3068\u3048\u3070\u3053\u3093\u306a\u30b1\u30fc\u30b9\u304c\u3002\u3002 \u3042\u308b\u60a3\u8005\u3055\u3093\u306e\u3068\u3053\u308d\u306b\u3001\u304a\u533b\u8005\u3055\u3093\u304b\u3089\u8acb\u6c42\u66f8\u304c\u5c4a\u304d\u307e\u3057\u305f\u3002\u984d\u306f$38\u3002\u300c &hellip;<\/p>\n","protected":false},"author":1,"featured_media":3992,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[8],"tags":[45],"class_list":["post-3085","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthinsurance","tag-fighting-as-consumer"],"jetpack_publicize_connections":[],"modified_by":"admin","jetpack_featured_media_url":"https:\/\/i0.wp.com\/smartandresponsible.com\/blog\/wp-content\/uploads\/2017\/06\/SP-flying-woman.png?fit=515%2C350&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/s1OwA5-eob","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/posts\/3085","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/comments?post=3085"}],"version-history":[{"count":1,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/posts\/3085\/revisions"}],"predecessor-version":[{"id":3086,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/posts\/3085\/revisions\/3086"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/media\/3992"}],"wp:attachment":[{"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/media?parent=3085"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/categories?post=3085"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/smartandresponsible.com\/blog\/wp-json\/wp\/v2\/tags?post=3085"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}