{"id":3447,"date":"2016-01-26T09:22:35","date_gmt":"2016-01-26T17:22:35","guid":{"rendered":"http:\/\/smartandresponsible.com\/blog\/?p=3447"},"modified":"2016-01-22T12:54:37","modified_gmt":"2016-01-22T20:54:37","slug":"my_hmo","status":"publish","type":"post","link":"https:\/\/smartandresponsible.com\/blog\/my_hmo\/","title":{"rendered":"\u79c1\u304cHMO\u3092\u9078\u3076\u308f\u3051"},"content":{"rendered":"<p>\u6211\u304c\u5bb6\u306e\u5065\u5eb7\u4fdd\u967a\u306f\u3044\u3064\u3082HMO\u3068\u6c7a\u307e\u3063\u3066\u3044\u307e\u3059\u3002\u4e00\u5ea6POS\u306b\u3057\u305f\u3053\u3068\u304c\u3042\u308a\u307e\u3057\u305f\u304c\u3001\u3059\u3050\u306bHMO\u306b\u623b\u3057\u307e\u3057\u305f\u3002\u5065\u5eb7\u4fdd\u967a\u306b\u3064\u3044\u3066\u306f\u3044\u308d\u3044\u308d\u306a\u8003\u3048\u65b9\u304c\u3042\u308b\u3068\u601d\u3044\u307e\u3059\u304c\u3001\u4eca\u65e5\u306f\u3001\u3042\u308b\u304d\u3063\u304b\u3051\u3067HMO\u304c\u6211\u304c\u5bb6\u306b\u306f\u6700\u9069\u3060\u3068\u518d\u78ba\u8a8d\u3057\u305f\u51fa\u6765\u4e8b\u3092\u304a\u8a71\u3057\u3057\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/p>\n<p>\u6211\u304c\u5bb6\u306e\u5065\u5eb7\u4fdd\u967a\u306f\u4e3b\u4eba\u306e\u96c7\u7528\u4e3b\u306e\u63d0\u4f9b\u3059\u308b\u4fdd\u967a\u3092\u4f7f\u3063\u3066\u3044\u307e\u3059\u3002\u3044\u308d\u3044\u308d\u306a\u7a2e\u985e\u306e\u4fdd\u967a\u304c6\u7a2e\u985e\u63d0\u4f9b\u3055\u308c\u3066\u304a\u308a\u3001\u305d\u3053\u304b\u3089\u81ea\u5206\u306b\u3042\u3063\u305f\u3082\u306e\u3092\u9078\u3076\u3053\u3068\u306b\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u305d\u306e\u4e2d\u306b\u306f\u6700\u8fd1\u6ce8\u76ee\u3055\u308c\u3066\u3044\u308bHigh Deductible Plan\u3082\u3042\u308a\u3001Health Savings Account\u3068\u7d44\u307f\u5408\u308f\u305b\u3066\u63d0\u4f9b\u3055\u308c\u3066\u304a\u308a\u96c7\u7528\u4e3b\u304c\u4e00\u5b9a\u984d\u3092Account\u306b\u5165\u308c\u3066\u304f\u308c\u308b\u306e\u3067\u3001\u75c5\u6c17\u3092\u3057\u306a\u3051\u308c\u3070\u91d1\u92ad\u7684\u306b\u306f\u6848\u5916\u304a\u5f97\u611f\u304c\u9ad8\u3044\u3082\u306e\u3082\u3042\u308a\u307e\u3059\u3002\u305f\u3060\u3001\u6211\u304c\u5bb6\u306b\u3068\u3063\u3066\u306e\u533b\u7642\u4fdd\u967a\u306e\u5f79\u5272\u306f\u3001\u300c\u5927\u75c5\u3092\u3057\u3066\u5927\u304d\u306a\u624b\u8853\u3092\u3057\u3066\u3082\u3001\u500b\u4eba\u8ca0\u62c5\u307b\u3068\u3093\u3069\u306a\u3044\u3088\u3046\u306b\u30d7\u30ed\u30c6\u30af\u30b7\u30e7\u30f3\u304c\u3042\u308b\u3082\u306e\u300d\u3068\u5272\u308a\u5207\u3063\u3066\u3044\u308b\u306e\u3067\u3001\u3069\u308c\u3060\u3051\u624b\u8853\u3057\u3066\u3082\u3069\u308c\u3060\u3051\u691c\u67fb\u3057\u3066\u3082\u3069\u308c\u3060\u3051\u5165\u9662\u3057\u3066\u3082\u3001Copay\u306e$250\u3060\u3051\u6255\u3048\u3070\u3042\u3068\u306f\u5168\u984d\u30ab\u30d0\u30fc\u3055\u308c\u308b\u73fe\u5728\u306e\u30d7\u30e9\u30f3\u3092\u9078\u3093\u3067\u3044\u307e\u3059\u3002\u307e\u305f\u3001HMO\u3067\u306f\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u306e\u533b\u5e2b\u3057\u304b\u4f7f\u3048\u307e\u305b\u3093\u304c\u3001\u3082\u3063\u3068\u30d5\u30ec\u30ad\u30b7\u30d6\u30eb\u306b\u533b\u5e2b\u3092\u9078\u3079\u308bPPO\u3082\u63d0\u4f9b\u3055\u308c\u3066\u3044\u307e\u3059\u304c\u3001\u73fe\u5728\u306eHMO\u3067\u306f\u9078\u3079\u308b\u533b\u7642\u30b0\u30eb\u30fc\u30d7\u304c\u5145\u5b9f\u3057\u3066\u304a\u308a\u3001\u7279\u306b\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u306b\u51fa\u308b\u5fc5\u8981\u306f\u306a\u3044\u3068\u307f\u3066HMO\u3067\u6e80\u8db3\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>Surprise Bill\u306a\u3089\u306cSurprise EOB?<\/h2>\n<p>\u666e\u6bb5\u306f\u5065\u5eb7\u3067\u5b9a\u671f\u5065\u8a3a\u4ee5\u5916\u533b\u8005\u306b\u884c\u3063\u305f\u3053\u3068\u306e\u306a\u3044\u79c1\u305f\u3061\u592b\u5a66\u3067\u3057\u305f\u304c\u3001\u6700\u8fd1\u4e3b\u4eba\u306e\u9996\u306b\u3057\u3053\u308a\u304c\u898b\u3064\u304b\u308a\u3001\u4f55\u5ea6\u304b\u3042\u3061\u3053\u3061\u306e\u533b\u7642\u6a5f\u95a2\u3067\u53d7\u8a3a\u3059\u308b\u3053\u3068\u306b\u306a\u308a\u307e\u3057\u305f\u3002HMO\u3067\u3059\u306e\u3067\u3001Primary Care Physician\uff08PCP\uff09\u306b\u307e\u305a\u4f1a\u3044\u3001\u305d\u3053\u304b\u3089\u5c02\u9580\u5bb6\u306b\u56de\u3057\u3066\u3082\u3089\u3044\u307e\u3059\u3002\u8d85\u97f3\u6ce2\u691c\u8a3a\u306e\u7d50\u679c\u3001\u304a\u305d\u3089\u304f\u5fc3\u914d\u3059\u308b\u3088\u3046\u306a\u3082\u306e\u3067\u306f\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u3001\u3057\u3053\u308a\u306f\u5b9f\u306f\u6db2\u4f53\u6027\u306e\u3082\u306e\u3067\u3042\u308b\u3053\u3068\u3082\u308f\u304b\u308a\u307e\u3057\u305f\u3002\u307b\u3063\u3066\u304a\u3044\u3066\u3082\u3044\u3044\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3082\u8a00\u308f\u308c\u305f\u306e\u3067\u3059\u304c\u3001\u7d50\u5c40\u3001\u306e\u3069\u306e\u4e0d\u5feb\u611f\u304c\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3001Aspiration\u3068\u547c\u3070\u308c\u308b\u51e6\u7f6e\u3092\u3057\u3066\u3082\u3089\u3044\u4e2d\u8eab\u3092\u5438\u5f15\u3057\u3066\u51fa\u3057\u3066\u3082\u3089\u3044\u307e\u3057\u305f\u3002\u3053\u306e\u51e6\u7f6e\u306fOutpatient\u3067\u3001\u304b\u306a\u308a\u7d20\u65e9\u304f\u7d42\u308f\u3063\u305f\u3068\u805e\u3044\u3066\u3044\u307e\u3059\u3002\u53d6\u308a\u51fa\u3057\u305f\u3082\u306e\u306e\u7d44\u7e54\u691c\u67fb\u3082\u884c\u3063\u3066\u3082\u3089\u3044\u3001\u60aa\u6027\u3067\u306f\u306a\u3044\u3053\u3068\u3082\u78ba\u8a8d\u3055\u308c\u307e\u3057\u305f\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u305d\u308c\u3067\u7d42\u308f\u308a\u3068\u601d\u3063\u3066\u3044\u305f\u3089\u3001\u5f8c\u3067\u4fdd\u967a\u4f1a\u793e\u304b\u3089Explanation of Benefit\uff08EOB\uff09\u304c\u6765\u307e\u3057\u305f\u3002\u6765\u305f\u3068\u3053\u308d\u307e\u3067\u306f\u3044\u3044\u306e\u3067\u3059\u304c\u3001\u3088\u304f\u898b\u3066\u307f\u305f\u3089\u305d\u306e\u51e6\u7f6e\u306e\u5168\u984d\u304cAmount Not Allowed\uff08\u5065\u5eb7\u4fdd\u967a\u3067\u30ab\u30d0\u30fc\u3055\u308c\u305f\u306a\u3044\u91d1\u984d\uff09\u3060\u3068\u3057\u3066\u8868\u793a\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u305f\u304f\u3055\u3093\u9805\u76ee\u304c\u3042\u308a\u307e\u3059\u304c\u3001\u5168\u984d\u5408\u8a08\u3059\u308b\u3068$3,800\u307b\u3069\u3002HMO\u3060\u3057\u3001PCP\u306eReferral\u3092\u3082\u3089\u3044\u3001Approval\u3092\u78ba\u8a8d\u3057\u305f\u3046\u3048\u3067\u51e6\u7f6e\u3092\u53d7\u3051\u3066\u3044\u308b\u306e\u3067\u3001\u3053\u308c\u306f\u4f55\u304b\u306e\u9593\u9055\u3044\u3060\u3068\u601d\u3044\u3001\u3059\u3050\u4fdd\u967a\u4f1a\u793e\uff08Health Net\uff09\u306b\u9023\u7d61\u3057\u305f\u3068\u3053\u308d\u4e0b\u8a18\u306e\u3088\u3046\u306a\u30e1\u30fc\u30eb\u304c\u6765\u307e\u3057\u305f\u3002<\/p>\n<p>&nbsp;<\/p>\n<p><em>Thank you for your inquiry. The claim you refer to has been processed and denied by Health Net, as it is the financial responsibility of your Participating Physician Group (PPG). Please be advised the claims have been to forwarded to your Participating Physician Group (PPG), for processing.<\/em><\/p>\n<p><em>\u8a33\uff1a\u3000\u304a\u554f\u3044\u5408\u308f\u305b\u3042\u308a\u304c\u3068\u3046\u3054\u3056\u3044\u307e\u3059\u3002\u3054\u8cea\u554f\u306e\u533b\u7642\u8cbb\u7533\u8acb\u306fHealth Net\uff08\u4fdd\u967a\u4f1a\u793e\uff09\u306f\u652f\u6255\u3044\u3092\u62d2\u5426\u3057\u307e\u3057\u305f\u3002\u306a\u305c\u306a\u3089\u533b\u7642\u8cbb\u8ca0\u62c5\u8cac\u4efb\u306f\u3042\u306a\u305f\u306eParticipating Physician Group(PPG)\u306b\u3042\u308b\u304b\u3089\u3067\u3059\u3002\u7533\u8acb\u51e6\u7406\u306f\u3042\u306a\u305f\u306ePPG\u306b\u79fb\u3055\u308c\u307e\u3057\u305f\u3002<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>\u3053\u306ePPG\u3068\u3044\u3046\u306e\u306f\u3001Medical Group\u3068\u547c\u3070\u308c\u305f\u308a\u3001Independent Physicians Association\u306a\u3069\u3068\u547c\u3070\u308c\u305f\u308a\u3059\u308b\u3088\u3046\u3067\u3059\u304c\u3001\u8981\u306f\u4fdd\u967a\u4f1a\u793e\u3068\u5951\u7d04\u3057\u3066\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u63d0\u4f9b\u3059\u308b\u533b\u7642\u56e3\u4f53\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u4e0a\u306e\u30e1\u30c3\u30bb\u30fc\u30b8\u306e\u610f\u5473\u3059\u308b\u3068\u3053\u308d\u306f\u3001\u4fdd\u967a\u4f1a\u793e\u306f\u3053\u306e\u533b\u7642\u63aa\u7f6e\u306b\u3064\u3044\u3066\u533b\u7642\u8cbb\u8ca0\u62c5\u3092\u76f4\u63a5\u884c\u3044\u307e\u305b\u3093\u304c\u3001\u4fdd\u967a\u4f1a\u793e\u3068\u5951\u7d04\u95a2\u4fc2\u306b\u3042\u308bPPG\u304c\u3053\u306e\u533b\u7642\u63aa\u7f6e\u3092Approve\u3057\u533b\u7642\u51e6\u7f6e\u306e\u63d0\u4f9b\u3092\u884c\u3044\u3001\u305d\u306e\u3046\u3048\u533b\u7642\u8cbb\u3092\u8ca0\u62c5\u3059\u308b\u8cac\u4efb\u304c\u3042\u308a\u307e\u3059\u30fb\u30fb\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u305d\u308c\u306a\u3089\u4fdd\u967a\u4f1a\u793e\u306f\u79c1\u305f\u3061\u306b\u6700\u521d\u304b\u3089\u8aa4\u89e3\u3092\u62db\u304f\u3088\u3046\u306aEOB\u306a\u3069\u9001\u3063\u3066\u3053\u306a\u3051\u308c\u3070\u3044\u3044\u3068\u601d\u3046\u306e\u3067\u3059\u304c\u3001\u3069\u3046\u3044\u3046\u308f\u3051\u304b\u624b\u5143\u306b\u5c4a\u3044\u305f\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002EOB\u306f\u5358\u306b\u4fdd\u967a\u88dc\u511f\u306e\u8aac\u660e\u66f8\u3067\u3042\u308a\u3001\u8acb\u6c42\u66f8\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u3068\u306b\u3082\u304b\u304f\u306b\u3082\u3001\u305d\u306e\u5f8c\u3001\u79c1\u305f\u3061\u306e\u3068\u3053\u308d\u306b\u306f\u3069\u3053\u304b\u3089\u3082\u8acb\u6c42\u66f8\u306f\u9001\u3089\u308c\u3066\u3053\u305a\u3001\u533b\u7642\u8cbb\u8ca0\u62c5\u306fCopay\u306e$20\u3060\u3051\u3067\u3057\u305f\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>HMO\u3067\u306a\u304b\u3063\u305f\u3089\u30fb\u30fb\u30fb<\/h2>\n<p>\u3053\u306e\u7d4c\u9a13\u3092\u901a\u3057\u3066\u3001HMO\u306e\u533b\u7642\u4fdd\u967a\u3092\u6301\u3063\u3066\u3044\u3066\u3088\u304b\u3063\u305f\u3068\u518d\u78ba\u8a8d\u3057\u307e\u3057\u305f\u3002\u3082\u3061\u308d\u3093\u3053\u308c\u306f\u3069\u306a\u305f\u306b\u3067\u3082\u5f53\u3066\u306f\u307e\u308b\u30b1\u30fc\u30b9\u3067\u306f\u306a\u304f\u3066\u3001\u305d\u308c\u305e\u308c\u306e\u3054\u5bb6\u5ead\u3067\u6700\u9069\u306a\u533b\u7642\u4fdd\u967a\u306f\u7570\u306a\u308a\u307e\u3059\u304b\u3089\u3001\u79c1\u305f\u3061\u306e\u8003\u3048\u3092\u62bc\u3057\u4ed8\u3051\u308b\u3082\u306e\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u305f\u3060\u3001\u5df7\u306b\u3088\u304f\u51fa\u56de\u3063\u3066\u3044\u308b\u60c5\u5831\u3067\u306f\u3001HMO\u306f\u30d5\u30ec\u30ad\u30b7\u30d3\u30ea\u30c6\u30a3\u304c\u306a\u3044\u306e\u3067\u3042\u307e\u308a\u3088\u304f\u306a\u3044\u30fb\u30fbPPO\u306e\u307b\u3046\u304c\u4f7f\u3044\u52dd\u624b\u304c\u826f\u3044\u30fb\u30fb\u3068\u3057\u3066\u3001\u4fdd\u967a\u306e\u4e00\u9762\u6027\u3060\u3051\u304c\u5f37\u8abf\u3055\u308c\u3066\u3044\u308b\u6c17\u304c\u3057\u3066\u3044\u307e\u3059\u3002\u53cd\u9762\u3067HMO\u304c\u63d0\u4f9b\u3059\u308b\u6d88\u8cbb\u8005\u4fdd\u8b77\u306e\u3057\u304f\u307f\u306b\u306f\u3042\u307e\u308a\u7126\u70b9\u304c\u3042\u305f\u3063\u3066\u3044\u307e\u305b\u3093\u3002\u3053\u3053\u3067\u306f\u305d\u306e\u90e8\u5206\u3092\u6398\u308a\u4e0b\u3052\u3066\u307f\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u3082\u3057\u3001\u6211\u304c\u5bb6\u306e\u533b\u7642\u4fdd\u967a\u304cPPO\u3067\u3042\u3063\u305f\u5834\u5408\u3001\u3068\u3082\u3059\u308b\u3068\u4eca\u56de\u306e\u30b1\u30fc\u30b9\u306f\u4fd7\u306b\u547c\u3070\u308c\u308b\u201dSurprise bill\u201d\uff08\u3073\u3063\u304f\u308a\u8acb\u6c42\uff09\u306b\u884c\u304d\u3064\u304f\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002Consumer Reports National Research Center\u8abf\u3079\u306b\u3088\u308b\u3001\u6700\u8fd12\u5e74\u9593\u306e\u9593\u306b\u3001\u30a2\u30e1\u30ea\u30ab\u306b\u4f4f\u3080\u4eba\u306e\u4e09\u5206\u306e\u4e00\u8fd1\u304f\u304c\u3001\u5065\u5eb7\u4fdd\u967a\u304c\u601d\u3063\u305f\u3088\u3046\u306b\u30ab\u30d0\u30fc\u3057\u306a\u304b\u3063\u305f\u305f\u3081\u306b\u5f8c\u3067Surprise bill\u3092\u53d7\u3051\u53d6\u3063\u305f\u3053\u3068\u304c\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>Surprise bill\u306f\u3001\u4fdd\u967a\u3067\u30ab\u30d0\u30fc\u3055\u308c\u308b\u3068\u601d\u3063\u305f\u533b\u7642\u51e6\u7f6e\u304c\u5b9f\u306f\u30ab\u30d0\u30fc\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\u3068\u3044\u3046\u3053\u3068\u304b\u3089\u8d77\u3053\u308b\u3082\u306e\u3067\u3059\u3002\u305f\u3068\u3048\u3070\u3001\u5185\u79d1\u533b\u306b\u7d39\u4ecb\u3055\u308c\u305f\u306e\u3067\u5f53\u7136\u4fdd\u967a\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3060\u3068\u601d\u3063\u305f\u5c02\u9580\u533b\u304c\u5b9f\u306f\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u3060\u3063\u305f\u3068\u304b\u3001\u624b\u8853\u306b\u304b\u304b\u308f\u308b\u533b\u5e2b\u3084\u30c6\u30af\u30cb\u30b7\u30e3\u30f3\u304c\u6570\u591a\u304f\u3044\u3066\u3001\u305f\u3068\u3048\u3070\u305d\u306e\u3046\u3061\u9ebb\u9154\u79d1\u533b\u304c\u4fdd\u967a\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3067\u306a\u304b\u3063\u305f\u3068\u304b\u3001\u624b\u8853\u306b\u304b\u304b\u308f\u308b\u69d8\u3005\u306a\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u306e\u3046\u3061\u3001\u305f\u3068\u3048\u3070\u7d44\u7e54\u691c\u67fb\u306e\u30b5\u30fc\u30d3\u30b9\u3060\u3051\u306f\u4fdd\u967a\u306e\u9069\u7528\u5916\u3060\u3063\u305f\u3002\u3002\u306a\u3069\u69d8\u3005\u306a\u30b1\u30fc\u30b9\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306a\u554f\u984c\u306b\u3088\u3063\u3066Surprise bill\u304c\u767a\u751f\u3057\u306a\u3044\u3088\u3046\u306b\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u81ea\u5206\u306e\u4fdd\u967a\u30dd\u30ea\u30b7\u30fc\u3092\u3088\u304f\u77e5\u308a\u3001\u533b\u7642\u63aa\u7f6e\u3092\u53d7\u3051\u308b\u524d\u306b\u5fc5\u305a\u305d\u306e\u5185\u5bb9\u3068\u4fdd\u967a\u306e\u30ab\u30d0\u30fc\u306b\u3064\u3044\u3066\u30c1\u30a7\u30c3\u30af\u3059\u308b\u3053\u3068\u304c\u5fc5\u8981\u306b\u306a\u308a\u307e\u3059\u3002\u5177\u4f53\u7684\u306b\u306f\u3001\u4e0b\u8a18\u306e\u3088\u3046\u306a\u70b9\u306b\u3064\u3044\u3066\u3067\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>\u5c02\u9580\u533b\u306a\u3069\u306b\u304b\u304b\u308b\u5834\u5408\u306b\u306f\u7279\u306b\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u306e\u533b\u5e2b\u3067\u3042\u308b\u3053\u3068\u3092\u4e8b\u524d\u306b\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3002\u3044\u3064\u3082\u884c\u3063\u3066\u3044\u308b\u5185\u79d1\u533b\u306bRefer(\u7d39\u4ecb)\u3055\u308c\u305f\u304b\u3089\u3068\u3044\u3063\u3066\u3001\u305d\u306e\u5c02\u9580\u533b\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3060\u3068\u52dd\u624b\u306b\u6c7a\u3081\u3064\u3051\u306a\u3044\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u624b\u8853\u3092\u53d7\u3051\u308b\u969b\u306f\u3001\u5916\u79d1\u533b\u3001\u9ebb\u9154\u79d1\u533b\u3001Lab\u30ef\u30fc\u30af\u3092\u3059\u308b\u30c6\u30af\u30cb\u30b7\u30e3\u30f3\u3001\u7d44\u7e54\u691c\u67fb\u306a\u3069\u3092\u3059\u308b\u75c5\u7406\u5b66\u533b\u306a\u3069\u3059\u3079\u3066\u306e\u5de5\u7a0b\u306b\u95a2\u308f\u308b\u95a2\u4fc2\u8005\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u7d39\u4ecb\u3055\u308c\u305f\u5c02\u9580\u533b\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u3067\u3042\u3063\u305f\u3089\u3001\u540c\u3058\u5c02\u9580\u306e\u533b\u5e2b\u3092\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u306b\u898b\u3064\u3051\u308b\u3053\u3068\u3002<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>MRI\u3001PET\u3001CT\u306a\u3069\u306e\u30c6\u30b9\u30c8\u3084\u305d\u306e\u4ed6\u306e\u8a3a\u65ad\u30c6\u30b9\u30c8\u306fPre-authorization\u304c\u5fc5\u8981\u306a\u5834\u5408\u304c\u307b\u3068\u3093\u3069\u306a\u306e\u3067\u3001\u5165\u624b\u3057\u8a3c\u62e0\u3068\u3057\u3066\u4fdd\u7ba1\u3057\u3066\u304a\u304f\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u533b\u7642\u63aa\u7f6e\u3092\u53d7\u3051\u308b\u3068\u304d\u306b\u306f\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u304b\u3069\u3046\u304b\u306e\u78ba\u8a8d\u3001\u5fc5\u8981\u306a\u533b\u7642\u63aa\u7f6e\u306e\u8a73\u7d30\u3001\u4fdd\u967a\u3067\u306e\u30ab\u30d0\u30fc\u984d\u3001Pre-authorization\u306a\u3069\u306e\u8a18\u9332\u3092\u304d\u3061\u3093\u3068\u63a7\u3048\u3066\u304a\u304f\u3002\u8acb\u6c42\u66f8\u304c\u304d\u305f\u3089\u3001\u305d\u308c\u3068\u7167\u5408\u3057\u3001\u4e0d\u5408\u7406\u306a\u3068\u3053\u308d\u304c\u3042\u308c\u3070\u78ba\u8a8d\u3059\u308b\u304c\u3001\u305d\u306e\u5834\u5408\u3082\u3001\u4fdd\u967a\u4f1a\u793e\u3001\u75c5\u9662\u3001\u30af\u30ea\u30cb\u30c3\u30af\u306a\u3069\u3044\u3064\u8ab0\u3068\u3069\u3093\u306a\u8a71\u3092\u3057\u305f\u304b\u306b\u3064\u3044\u3066\u8a18\u9332\u3092\u3068\u3063\u3066\u304a\u304f\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>PPO\u3084EPO\u3067\u306f\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u306e\u533b\u5e2b\u3078\u76f4\u63a5\u53d7\u8a3a\u3059\u308b\u3053\u3068\u304c\u53ef\u80fd\u3067\u3042\u308b\u304c\u3001\u305d\u306e\u5834\u5408\u306f\u3001\u533b\u7642\u63aa\u7f6e\u304c\u3044\u304f\u3089\u3067\u3042\u308a\u3001\u305d\u306e\u3046\u3061\u306e\u3044\u304f\u3089\u3092\u81ea\u5df1\u8ca0\u62c5\u3059\u308b\u3053\u3068\u306b\u306a\u308b\u306e\u304b\u3001\u3042\u304b\u3089\u3058\u3081\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u3082\u3057\u3082Surprise bill\u304c\u6765\u305f\u3089\u3001\u660e\u7d30\u66f8\u3092\u30ea\u30af\u30a8\u30b9\u30c8\u3057\u3001\u9593\u9055\u3063\u305f\u8acb\u6c42\u304c\u306a\u3044\u304b\u3092\u30c1\u30a7\u30c3\u30af\u3059\u308b\u3002\u9593\u9055\u3044\u306f\u9ad8\u3044\u78ba\u7387\u3067\u767a\u751f\u3057\u3066\u3044\u308b\u306e\u3067\u3001\u53d7\u3051\u3066\u3044\u306a\u3044\u533b\u7642\u63aa\u7f6e\u304c\u5165\u3063\u3066\u3044\u306a\u3044\u304b\u3001\u30b3\u30fc\u30c7\u30a3\u30f3\u30b0\u306e\u30a8\u30e9\u30fc\u306a\u3069\u3067\u9593\u9055\u3063\u305f\u63aa\u7f6e\u306b\u3059\u308a\u66ff\u308f\u3063\u3066\u3044\u306a\u3044\u304b\u306a\u3069\u3092\u8a73\u3057\u304f\u30c1\u30a7\u30c3\u30af\u3059\u308b\u3053\u3068\u3002\u305d\u306e\u3046\u3048\u3067\u3001\u9593\u9055\u3063\u305f\u9805\u76ee\u3092\u6b63\u3057\u3001\u4e0d\u9069\u6b63\u306a\u4fa1\u683c\u3092\u4fee\u6b63\u3059\u308b\u51e6\u7f6e\u3092\u30ea\u30af\u30a8\u30b9\u30c8\u3059\u308b\u3053\u3068\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u533b\u7642\u8cbb\u306e\u8acb\u6c42\u66f8\u306f\u305c\u3063\u305f\u3044\u306b\u307b\u304a\u3063\u3066\u304a\u304b\u306a\u3044\u3053\u3068\u3002\u4e0d\u53ef\u89e3\u3060\u306a\u3068\u601d\u3063\u305f\u3089\u3059\u3050\u306b\u9023\u7d61\u3057\u3066\u78ba\u8a8d\u3059\u308b\u3053\u3068\u3002\u533b\u7642\u8cbb\u306e\u8acb\u6c42\u306f\u307b\u304a\u3063\u3066\u304a\u304f\u3068\u601d\u3063\u305f\u3088\u308a\u3082\u65e9\u304fCollection Agency\u306b\u56de\u308b\u3053\u3068\u3082\u3042\u308a\u3001\u3053\u308c\u306f\u6975\u529b\u3055\u3051\u305f\u3044\u3068\u3053\u308d\u3002<\/li>\n<\/ul>\n<ul>\n<li>\u4eba\u306e\u3044\u3046\u3053\u3068\u3092\u9d5c\u5451\u307f\u306b\u3057\u306a\u3044\u3053\u3068\u3002\u533b\u8005\u306f\u4fdd\u967a\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u306b\u5165\u3063\u305f\u308a\u5916\u308c\u305f\u308a\u3001\u3064\u306d\u306b\u5909\u5316\u304c\u3042\u308b\u3002\u533b\u8005\u81ea\u4fe1\u306f\u4fdd\u967a\u306e\u8acb\u6c42\u306b\u3064\u3044\u3066\u7121\u77e5\u306a\u3053\u3068\u3082\u3042\u308a\u3001\u8acb\u6c42\u4e8b\u52d9\u3092\u3084\u3063\u3066\u3044\u308b\u4eba\u3082\u3001\u3042\u307e\u308a\u306b\u591a\u304f\u306e\u4fdd\u967a\u4f1a\u793e\u306e\u3042\u307e\u308a\u306b\u591a\u304f\u306e\u4fdd\u967a\u30d7\u30e9\u30f3\u3092\u6271\u3063\u3066\u304a\u308a\u3001\u3059\u3079\u3066\u3092\u628a\u63e1\u3057\u3066\u3044\u308b\u308f\u3051\u3067\u306f\u306a\u3044\u3002\u8ab0\u304b\u8a33\u304c\u5206\u304b\u308b\u4eba\u304c\u89e3\u6c7a\u3057\u3066\u304f\u308c\u308b\u3068\u601d\u308f\u305a\u3001\u81ea\u5206\u306e\u533b\u7642\u3068\u4fdd\u967a\u306e\u3053\u3068\u306f\u81ea\u5206\u304c\u826f\u304f\u628a\u63e1\u3057\u3066\u3001\u76f8\u624b\u306e\u9593\u9055\u3044\u3092\u6b63\u3059\u3053\u3068\u304c\u3067\u304d\u308b\u304f\u3089\u3044\u306e\u60c5\u5831\u3092\u305d\u308d\u3048\u3066\u304a\u304f\u3053\u3068\u3002<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>\u3053\u308c\u306b\u76ee\u3092\u901a\u3059\u3060\u3051\u3067\u3001\u533b\u7642\u77e5\u8b58\u3082\u5c11\u306a\u304f\u3001\u75c5\u9662\u306e\u3057\u304f\u307f\u3082\u3088\u304f\u308f\u304b\u3089\u306a\u3044\u500b\u4eba\u304c\u3001\u3053\u308c\u3092\u5168\u90e8\u3084\u308b\u3053\u3068\u306e\u5927\u5909\u3055\u304c\u4f1d\u308f\u3063\u3066\u304d\u307e\u3059\u306d\u3002\u5177\u5408\u304c\u60aa\u3044\u306e\u3067\u533b\u8005\u306b\u304b\u304b\u308b\u306e\u306b\u3001\u3053\u3093\u306a\u3053\u3068\u3092\u5fc3\u914d\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3068\u306f\u4f59\u8a08\u306b\u5177\u5408\u304c\u60aa\u304f\u306a\u308a\u305d\u3046\u3067\u3059\u3002\u3053\u308c\u3089\u306e\u554f\u984c\u306f\u3001HMO\u3067\u306f\u5168\u90e8\u89e3\u6c7a\u3055\u308c\u308b\u308f\u3051\u3067\u306f\u306a\u3044\u3082\u306e\u306e\u3001\u968f\u5206\u3068\u8ca0\u62c5\u304c\u8efd\u304f\u306a\u308a\u307e\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<h2>HMO\u306e\u5229\u70b9<\/h2>\n<p>HMO\u3068\u4e00\u8a00\u306b\u884c\u3063\u3066\u3082\u3001\u3044\u304f\u3064\u304b\u306e\u30bf\u30a4\u30d7\u304c\u3042\u308a\u3001Kaiser\u306e\u3088\u3046\u306b\u3001HMO\u4fdd\u967a\u4f1a\u793e\u3068\u75c5\u9662\u30fb\u533b\u7642\u30b9\u30bf\u30c3\u30d5\u304c\u4e00\u4f53\u306b\u306a\u3063\u3066\u3044\u308b\uff08HMO\u304c\u533b\u8005\u3092\u96c7\u3063\u3066\u3044\u308b\uff09\u30bf\u30a4\u30d7\u3084\u3001HMO\u3092\u63d0\u4f9b\u3057\u3066\u3044\u308b\u4fdd\u967a\u4f1a\u793e\u304c\u533b\u5e2b\u30b0\u30eb\u30fc\u30d7\uff08Participating Physicians Group\u3068\u304bMedical Group\u3068\u547c\u3070\u308c\u308b\uff09\u3068\u5951\u7d04\u3057\u3001HMO\u306f\u4e00\u5b9a\u5951\u7d04\u984d\u3092Group\u306b\u652f\u6255\u3044\u3001Group\u304cHMO\u5951\u7d04\u306b\u57fa\u3065\u3044\u305f\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u63d0\u4f9b\u3057\u3001\u533b\u5e2b\u3078\u306e\u652f\u6255\u3044\u306fGroup\u5185\u3067\u884c\u308f\u308c\u308b\u30bf\u30a4\u30d7\u306a\u3069\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u57fa\u672c\u7684\u306aHMO\u306e\u3057\u304f\u307f\u306f\u3001Primary Care Physician(PCP)\u3068\u547c\u3070\u308c\u308b\u5185\u79d1\u533b\u30fb\u5bb6\u5ead\u533b\u306a\u3069\u3092\u9078\u629e\u3059\u308b\u3053\u3068\u3001\u5b9a\u671f\u5065\u8a3a\u306f\u3082\u3061\u308d\u3093\u3001\u5c02\u9580\u533b\u3092\u5fc5\u8981\u3068\u3059\u308b\u3088\u3046\u306a\u75c5\u72b6\u3067\u3042\u3063\u3066\u3082\u3001\u307e\u305a\u306f\u5fc5\u305a\u3053\u306ePCP\u306b\u30b3\u30f3\u30bf\u30af\u30c8\u3057\u3001PCP\u304c\u5fc5\u8981\u306b\u5fdc\u3058\u7279\u6b8a\u30c6\u30b9\u30c8\u3084\u5c02\u9580\u533b\u3078\u7d39\u4ecb\u72b6\uff08Referral\uff09\u3092\u3060\u3057\u3001\u305d\u308c\u306b\u5f93\u3063\u3066\u5c02\u9580\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u308b\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002HMO\u306f\u6cd5\u5f8b\u306b\u3088\u3063\u3066\u3001\u88ab\u4fdd\u967a\u8005\u304c\u5fc5\u8981\u3068\u3059\u308b\u3068\u304d\u5fc5\u8981\u306a\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u3089\u308c\u308b\u3088\u3046\u306b\u30b5\u30fc\u30d3\u30b9\u306eavailability, accessibility, quality\u3092\u78ba\u4fdd\u3059\u308b\u3053\u3068\u3092\u7fa9\u52d9\u4ed8\u3051\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u4e00\u90e8\u3067\u306f\u3001HMO\u3060\u3068\u5c02\u9580\u533b\u306b\u307f\u3066\u3082\u3089\u3044\u306b\u304f\u3044\u306a\u3069\u3068\u3044\u3046\u8aa4\u89e3\u3082\u3042\u308b\u3088\u3046\u3067\u3059\u304c\u3001\u3068\u304f\u306b\u8457\u540d\u306a\u5fc3\u81d3\u5916\u79d1\u533b\u306b\u624b\u8853\u3057\u3066\u3082\u3089\u3044\u305f\u3044\u3068\u304b\u3001\u7279\u6b8a\u306a\u7d4c\u6b74\u306e\u5c02\u9580\u533b\u306b\u3069\u3046\u3057\u3066\u3082\u307f\u3066\u3082\u3089\u3044\u305f\u3044\u3068\u3044\u3046\u7279\u5225\u306a\u30b1\u30fc\u30b9\u3067\u306a\u3044\u9650\u308a\u3001\u5341\u5206\u306a\u5c02\u9580\u6027\u3092\u5099\u3048\u305f\u5c02\u9580\u533b\u304c\u78ba\u4fdd\u3055\u308c\u3066\u3044\u308b\u306f\u305a\u3067\u3059\u3002\u307e\u305f\u3001\u6551\u6025\u306e\u3068\u304d\u3001\u65c5\u884c\u4e2d\u3067\u7dca\u6025\u6027\u306e\u9ad8\u3044\u3068\u304d\u306f\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u3067\u533b\u7642\u63aa\u7f6e\u3092\u53d7\u3051\u3066\u3082\u30ab\u30d0\u30fc\u3055\u308c\u308b\u3053\u3068\u306b\u306a\u3063\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>PPO\u3084EPO\u304c\u767b\u5834\u3057\u305f\u5f8c\u3067\u306f\u3001\u3053\u308c\u3089\u306e\u30dd\u30ea\u30b7\u30fc\u304cPCP\u3092\u901a\u3055\u306a\u304f\u3068\u3082\u5c02\u9580\u533b\u306b\u76f4\u63a5\u4f1a\u3048\u308b\u3068\u3044\u3046\u5229\u70b9\u304cPR\u3055\u308c\u3001\u4e00\u65b9\u3067\u305d\u308c\u304c\u8a31\u3055\u308c\u306a\u3044HMO\u306f\u30d5\u30ec\u30ad\u30b7\u30d3\u30ea\u30c6\u30a3\u304c\u4f4e\u304f\u4f7f\u3044\u52dd\u624b\u304c\u60aa\u3044\u306a\u3069\u3001HMO\u306e\u6b20\u70b9\u3092\u3068\u308a\u3042\u3052\u305f\u8a18\u4e8b\u304c\u591a\u304f\u306a\u308a\u307e\u3057\u305f\u3002\u305f\u3060\u3001\u7269\u4e8b\u306f\u3001\u3044\u3064\u3082\u767d\u9ed2\u306f\u3063\u304d\u308a\u3057\u3066\u3044\u308b\u3053\u3068\u3070\u304b\u308a\u3067\u306f\u306a\u304f\u3001\u9577\u6240\u3070\u304b\u308a\u306e\u3082\u306e\u3082\u306a\u3051\u308c\u3070\u77ed\u6240\u3070\u304b\u308a\u306e\u3082\u306e\u3082\u306a\u3044\u306e\u304c\u666e\u901a\u3067\u3059\u3002\u30b9\u30d4\u30fc\u30c9\u306e\u901f\u3044\u4eba\u3068\u3044\u3046\u306e\u306f\u3001\u3088\u304f\u8a00\u3048\u3070\u3066\u304d\u3071\u304d\u5c4b\u3001\u60aa\u304f\u8a00\u3048\u3070\u77ed\u6c17\u3068\u3044\u3046\u3088\u3046\u306b\u3001\u4e00\u3064\u306e\u7279\u5fb4\u304c\u3088\u304f\u51fa\u308c\u3070\u9577\u6240\u3001\u60aa\u304f\u51fa\u308c\u3070\u77ed\u6240\u3068\u3044\u3046\u306e\u304c\u4e16\u306e\u5b9f\u969b\u3067\u3059\u3002HMO\u3082\u3057\u304b\u308a\u3067\u3001\u4e00\u3064\u4e00\u3064\u306e\u7279\u5fb4\u306f\u77ed\u6240\u306b\u3082\u306a\u308a\u9577\u6240\u306b\u3082\u306a\u308a\u307e\u3059\u3002\u307e\u3068\u3081\u308b\u3068\u3053\u3093\u306a\u611f\u3058\u3002<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>HMO\u306e\u5834\u5408<\/strong><\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"319\">\u77ed\u6240<\/td>\n<td width=\"319\">\u9577\u6240<\/td>\n<\/tr>\n<tr>\n<td width=\"319\">PCP\u3092\u9078\u629e\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u308b\u3068\u304d\u306b\u306f\u5fc5\u305aPCP\u3092\u901a\u3057\u3066Refer\u3057\u3066\u3082\u3089\u308f\u306d\u3070\u306a\u3089\u306a\u3044\u3002<\/td>\n<td width=\"319\">PCP\u306f\u60a3\u8005\u306e\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u30fb\u30b3\u30fc\u30c7\u30a3\u30cd\u30fc\u30bf\u30fc\u3067\u3042\u308a\u3001\u9069\u5207\u306a\u5c02\u9580\u533b\u3092\u898b\u3064\u3051\u308b\u3053\u3068\u3001\u305d\u306e\u5c02\u9580\u533b\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3057\u3001Referral\u51e6\u7406\u3092\u3059\u308b\u3068\u3068\u3082\u306b\u3001\u5fc5\u8981\u306aPre-authorization\u3092\u53d6\u5f97\u3059\u308b\u307e\u3067\u304c\u3059\u3079\u3066PCP\u306e\u8cac\u4efb\u3067\u3042\u308a\u3001\u60a3\u8005\u306e\u8cac\u4efb\u3067\u306f\u306a\u3044\u3002<\/td>\n<\/tr>\n<tr>\n<td width=\"319\">\u30a8\u30de\u30fc\u30b8\u30a7\u30f3\u30b7\u30fc\u3084\u65c5\u884c\u4e2d\u306e\u5834\u5408\u306a\u3069\u306e\u7279\u5225\u306a\u30b1\u30fc\u30b9\u3092\u9664\u3044\u3066\u3001\u57fa\u672c\u7684\u306b\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u306e\u307f\u306e\u5229\u7528\u3068\u306a\u308a\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u306e\u30b5\u30fc\u30d3\u30b9\u306f\u4fdd\u967a\u306e\u5bfe\u8c61\u5916\u3068\u306a\u308b\u3002<\/td>\n<td width=\"319\">PCP\u3092\u901a\u3057\u3066\u3001PCP\u304c\u30a2\u30ec\u30f3\u30b8\u3057\u3066\u304f\u308c\u305f\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u308b\u9650\u308a\u3001\u6570\u5341\u30c9\u30eb\uff08\u8a3a\u5bdf\uff09\uff5e\u6570\u767e\u30c9\u30eb\uff08\u624b\u8853\u3084\u5165\u9662\uff09\u306eCo-pay\u3060\u3051\u306e\u81ea\u5df1\u8ca0\u62c5\u3067\u3001\u305d\u308c\u4ee5\u4e0a\u306e\u8acb\u6c42\u66f8\u3092\u53d7\u3051\u53d6\u308b\u3053\u3068\u306f\u57fa\u672c\u7684\u306b\u306a\u3044\u3002<em>*\u3000\u6700\u8fd1\u3067\u306f\u3001\u3068\u304f\u306b\u4f4e\u30b3\u30b9\u30c8HMO\u3092\u4e2d\u5fc3\u306b\u3001\u5165\u9662\u306a\u3069\u306e\u5834\u5408\u306b\u306fCo-insurance\u7684\u306a\u8ca0\u62c5\uff05\u3092\u8a2d\u5b9a\u3057\u3066\u3044\u308b\u3082\u306e\u3082\u3042\u308a\u307e\u3059\u3002\u3067\u304d\u308c\u3070\u5b9a\u984dCopay\u306e\u3082\u306e\u3092\u9078\u3076\u307b\u3046\u304c\u5b89\u5fc3\u3067\u3059\u3002<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>HMO\u306fHealth Management Organization\u306e\u7565\u3067\u3042\u308a\u3001\u3053\u306eManagement\u304c\u5b9f\u306f\u5927\u304d\u306a\u30ad\u30fc\u30ef\u30fc\u30c9\u3067\u3059\u3002HMO\u306f\u60a3\u8005\u306eHealth Issue\u3084Service\u3092Manage\u3057\u3066\u304f\u308c\u308b\u533b\u7642\u7d44\u7e54\u3060\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002Manage\u3055\u308c\u308b\u306e\u3067\u60a3\u8005\u306e\u30b5\u30a4\u30c9\u304b\u3089\u3059\u308b\u3068\u5c02\u9580\u533b\u306e\u9078\u629e\u306a\u3069\u306b\u304a\u3044\u3066\u5b8c\u5168\u306a\u308b\u81ea\u7531\u306f\u306a\u3044\u3082\u306e\u306e\u3001Management\u306fPCP\u304c\u5f15\u304d\u53d7\u3051\u3066\u304f\u308c\u308b\u306e\u3067\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u306e\u30b5\u30fc\u30d3\u30b9\u3092\u601d\u3044\u304c\u3051\u306a\u304f\u4f7f\u3063\u3066\u3057\u307e\u3063\u305f\u308a\u3001\u4fdd\u967a\u306e\u5bfe\u8c61\u5916\u306e\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u3066\u3057\u307e\u3063\u305f\u308a\u3001Pre-authorization\u304c\u5fc5\u8981\u3060\u3068\u77e5\u3089\u305a\u306b\u691c\u67fb\u3092\u3046\u3051\u3066\u3057\u307e\u3063\u305f\u308a\u3057\u3066\u3001\u3042\u3068\u3067\u6cd5\u5916\u306a\u8acb\u6c42\u304c\u304f\u308b\u3053\u3068\u304b\u3089\u306f\u4e00\u5207\u89e3\u653e\u3055\u308c\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u57fa\u672c\u7684\u306b\u3044\u3064\u3082\u5b9a\u984d\u306eCo-pay\u3060\u3051\u304c\u81ea\u5df1\u8ca0\u62c5\u3067\u3001\u305d\u308c\u4ee5\u5916\u306b\u533b\u7642\u8cbb\u304c\u304b\u304b\u308b\u3053\u3068\u306f\u307b\u307c\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>\u4e0a\u306e\u8868\u306e\u30df\u30e9\u30fc\u30a4\u30e1\u30fc\u30b8\u3068\u3067\u3082\u3044\u3044\u307e\u3057\u3087\u3046\u304b\u3001\u77ed\u6240\u3068\u9577\u6240\u3092\u9006\u306b\u3057\u305f\u3082\u306e\u304cPPO\u3084EPO\u306a\u3069\u306e\u4fdd\u967a\u3067\u3059\u3002<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>PPO\u306a\u3069\u306e\u5834\u5408<\/strong><\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"319\">\u77ed\u6240<\/td>\n<td width=\"319\">\u9577\u6240<\/td>\n<\/tr>\n<tr>\n<td width=\"319\">\u60a3\u8005\u81ea\u8eab\u304c\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u306e\u9078\u629e\u3084\u30b3\u30fc\u30c7\u30a3\u30cd\u30fc\u30c8\u306b\u81ea\u4e3b\u7684\u306b\u304b\u304b\u308f\u308b\u5fc5\u8981\u304c\u3042\u308b\u3002\u9069\u5207\u306a\u5c02\u9580\u533b\u3092\u898b\u3064\u3051\u308b\u3053\u3068\u3001\u305d\u306e\u5c02\u9580\u533b\u304c\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5185\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3057\u3001\u5fc5\u8981\u306aPre-authorization\u306e\u53d6\u5f97\u3092\u3059\u308b\u306a\u3069\u3001\u533b\u7642\u30b3\u30fc\u30c7\u30a3\u30cd\u30fc\u30c8\u306b\u7a4d\u6975\u7684\u306b\u304b\u304b\u308f\u308a\u78ba\u8a8d\u3092\u3059\u308b\u8cac\u4efb\u306f\u60a3\u8005\u306b\u3042\u308b\u3002<\/td>\n<td width=\"319\">PCP\u304c\u5fc5\u8981\u306a\u3044\u5834\u5408\u304c\u591a\u304f\u3001\u60a3\u8005\u306f\u81ea\u7531\u306b\u5c02\u9580\u533b\u3092\u9078\u3076\u3053\u3068\u304c\u3067\u304d\u308b\u3002<\/td>\n<\/tr>\n<tr>\n<td width=\"319\">\u81ea\u5df1\u8ca0\u62c5\u7387\u304c\u9ad8\u304f\u306a\u308b\u304c\u3001\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5916\u306b\u51fa\u3067\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u308b\u81ea\u7531\u304c\u3042\u308b\u3002<\/td>\n<td 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