Peninsula reporter Wang Chunyan.
Recently, some residents are concerned about the difference in reimbursement ratio between private hospitals designated by medical insurance and public hospitalsThe reporter learned from the interview that according to the medical insurance policy, as long as the medical treatment is in the designated medical institution of the medical insurance, the reimbursement ratio is only related to the category of the insured (employees, residents, in-service, retirement, etc.), the level of the medical institution and other factors, and has nothing to do with the public and private attributes of the medical institution. Therefore, as long as she is seeking medical treatment in a medical institution designated by medical insurance, Ms. Zhang's reimbursement ratio is usually only related to her own insurance category and the level of medical institution she is receiving medical treatment, and the reimbursement ratio of private hospitals designated by medical insurance at the same level is the same as that of public hospitals.
Master the following knowledge points to be more relaxed when encountering medical insurance reimbursement:
Try to use the medical insurance catalogue for medical treatment and drug purchases. What expenses can be reimbursed by medical insurance, and which expenses are not reimbursed by medical insurance?This mainly depends on the medical insurance catalog, including the medical insurance drug catalog, the diagnosis and treatment project catalog and the medical service facility scope catalog, which is what we often call the "three major catalogs". The medical expenses incurred by the insured in the designated hospitals in accordance with the "three major catalogs" shall be paid by the medical insurance** in accordance with the regulations.
Filing for medical treatment in other places is the first to be filed. If the insured person needs to seek medical treatment in other places due to long-term residence or work in other places, he or she shall go through the filing of long-term residents in other places in a timely manner, and then the designated medical institutions that have opened remote medical treatment network settlement in the place of filing can directly settle the medical expenses, and enjoy the same medical insurance reimbursement ratio as that of medical treatment in this city.
If a long-term resident in another place returns to the city for medical treatment more than 6 months after the record, the medical expenses for inpatient and outpatient chronic diseases in the province shall enjoy the same medical insurance reimbursement ratio as that for medical treatment in the cityIf a long-term resident in a different place returns to the city for medical treatment less than 6 months after filing, he or she shall enjoy the same medical insurance reimbursement ratio as that of the city for medical treatment by submitting the household registration certificate, residence permit or work certificate of the place where the medical treatment is recorded. The reimbursement policy for medical expenses in other places before long-term filing and medical expenses outside the place of long-term residence after filing shall be implemented.
If the insured person needs to go to other places for medical treatment due to referral and transfer, self-medical treatment, etc., he or she should apply for the filing of temporary medical treatment across provinces in a timely manner (those who temporarily go out for medical treatment in the province do not need to be recorded). For "temporary out-of-town medical personnel" in the province, the proportion of inpatient and outpatient chronic disease medical expenses across cities and provinces is 5 percentage points lower than that of medical institutions at the same level in the city. When the insured person files for medical treatment in other places, he or she must accurately select the filing type according to his or her actual situation, so as not to affect the reimbursement treatment.
Priority is given to primary medical institutions for minor illnesses. Minor diseases such as common diseases and frequent diseases should be treated in primary medical institutions as much as possible, and the starting line of medical insurance is lower and the reimbursement ratio is higher, which is more economical and cost-effective for patients. One thing to note is that you must choose medical institutions carefully, and you can only be reimbursed if you go to a medical insurance designated medical institution.
Don't cut off your medical insurance premiums. Insured units and individuals must pay the monthly employee medical premiums on time and in full. If the employee fails to pay the employee's medical insurance premiums in full and on time in accordance with the regulations, his medical insurance benefits will be suspended from the next month after the payment is interrupted. Resident medical insurance participants should participate in the insurance and pay on time during the centralized payment period, and if they fail to pay during the centralized payment period, they need to calculate the waiting period for 3 months from the month of payment, and they cannot enjoy medical insurance benefits during the waiting period. Insured persons due to employment, study and other reasons across the overall planning of the region, to timely in accordance with the provisions of the basic medical insurance relationship transfer and continuation, to avoid the interruption of medical insurance. After the medical insurance is discontinued, you will not be able to enjoy the medical insurance benefits.
Serious and chronic diseases can be recognized for outpatient chronic diseases. The treatment of outpatient chronic diseases is higher than that of ordinary outpatient treatment, and some insured persons who suffer from serious diseases and chronic diseases need long-term outpatient treatment, after the qualification of outpatient chronic diseases is confirmed, the relevant expenses incurred in the diagnosis and treatment of corresponding diseases shall be paid according to the relevant provisions of outpatient chronic disease treatment. In our daily work, we often encounter insured people seeking medical treatment in other places, and the reimbursement amount is very low due to the wrong selection of general outpatient clinics during the settlement of outpatient chronic diseases. Due to the inconsistency of medical insurance policies in various places, it is recommended that the insured remind the hospital settlement staff that they have some kind of outpatient chronic disease qualification when settling for medical treatment in other places, so as to avoid personal economic losses caused by the wrong settlement category.