Take Tereza, a targeted drug for lung cancer. Without medical insurance, this drug alone can cost 6.5438+0.8 million a year! ! !
Fortunately, our country has introduced many medical insurance policies, and many cancer-specific drugs have been included in the scope of medical insurance reimbursement, which has indeed reduced a lot of economic pressure for cancer patients.
First, the premise of medical insurance reimbursement
1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.
2. The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can only be paid by the basic medical insurance fund according to regulations.
3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.
Second, the basic reimbursement process
202 1, medical insurance is implementing one card, remote reimbursement, outpatient reimbursement. On the whole, the new medical insurance regulations have formulated national unified standards in terms of hospitalization and outpatient payment, reimbursement ratio and maximum reimbursement amount, which means that all standards are based on the latest standards from 202 1.
Medical insurance card ID is mainly divided into three categories: urban employee medical insurance card, urban resident medical insurance card and rural medical insurance card.
Most areas of rural medical insurance card ID have been merged with urban residents' medical insurance cards, and the reimbursement process is similar. Take medical insurance reimbursement for urban and rural residents as an example: pay hospitalization deposit when you are hospitalized; When leaving the hospital, settle the discharge expenses at the hospitalization expense office; Put the following materials together and go to the medical insurance office set up by the hospital for on-site settlement.
The materials to be prepared are as follows:
1, the insured's medical insurance card, ID card and its copy, and a copy of the patient's local bank card (if family bank card is needed, family ID card and its copy and bank card copy are also required);
2, the total list of hospitalization expenses, all kinds of inspection reports must be attached with details, copies of hospital medical records, invoices;
3. Discharge diagnosis, discharge summary (official seal), etc.
Attention; Outpatients can also reimburse some medical insurance drugs, and generally directly set the medical insurance price. The process of employee medical insurance is similar, but the difference is that employee medical insurance needs to be registered within 24 hours before hospitalization or in a good hospital. General employees' medical insurance can be directly reimbursed, and there is no need to print expense lists and medical records. I suggest you print it out and get ready.
Third, medical insurance reimbursement for serious illness.
Serious illness medical insurance is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness. The purpose is to solve the problem of "poverty caused by illness and returning to poverty due to illness", so that most people will not fall into economic difficulties because of illness.
For cancer patients, critical illness medical insurance is the main way of reimbursement on the basis of basic medical insurance.
Conditions for reimbursement of serious illness medical insurance:
In a natural year, if the compliance medical expenses (at their own expense) exceed the per capita income of local residents in the previous year, they can be reimbursed; And the insured needs to have medical insurance for urban and rural residents and/or medical insurance for employees.
Critical illness medical insurance reimbursement process:
1. The insured will send the following materials to the medical insurance department of the local designated hospital (generally a third-class or second-class public hospital in a county or city), and fill in relevant forms for preliminary examination.
2, the designated hospitals will submit the information of the insured residents who have passed the preliminary examination to the urban medical insurance institutions for review;
3, the final audit qualified insured residents by the urban medical insurance agencies to pay serious illness reimbursement, and notify the insured.
The information required to apply for critical illness medical insurance is as follows:
1, the identity card of the insured and its copy, and the medical insurance card;
2. Summary of hospitalization expenses, copies of hospitalization medical records and invoices; 3, discharge diagnosis, discharge summary (need to build official seal).
Note: It should be noted that at present, the major illness insurance adopts step-by-step reimbursement, and the more self-funded parts, the higher the reimbursement ratio will be. There are also certain restrictions on the reimbursement period of critical illness medical insurance. Generally, it is up to two years from the date of the first diagnosis or recurrence of the tumor, but Chinese medicine treatment can enjoy five years.
Fourth, serious illness relief.
For families who are still unable to afford medical insurance for serious illness after reimbursement, they can apply to the state for serious illness relief.
The scope of application of serious illness relief is:
1, orphans and disabled children with minimum living allowance in urban and rural areas, five guarantees in rural areas, three no-workers in urban areas and government support;
2. Poor families whose actual daily basic living expenses are lower than the local minimum living standard due to illness;
3. The above-mentioned relief objects must have local hukou, participate in urban (employees and residents) medical insurance or new rural cooperative medical care, and be treated in designated medical institutions, and be reimbursed by medical insurance.
The materials required for serious illness application are:
1. Household register, ID card of the applicant, copy of rural (urban) minimum living allowance, and copy of medical records;
2. List of hospitalization medical expenses, hospitalization invoice and discharge certificate of the applicant (official seal is required);
3, medical assistance application, medical diagnosis.
Application process:
1. The applicant first takes these materials to the village (neighborhood) committee and applies under the guidance of the staff;
2, after the village (neighborhood) committee, town (county) social assistance office, District Civil Affairs Bureau investigation and audit. Eligible to issue a number of grants, do not meet the conditions of the reasons. The general subsidy ratio is 10%-50%, and the specific subsidy amount can be consulted with the local medical insurance bureau.
Five, special outpatient reimbursement
Under normal circumstances, we call the outpatient service for treating serious diseases, chronic diseases and special diseases including cancer special outpatient service. Some serious and chronic diseases do not necessarily need hospitalization, but can also be treated in outpatient clinics, so there are special outpatient clinics.
Reimbursement conditions:
The insured must have one of the special diseases listed in the local medical insurance and meet the basic diagnostic criteria.
Materials to be prepared for reimbursement:
1, social security card, the original and copy of the insured's ID card, two recent one-inch bareheaded photos, and a copy of the insured's bank card or passbook (if the family handles it for you, you need to bring your family account book and copy);
2. Check the original data and films (such as CT and nuclear magnetic resonance). ), original outpatient medical records, inpatient medical records (official seal), etc.
Application process:
1, the hospital medical insurance center asked, you can get a special outpatient application form, which will prompt the materials you need to prepare;
2. Take the above materials to the local medical insurance center and apply for special outpatient treatment under the guidance of the staff;
3. After successful application, you will get a special outpatient medical card. You can use this card to see a doctor in the future, and you can enjoy special outpatient reimbursement, which is generally 60%-90%.
Intransitive verb charity aid
In addition to the above-mentioned medical insurance reimbursement at the government level, if you are a low-income group or a person with special financial difficulties, you can also get treatment by applying for charitable donations, which reduces the financial burden of patients and prolongs their lives. Different drugs are administered in different forms. For details, please contact the relevant project office or visit the relevant website.
Seven, other medical insurance issues
1, seeing a doctor in a different place
Cancer patients often go elsewhere. 202 1, there is a new policy for medical treatment in different places, and many areas have also realized direct settlement or reimbursement of medical treatment expenses in different places.
note:
To apply for medical treatment in different places in advance, you can apply to the local social security bureau or apply online. Patients who have no time to file. You need to pay your medical expenses first. When leaving the hospital, you can bring the discharge certificate, hospitalization certificate, hospitalization expenses details, invoices, hospitalization medical records and other materials to the insured place for reimbursement.
Step 2 introduce
For patients who need referral, they need to issue a referral certificate, and according to the situation of medical treatment in different places, they will be reimbursed directly in the referral hospital with the medical insurance card. Patients who don't get the referral certificate may encounter high reimbursement starting point, low proportion or no reimbursement.
Note: Due to the different medical insurance policies in different regions, the medical insurance reimbursement process in different regions may be different. Please consult the hospital or local medical insurance office for details. You can call 1 14 (knowledgeable person) 12580 (mobile directory assistance) and 12333 (social security bureau) to get their numbers.
I hope all patients can be reimbursed for medical insurance smoothly and reduce the economic pressure!