Fortunately, many medical insurance policies have been introduced in our country, and many cancer-specific drugs have been included in the scope of medical insurance reimbursement, which has indeed alleviated a lot of economic pressure for cancer patients. The following medical insurance reimbursement strategies can be collected by friends in need.
First, the premise of medical insurance reimbursement
The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the scope of medical service facilities standards and payment standards, and can be paid by the basic medical insurance fund according to regulations.
Among the medical expenses that the insured meets the scope of basic medical insurance payment, the part that is higher than the Qifubiaozhun of social medical co-ordination fund and lower than the maximum payment limit shall be paid by social medical co-ordination fund in a unified proportion.
Second, the basic medical insurance 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 hospitalized; When leaving the hospital, settle the discharge expenses in 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 and various inspection and laboratory reports must be accompanied by detailed information, copies of hospitalization medical records and invoices:
3. Discharge diagnosis, discharge summary (official seal), etc.
Note: Outpatients can also reimburse some medical insurance drugs, and generally set the medical insurance price directly. The process of employee medical insurance is similar, but the difference is that employee medical insurance registration is required before hospitalization or within 24 hours of hospitalization. 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.
3. Reimbursement of medical insurance for serious illness (necessary for cancer patients): Medical insurance for serious illness is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness, with the purpose of solving the problem of "poverty caused by illness and returning to poverty due to illness" strongly reflected by the masses, so that most people will no longer fall into economic difficulties due to 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, medical expenses that meet the requirements (at their own expense) are greater than the per capita income of local residents in the previous year, which can be reimbursed; And the insured needs to have medical insurance for urban and rural residents and/or medical insurance for employees.
Medical insurance reimbursement process for serious illness:
1. The insured shall go to the medical insurance department of a local designated hospital (generally a third-class or second-class public hospital in a county or city) with the following materials. And fill in the relevant forms for preliminary examination.
(2) the designated hospitals will report the information of the insured residents who have passed the preliminary examination to the urban medical insurance agency for review;
3. The insured residents who pass the final examination shall be reimbursed for serious illness by the urban medical insurance agency, and the insured person shall be notified at the same time.
The information required to apply for critical illness medical insurance is as follows:
Identity card and photocopy of the insured, medical insurance card:
Summary of hospitalization expenses, copies of hospitalization medical records and invoices;
Discharge diagnosis instructions, discharge summary (with official seal), etc.
It should be noted that the major illness insurance currently adopts step reimbursement. The more out-of-pocket expenses, the higher the reimbursement ratio. 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 still can't afford medical insurance reimbursement for serious illness, they can apply to the state for serious illness relief.
The scope of application of serious illness relief is:
1. Urban and rural minimum living security objects, rural five-guarantee objects, urban three-no-people, orphans and disabled children supported by the government:
2 due to illness, the actual consumption expenditure of daily basic life is lower than the local minimum living standard for poor families:
3. The above-mentioned recipients must have local accounts, 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. Applications for medical assistance and medical diagnosis.
Application process:
1 applicants first take these materials to the village (neighborhood) Committee and apply 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 for the payment of relief funds, do not meet the conditions to indicate 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
Usually, we call the outpatient fever of diagnosing and 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 photocopy of the insured's ID card, two recent one-inch bareheaded photos, and a copy of the insured's bank card or passbook (the household registration book and a copy of the household registration book that the family handles for you);
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. When the hospital medical insurance center asks, you can get a special outpatient application form, which will prompt the materials that need to be prepared;
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 ID. 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
Seek medical treatment in different places
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.
It should be noted that if you apply for medical treatment in different places in advance, you can apply to the local social security bureau or apply online. Patients who haven't had time to file a case need to pay their own medical expenses first, and then take the discharge certificate, hospitalization certificate, hospitalization expenses details, invoices, hospitalization medical records and other materials to the insured place for reimbursement when they leave the hospital.
Transfer the patient to another medical institution for treatment.
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.