Why can't some medical insurance be reimbursed?
Many drugs can be reimbursed, and the drugs reimbursed by medical insurance are limited. Only drugs in the medical insurance catalogue can be reimbursed, but drugs outside the medical insurance catalogue cannot be reimbursed, such as many expensive imported innovative drugs and patented drugs. So communicate with the doctor before taking medicine. If you want to save money, use the medicine in the catalogue.
Medical insurance First of all, the difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level. Generally, Class A drugs can enjoy full coverage, while Class C drugs need all out-of-pocket expenses, and Class B drugs report 80% and pay 20%. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.
How to avoid the situation that drugs cannot be reimbursed?
Article 1: Seek medical treatment and purchase medicines at designated institutions. When you go to a pharmacy to buy medicine, you must find a designated medical insurance institution! Because only go to a designated hospital for medical treatment and hospitalization can be reimbursed; If you go to a non-designated medical institution, there is no way to reimburse the treatment expenses, and you can only bear it yourself. The same is true for buying medicine. Only designated pharmacies with medical insurance can swipe their medical insurance cards to buy medicines, and other pharmacies can only pay their own expenses.
Article 2: Don't transfer to another hospital without permission. If some diseases cannot be treated in designated medical institutions and need to be treated in a better hospital, you need to apply for referral first, and the referral with complete procedures can be reimbursed; If you don't apply for referral in advance, it is equivalent to going to a designated medical institution that you have no choice, which is generally not reimbursable. There is often a gap in the reimbursement ratio. Generally speaking, the higher the level of hospital treatment, the lower the reimbursement rate.
Article 3: You can only report after crossing the medical insurance deductible line. Medical insurance has a deductible line, and the part that exceeds that amount can only be reimbursed after it is paid by itself. For example, X stipulates that the outpatient deductible line is 1.800 yuan, and if the total amount of outpatient medical treatment in one year is less than 1.800 yuan, all the money must be paid by yourself; And if it exceeds 1800 yuan, it can be reimbursed. At the same time, medical insurance also has a cap line, which means that medical insurance can give you the most money, and the excess money cannot be reimbursed.
Article 4: Many drugs can be reimbursed, and the drugs reimbursed by medical insurance are limited. Only drugs in the medical insurance catalogue can be reimbursed, but drugs outside the medical insurance catalogue cannot be reimbursed, such as many imported expensive innovative drugs and patented drugs. So communicate with the doctor before taking medicine. If you want to save money, use the medicine in the catalogue.
Article 5: Some special surcharges can't be reimbursed. The most common one is the room charge for hospitalization, or it requires advanced services, such as specialists and nurses. These are not reimbursable. If you really have special needs, pay for it yourself.