Can the hospital threshold fee be reimbursed?

Hospital threshold fees cannot be reimbursed.

Hospital threshold fee generally refers to the deductible line of medical insurance. In social security benefits, not all expenses of hospitalization are reimbursed, and generally all three expenses are not reported. First, it is not reported outside the scope of medical insurance reimbursement. All reimbursement contents must conform to the three catalogues of basic medical insurance, including the catalogue of basic medical insurance drugs, the catalogue of diagnosis and treatment items and the standards of medical service facilities. If it is an item outside the three catalogues, it will not be reimbursed. Second, the personal burden is not reported. Some drugs or services can only be partially reimbursed, and individuals have to bear part of it. This part of the personal burden is not within the scope of reimbursement.

Medical insurance reimbursement process:

1. Under normal circumstances, when you need to be hospitalized due to illness, you can go to your designated hospital with your medical insurance card and medical records, and settle with your medical insurance card. That is, some of them are paid by themselves, and some medical insurance centers and hospitals reimburse and settle accounts;

2 from designated hospitals to secondary or tertiary hospitals, medical insurance cards can be used for settlement;

3. The patient is critically ill and hospitalized in a non-designated hospital. He should go to the municipal medical insurance center for emergency rescue disease identification within 5 days. After being identified as an emergency rescue disease, he can use the medical insurance card for settlement in the rescue hospital;

4, transferred to other places for treatment, with the consent of the hospital and medical insurance center, the referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement;

5, medical insurance reimbursement is calculated in proportion, generally ranging from 70%. The proportion and amount of reimbursement are related to factors such as self-examination, medication and medical grade;

6. At the time of reimbursement, the insured person needs to prepare relevant materials for hospitalization, such as outpatient medical records, discharge records, discharge diagnosis (disease diagnosis), hospitalization invoices (which can be reported to the outpatient department), general list of hospitalization expenses, and medical insurance statements. If the hospital has done CT, B-ultrasound, electrocardiogram and other inspections, it is also necessary to prepare relevant inspection reports;

7, discharge settlement, submit relevant information, in the medical insurance reimbursement window can be reimbursed. After approval, the reimbursement amount will generally arrive within 15 working days.

In summary, the medical expenses of the threshold fee are not reimbursed. Even if the drugs, diagnosis and treatment items and services used are within the scope of reimbursement, the expenses below the Qifubiaozhun will not be reimbursed, and only the part exceeding the Qifubiaozhun will be reimbursed according to the prescribed proportion.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.