Can the outpatient service of traditional Chinese medicine hospital be reimbursed?

Outpatient service of traditional Chinese medicine hospital can be reimbursed.

The items that can be reimbursed by medical insurance are as follows:

1. Hospitalization: Medical insurance can guarantee hospitalization caused by illness or accident, including medical service fees, medicine fees, materials fees, examination fees, etc.

2. Outpatient treatment: Medical insurance can reimburse medical expenses for outpatient treatment, including registration fees, inspection fees, inspection fees, medicine fees, etc.

3. Physical examination: Medical insurance can reimburse medical examination expenses paid by individuals at their own expense.

It should be noted that there may be differences in different regions and policies, and the specific scope and standard of reimbursement shall be subject to local policies.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

Reimbursement standard of medical insurance for chronic diseases:

1. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The expenses of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure were further increased by 10 percentage point.

2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and shall not exceed the maximum payment limit for chronic diseases within one medical year or within the validity period;

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the two diseases identified first, and calculate the deductible for each disease separately. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

To sum up, drugs included in the scope of basic medical insurance payment are divided into Class A and Class B. Class A drugs refer to drugs that are basically unified throughout the country and can ensure the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard. Moreover, the reimbursement scope of medical service facilities in the basic medical insurance covers the life service facilities provided by designated medical institutions and necessary for the insured to receive diagnosis, treatment and nursing, mainly including inpatient bed fees or outpatient observation bed fees.

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.