How to reimburse medical insurance for chemotherapy

The process of applying for reimbursement of major medical insurance for chemotherapy is as follows:

1. The patient needs to issue an itemized bill of chemotherapy expenses at the hospital and ensure that the expenses on the itemized bill are real and effective. Then, patients need to prepare the relevant application materials, including ID cards, medical insurance cards, hospitalization invoices, cost detail list, etc..

2. Patients need to go to the local social security bureau or medical insurance center to apply for reimbursement of major medical insurance, submit relevant materials and fill in the application form.

3, after review, eligible patients can get the appropriate amount of reimbursement.

Chemotherapy costs can be reimbursed by the medical insurance, but not all of them.

1, if the tumor patients participated in the employee health insurance, then only a certain percentage of after-the-fact compensation reimbursement. The maximum annual payment limit of urban workers' medical insurance is 500,000 yuan; if the tumor patients participate in the New Agricultural Cooperative, then the reimbursement rate is usually 80%.

2. If the tumor patients go to other places for medical treatment, the reimbursement rate is smaller, such as the New Agricultural Cooperative, 80% of the reimbursement for local medical treatment, and 30% of the reimbursement for medical treatment in other places. There may be some cities where the reimbursement rate for off-site medical treatment is even lower.

3, in China's health insurance special outpatient, all kinds of malignant tumor radiotherapy costs have long been included in the health insurance reimbursement scope.

The process of applying for reimbursement of major medical insurance for chemotherapy is as follows:

1. The patient needs to issue an itemized list of chemotherapy costs in the hospital and ensure that the costs on the list are real and effective. Then, patients need to prepare the relevant application materials, including ID cards, medical insurance cards, hospitalization invoices, expense detail list, etc..

2. Patients need to go to the local social security bureau or medical insurance center to apply for reimbursement of major medical insurance, submit relevant materials and fill in the application form.

3, after the audit, eligible patients can get the appropriate amount of reimbursement.

In summary: the scope of medical insurance reimbursement is somewhat limited, only in the designated medical institutions for treatment and designated pharmacies to purchase drugs can be reimbursed. For the purchase of drugs, not all drugs can be reimbursed, especially imported drugs, as well as drugs needed for major diseases, many of which are not reimbursed.

Legal basis:

The Law of the People's Republic of China on Social Insurance

Article 26

The standard of treatment of basic medical insurance for employees, new rural cooperative medical insurance and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.

Article 30

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health;

(4) those that seek medical treatment outside of China.

Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.