How to handle medical insurance reimbursement for discharge procedures

Medical insurance reimbursement process:

1. The parties shall go to the hospital to go through the medical insurance networking formalities with valid certificates such as medical insurance card or ID card and household registration book, and go through the settlement formalities directly when they leave the hospital;

2. Or bring all relevant materials to the relevant departments of the local social security center. Those who meet the requirements after the completion of the audit can be settled immediately.

When you are hospitalized or discharged, you need to hold a personal medical insurance ic card to go to the designated medical institution's medical insurance processing window for discharge registration. When you are in hospital, you usually need to pay 2000 yuan in advance for medical expenses. If you do not go through the hospitalization registration formalities, the medical expenses incurred before will not be included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, it should be handled at the medical insurance window with the emergency certificate on the next day of hospitalization. If the hospitalization procedure exceeds the time limit, you need to bear the medical expenses yourself.

After the insured is hospitalized, the deductible line of the overall fund will be divided into three grades, namely, tertiary hospital 1 000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a medical insurance settlement year, the medical expenses for multiple hospitalizations can be calculated cumulatively.

If the insured person needs to be referred or transferred due to illness, he/she should put forward the opinion of transfer after being diagnosed by the deputy chief physician and director of the department at the designated medical institution, and should also fill in the application by his/her unit, which will be approved by the medical insurance management department of the designated medical institution. After approval, the referral or transfer formalities can be handled. General transfer is limited to specialized hospitals in the province, and the fees need to be paid in advance. The reimbursement standard is that you need to bear 10% first, and then reimburse according to the local reimbursement ratio.

Fourth, when the designated medical institutions are discharged from the hospital, the designated hospitals calculate the reimbursement amount and the part to be borne according to the relevant medical insurance policies. The amount of reimbursement is mainly settled by designated medical institutions and social insurance agencies, and individuals should settle their own amount by designated medical institutions and insured persons.

What information should be provided for hospitalization medical reimbursement?

1. ic card and ID card for medical insurance reimbursement;

2. Regular hospitalization invoices;

3. A detailed list of medical expenses stamped by the hospital;

4. Discharge or diagnosis certificate;

5. A copy of the hospital medical records stamped with the seal of the hospital;

6. Persons who need to be referred for medical treatment need to bring the Application Form for Social Insurance Referral in Different Places when reimbursing;

7. If the resettlement personnel want to reimburse the medical expenses, they also need to bring a copy of the Application Form for Resettlement Personnel with Basic Medical Insurance for Urban Employees.

Matters needing attention

When reimbursing expenses, the first invoice and the copy of medical record should show the same name and ID card; Secondly, the medical record should have a copy of the doctor's advice and serve as the basis for hospitalization diagnosis; Do not accept the third outpatient invoice.

The above is the related process of medical insurance reimbursement after discharge, and the required reimbursement materials. If you need this, you can learn and understand it further.

Legal basis:

Article 28 of the Social Insurance Law conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid by the basic medical insurance fund in accordance with state regulations. Article 29 of the Social Insurance Law, the part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.