How to report the medical insurance for tooth extraction reimbursement

The medical insurance reimbursement process for tooth extraction is as follows:

1, to determine whether the cost of tooth extraction is within the scope of medical insurance reimbursement; If it is within the scope, social security can be reimbursed;

2. Understand the proportion of local medical insurance reimbursement and the cost of tooth extraction treatment, so as to calculate the amount of reimbursement;

3. If tooth extraction is involved in hospital, it shall be reimbursed according to the proportion of hospitalization reimbursement of medical insurance;

4. wisdom tooth extraction belongs to the scope of medical insurance reimbursement, and the reimbursement ratio of different groups is different, such as 50% of on-the-job employees and 75-80% of retired employees;

5. When reimbursing, you need to bring the medical insurance manual to the designated hospital and ensure that there are treatment details, otherwise it will not be reimbursed.

Reimbursement scope of medical insurance:

1. Reimbursement items of basic medical insurance: including outpatient treatment, hospitalization, medical expenses, diagnosis and treatment items, etc.

2. Reimbursement of medical insurance for special diseases: reimbursement of medical expenses for major diseases or special diseases;

3. Medical insurance reimbursement for work-related injuries: covering the treatment expenses caused by work-related injuries;

4. Reimbursement of maternity medical insurance: involving pregnancy check-up, delivery, family planning operation and other expenses;

5. Chronic disease outpatient medical insurance reimbursement: chronic disease outpatient treatment reimbursement;

6. Reimbursement of Medicaid: a subsidy for medical expenses of people with financial difficulties.

To sum up, the process of medical insurance reimbursement for tooth extraction includes determining the scope of expenses, understanding the reimbursement ratio and expenses, reimbursing tooth extraction in hospital in proportion, and reimbursing different groups of people in different proportions, and bringing medical insurance manuals and treatment details to designated hospitals for reimbursement.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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.