How to reimburse medical insurance for gastroscopy

Gastroscope medical insurance reimbursement depends on the specific situation, and the reimbursement standards are as follows:

1. If it is commercial medical insurance, because gastroscopy actually belongs to outpatient medical expenses, if the insured only goes to outpatient for gastroscopy, then usually only outpatient and emergency insurance can be reimbursed. If the insured must have a gastroscope during hospitalization, then the corresponding medical expenses can be included in the hospitalization expenses and reimbursed by commercial medical insurance, or the insured can go to the outpatient clinic for gastroscopy before and after hospitalization, then commercial medical insurance can generally reimburse. For example, millions of medical insurance can reimburse emergency medical expenses, hospitalization medical expenses, special outpatient medical expenses and outpatient surgery medical expenses before and after hospitalization;

2. If it is basic medical insurance, if there is a gastroscope when you see a doctor in the outpatient department, then the medical expenses arising therefrom can generally be paid directly with the money in the personal account of medical insurance. If you are doing gastroscopy during hospitalization, you can use the medical insurance co-ordination account for reimbursement.

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.

What is the proportion of medical insurance reimbursement?

The proportion of medical insurance reimbursement is determined according to local policies and regulations, and there may be differences in the proportion of reimbursement in different regions. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%;

2. Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

According to the legal basis, gastroscopy during hospitalization can be reimbursed through medical insurance, and outpatient examination cannot be reimbursed, but it can be paid by social security card. In addition, before gastroscopy, you should not eat or drink, especially porridge, milk tea and other liquids with particles or colors, because food or colored liquids will affect the lens of gastroscope, and food residues will stick to the surface of stomach wall and interfere with the inspection results. In addition, it can cause nausea during gastroscopy, and food or liquid in the stomach can easily cause vomiting.

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.