How to apply for social security reimbursement in discharge procedures?

The reimbursement procedures for discharged medical insurance are as follows:

1. The insured pays medical expenses in advance: after being discharged from the hospital, the insured needs to settle accounts at the settlement window of the hospital first, that is, the insured needs to pay medical expenses himself first. If you have basic medical insurance, you can generally reimburse and settle directly at the settlement window of the hospital;

2. Submit reimbursement materials to the insurance company: submit prepared reimbursement materials to the insurance company, such as outpatient medical records, discharge records, discharge diagnosis (disease diagnosis), hospitalization invoices (outpatient invoices can be provided), total hospitalization expenses list, medical insurance statement, CT/ ultrasound/electrocardiogram and other related inspection reports;

3. Review: The insurance company reviews the reimbursement materials submitted by the insured and confirms the reimbursement plan. For example, the reimbursement of medical expenses can only be reimbursed after deducting the medical expenses and deductibles that have been reimbursed by basic medical insurance or other medical insurance. For example, a medical insurance can be reimbursed 100% with social security and 80% without social security;

4. Reporting: the auditor of the insurance company reports the audit results and plans, and the special person signs for approval;

5. Reimbursement: The insurance company will notify the insured to receive the reimbursement, but it can generally be credited to the bank account designated by the insured;

6. Closing the case: After the claim is settled, the case is closed.

It should be noted that if you can't directly reimburse the basic medical insurance at the hospital's settlement window, you must go to the local medical insurance institution for reimbursement. Pay attention to ask the medical insurance institution to provide a copy of the invoice, and affix the seal of the medical insurance institution on the copy. If the invoice is received at the hospital settlement window and reimbursed by the medical insurance institution, then the hospital needs to provide a copy of the stamped invoice and print the medical insurance settlement form. After all, if there is no invoice for medical expenses, then commercial medical insurance cannot be reimbursed.

legal ground

Article 28 of the Social Insurance Law (revised 20 18) shall be paid by the basic medical insurance fund in accordance with the provisions of the state if it meets the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses.

"Social Insurance Law (20 18 Revision)" Article 29 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.