How to reimburse medical insurance for serious illness in different places

In order to ensure that the medical expenses of patients in different regions can be properly compensated.

First, understand the reimbursement policies and requirements.

First of all, patients need to know the medical insurance policies for critical illness in different places in their regions and places of medical treatment, including reimbursement ratio, reimbursement scope and reimbursement limit. At the same time, it is also necessary to clarify the materials and requirements required for reimbursement, such as diagnosis certificate, medical expense invoice, medical insurance card, etc.

Second, go through the formalities of medical treatment in different places.

Before patients seek medical treatment in different places, they usually need to go to the social security agency or medical insurance department of the insured place to go through the medical treatment procedures in different places. When filing, you need to submit personal identification, medical insurance cards and other related materials, and fill out the application form for medical treatment in different places. After successful filing, patients can enjoy medical insurance for critical illness at the place where they seek medical treatment.

Third, medical treatment and expense settlement.

In the process of medical treatment in different places, patients need to choose medical institutions that meet the requirements, and keep relevant medical expense invoices and diagnosis certificates. After the medical treatment, the patient needs to take the relevant materials to the medical insurance department of the place where he goes to see the doctor to settle the expenses. At this time, the medical insurance department will conduct a preliminary review according to the policy and reimburse medical expenses.

Fourth, submit reimbursement materials.

After completing the expense settlement, the patient should submit all the materials required for reimbursement (including medical expense invoice, diagnosis certificate, medical insurance card, etc.). ) to the medical insurance department of the insured place. Ensure the authenticity and integrity of the materials when submitting, so as not to affect the reimbursement progress.

Verb (short for verb) waiting for review and receiving reimbursement.

After receiving the reimbursement materials, the medical insurance department of the insured place will conduct further audit and accounting. After approval, patients can receive reimbursement according to the prescribed procedures. The payment method can be cash payment or bank transfer, depending on local policies.

To sum up:

The process of reimbursement for serious illness medical insurance in different places includes the steps of understanding policy requirements, filing procedures, medical treatment and expense settlement, submitting reimbursement materials, waiting for review, and receiving reimbursement. When patients seek medical treatment in different places, they should know the relevant policies and procedures in advance to ensure their rights and interests are protected. At the same time, we should also pay attention to keeping relevant materials so as to provide proof during the reimbursement process.

Legal basis:

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

Article 29 provides that:

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.

Guiding opinions on further improving the settlement of medical expenses for medical treatment in different places in basic medical insurance

Clearly pointed out:

It is necessary to simplify the filing process of medical treatment in different places, optimize the settlement service of medical treatment in different places, strengthen the supervision of medical treatment in different places, and ensure that patients in different places can get medical expenses reimbursement in time.