What is the meaning of outpatient co-ordination and how to reimburse it?

Medical insurance outpatient co-ordination refers to a kind of medical insurance treatment that the medical expenses of general outpatient service, outpatient prescribed diseases and outpatient surgical diseases that meet the scope of medical insurance payment are reimbursed by the outpatient co-ordination fund according to a certain proportion.

The overall reimbursement procedure is as follows:

1, the insured person must show his citizen card to swipe his card, and the outpatient department must inform the hospital of the type of treatment. The medical insurance fund will not pay the medical expenses incurred by the insured employees when they seek medical treatment for those who fail to show their cards or the type of treatment is unclear;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category, according to the relevant requirements of the credit card to buy drugs, because of special circumstances by others to buy drugs, must show the insured and the purchaser's ID card, and registered by the pharmacy;

3. Outpatient medical expenses such as drugs, laboratory tests, laboratory sheets and consumables incurred by the insured of employee medical insurance during outpatient treatment. Within the scope of the medical insurance reimbursement policy in a natural year, if the accumulated expenses of the deductible standard of tertiary hospitals are within 300 yuan, they will be reimbursed at the rate of 60%.

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.

To sum up, the proportion of medical insurance reimbursement in different regions is different. Urban and rural residents living in different places for a long time, urban and rural residents over 60 years of age and women over 55 years of age, urban and rural residents working in different places and their accompanying children have registered for medical treatment in different places. The deductible standards for hospitalization in the registered places are 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan respectively, and the reimbursement ratio is implemented by local designated hospitals.

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.