How to reimburse chronic diseases in outpatient department

The outpatient chronic disease reimbursement process is that the patient himself applies to the social security center and fills in the formal application form; Report the diagnosis proof materials of hospitals above the second level to the social security center, and handle the chronic disease certificate calendar after being appraised and audited by the expert Committee; Patients go to the outpatient department of the designated hospital to see a doctor and buy medicine; Within the specified time, go to the social security center to reimburse the medical expenses for chronic diseases. When seeing a doctor in a designated hospital, you can show your social security card to prove your insured status and registration. Individuals don't need to pay first and then reimburse, but can be directly reimbursed by social security and hospital settlement. Only when they check out will they pay the out-of-pocket part.

The specific procedures and requirements for reimbursement of outpatient expenses for chronic diseases may vary according to different regions, hospitals and insurance companies, but the general procedures for reimbursement are as follows:

1. When you see a doctor in a hospital outpatient department, you need to ask the doctor for a complete medical record and expense list for reimbursement.

2. Prepare all kinds of required reimbursement materials, such as ID cards, social security cards, medical insurance cards, medical records, expense lists, etc.

3. Submit the reimbursement application materials to the relevant insurance institutions or medical insurance departments, fill in the relevant application forms and sign for confirmation.

4. Waiting for approval. It usually takes some time to get the approval result, which may or may not pass.

5. If approved, the reimbursement amount will be returned to the applicant's social security card or other designated account.

It should be noted that different insurance companies and medical insurance departments may have different requirements and standards for reimbursement of outpatient expenses for chronic diseases, so it is necessary to know the relevant policies and requirements in detail before applying for reimbursement. At the same time, hospitals and doctors who meet the requirements of insurance policies should be selected as far as possible when visiting outpatient clinics, so as to apply for reimbursement more conveniently.

How long is the medical insurance reimbursement period?

The time limit for medical insurance reimbursement is generally one year. Beyond this period, medical insurance reimbursement will be more difficult. Even if it can be reimbursed, the scope of reimbursement is limited. So as long as it is reimbursed within one year after discharge. Once this period has passed, the insurance will be renewed.

To sum up, outpatient reimbursement for chronic diseases and special diseases generally needs to be identified in advance, and can be reimbursed with relevant documents and invoices after being identified. The reimbursement process may be different in different regions. It is recommended to consult the local medical insurance bureau or social security center.

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.