How to reimburse medical insurance for accidental falls?

The medical insurance reimbursement process for accidental falls is:

1. First of all, inform the insurance company in detail at the first time.

2. Step 2, prepare relevant claims information;

3. The third step is the insurance company to review the claim data;

4. Finally get the insurance money.

Go to the hospital medical insurance office for registration within three working days of hospitalization, issue the hospitalization application form, hospitalization invoice, detailed list and medical record in the medical insurance office when leaving the hospital, and settle the reimbursement at the hospitalization fee office.

When going through hospitalization procedures: medical insurance patients should show their ID cards and medical insurance, and then go through hospitalization procedures and registration. Only in this way can we ensure that some expenses in the hospital are included in the scope of medical insurance reimbursement.

First of all, we should inform the insurance company in detail at the first time. The second step is to prepare relevant claims information. In the third step, the insurance company reviews the claim information and finally gets the insurance money. When applying for reimbursement of accidental medical insurance, the insured must ensure that the accident must be unintentional, non-disease, sudden and foreign. In addition, this part of medical expenses must be caused by accidents, such as heatstroke, sudden death, pregnancy, food poisoning and other accidents are not in the external medical insurance coverage, so it is impossible to reimburse the related medical expenses caused by them.

First, how to reimburse medical insurance for accidental falls in social security?

1. If you fall, you will be treated in the hospital. Then you can use the new rural cooperative medical system for reimbursement, because it is within the scope of reimbursement.

2. This policy has increased the reimbursement rate of outpatient and inpatient expenses within the scope of the new rural cooperative medical system to about 50% and 75% respectively. As long as they meet the requirements, they can be reimbursed, but the higher the hospital level, the lower the reimbursement ratio. Everyone can choose according to their own situation and illness, and can't delay treatment for more reimbursement.

3. These situations are not within the reimbursement scope of the new rural cooperative medical system. Medical expenses for traffic accidents or work-related injuries due to personal reasons will not be reimbursed. Medical insurance does not reimburse medical expenses caused by drunk driving, drug abuse and theft. Medical insurance does not reimburse medical expenses caused by abortion or abortion for personal reasons.

You can report two or four kinds of accidental injuries.

According to the "Measures", the medical expenses of accidental injuries incurred by the insured due to the following circumstances can be included in the reimbursement scope of social medical insurance:

(1) Accidental injury of the insured without liability;

(2) Accidental injury that the insured bears part of the responsibility as determined by the relevant departments;

(3) In a criminal or public security case in which the insured was injured due to another person's illegal act, after the judgment or ruling of the people's court, the responsible person failed to make full compensation, or the case was not solved within six months from the date of the injury, and the responsible person could not be determined;

(four) after the judgment or ruling of the people's court, the responsible person fails to make full compensation.

legal ground

Social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.