Can painless gastroscope be reimbursed?

The medical insurance reimbursement for painless gastroscopy is as follows:

1, if it is an outpatient painless gastroscope, then the medical insurance will not be reimbursed, but it can be paid directly with the money from the medical insurance personal account;

2. If you do painless gastroscopy during hospitalization, some expenses mainly include the operating expenses of gastroscope itself, and medical insurance can generally be reimbursed.

3. The medical expenses required for gastroscopy belong to the scope of medical insurance, and the anesthetic required for painless gastroscopy belongs to the self-funded project. Endoscopy is generally not included in the scope of medical insurance and needs to be paid at its own expense. After the examination, taking the prescription to the township health center to get the medicine can be partially reimbursed.

Medical insurance is divided into co-ordination account and personal account, in which co-ordination account can be mainly used to reimburse related medical expenses incurred in hospitalization, but out-of-pocket expenses are not reimbursed, while personal account can be used to directly pay out-of-pocket expenses, such as buying medicines at pharmacies and seeing general outpatient clinics.

The scope of reimbursement of medical insurance refers to the scope of drug management and diagnosis and treatment of basic medical insurance in order to protect the basic medical needs of the insured. The basic medical insurance stipulates the reimbursement scope of drug list, diagnosis and treatment items and medical service facilities, including urban medical insurance reimbursement, employee medical insurance reimbursement and rural medical insurance reimbursement.

The reimbursement process of medical insurance is as follows:

1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;

2. After receiving the application materials, the accepting department shall review, settle accounts and pay;

3. If the social security agency approves the application, the applicant will be reimbursed after receiving the "Social Medical Insurance Medical Expense Reimbursement Form".

legal ground

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 24 of People's Republic of China (PRC) Social Insurance Law

The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25 of People's Republic of China (PRC) Social Insurance Law

The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government. Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 of People's Republic of China (PRC) Social Insurance Law

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 of People's Republic of China (PRC) Social Insurance Law

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.

Article 30 of People's Republic of China (PRC) Social Insurance Law

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.