How to deal with special diseases in outpatient department?

The treatment of outpatient special diseases needs to follow certain procedures and regulations to ensure that patients can get reasonable and effective medical security.

First, understand the outpatient special disease policy

First of all, patients or their families need to know the relevant policies of outpatient special diseases, including which diseases belong to outpatient special diseases, application conditions, handling procedures and so on. This information can be obtained by consulting the local social security bureau, medical insurance center or medical institution.

Second, prepare the application materials

When applying for outpatient special diseases, patients need to prepare relevant application materials. Usually includes:

1. Identity certificate: valid documents such as the patient's ID card or household registration book;

2. Medical diagnosis certificate: a medical certificate issued by a medical institution that is clearly diagnosed as an outpatient special disease;

3. Social security card or medical insurance card: used to handle medical insurance related procedures;

4. Other relevant materials: According to local policy requirements, other relevant supporting materials may be needed.

Third, submit an application.

After the patient or family members prepare the application materials, they need to submit the application to the local social security bureau, medical insurance center or designated medical institutions. When submitting an application, you need to fill in the relevant application form and attach all necessary application materials.

Four. Review and appraisal

The social security bureau, medical insurance center or medical institution will review the application materials of patients, including the authenticity and validity of the diagnosis certificate. After examination and approval, the patient will be identified as a special disease outpatient and included in the corresponding medical security scope.

Five, enjoy the treatment of special diseases

After patients are identified as outpatients with special diseases, they can enjoy corresponding special disease treatment, including preferential outpatient treatment fees and increased reimbursement ratio. At the same time, patients also need to abide by the relevant medical insurance regulations to ensure the rationality and standardization of medical behavior.

To sum up:

Outpatient special diseases need to understand relevant policies, prepare application materials, submit applications and review them, and finally enjoy special disease treatment. In the whole process, patients and their families need to cooperate patiently to ensure the smooth application process.

Legal basis:

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

Article 23 provides that:

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.

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

Article 30 provides that:

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.