Can postpartum repair be reported to medical insurance?

Postpartum repair cannot be reported to medical insurance.

The cost of postpartum repair is generated after the baby comes home, and it is not a part of the funds that must be spent when giving birth, so these expenses are not reimbursed by the state. If the postpartum nursing fee is generated in the hospital, it can be reimbursed if it is taken out of the hospital account.

The medical insurance reimbursement process is as follows:

1. Under normal circumstances, when you need to be hospitalized due to illness, you can go to your designated hospital with your medical insurance card and medical records, and settle with your medical insurance card. That is, some of them are paid by themselves, and some medical insurance centers and hospitals reimburse and settle accounts;

2 from designated hospitals to secondary or tertiary hospitals, medical insurance cards can be used for settlement;

3. The patient is critically ill and hospitalized in a non-designated hospital. He should go to the municipal medical insurance center for emergency rescue disease identification within 5 days. After being identified as an emergency rescue disease, he can use the medical insurance card for settlement in the rescue hospital;

4, transferred to other places for treatment, with the consent of the hospital and medical insurance center, the referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement;

5, medical insurance reimbursement is calculated in proportion, generally ranging from 70%. The proportion and amount of reimbursement are related to factors such as self-examination, medication and medical grade;

6. At the time of reimbursement, the insured person needs to prepare relevant materials for hospitalization, such as outpatient medical records, discharge records, discharge diagnosis (disease diagnosis), hospitalization invoices (which can be reported to the outpatient department), general list of hospitalization expenses, and medical insurance statements. If the hospital has done CT, B-ultrasound, electrocardiogram and other inspections, it is also necessary to prepare relevant inspection reports;

7, discharge settlement, submit relevant information, in the medical insurance reimbursement window can be reimbursed. After approval, the reimbursement amount will generally arrive within 15 working days.

The post-natal social security reimbursement process for employees is as follows:

1. Within 18 months after an employee gives birth or has an operation, the employer shall apply to the social insurance agency for maternity insurance benefits. When applying, you should fill in the Application Form for Maternity Allowance for Employees and provide the following information:

(1) birth certificate issued by the family planning administrative department;

(2) Original materials such as reproductive medical certificate, outpatient medical records, discharge summary, and family planning operation records;

(3) the baby's birth certificate.

2. The social insurance agency shall, within 15 working days from the date of accepting the application, review the information provided by the employer. After the review is completed, the maternity insurance premium will be allocated to the employer where the employee is located, and the employer will distribute it to the employee according to the maternity insurance treatment items and standards stipulated in these Measures;

3. It should be noted that if the employer fails to handle maternity insurance for employees according to the regulations, the maternity insurance expenses incurred by employees shall be paid by the employer in accordance with the maternity insurance treatment items and standards stipulated in these Measures;

4. The materials required for reimbursement are:

(1) medical expense declaration form;

(2) my ID card or social medical security card;

(3) I have a bank card with UnionPay logo;

(4) My medical record book and so on.

To sum up, at present, China's medical insurance system has not been included in the postpartum repair project, so in most cases, postpartum repair cannot be reimbursed through medical insurance. Moreover, some hospitals usually need to pay extra even if they carry out postpartum repair projects. Therefore, pregnant women need to fully understand and consider their own economic situation when carrying out postpartum repair.

Legal basis:

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

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 54

The employer has paid maternity insurance, and its employees enjoy maternity insurance benefits; Unemployed spouses of employees enjoy maternity medical expenses in accordance with state regulations. The required funds are paid from the maternity insurance fund. Maternity insurance benefits include maternity medical expenses and maternity allowance.