The hospitalization reimbursement process of social medical insurance and commercial medical insurance

At present, people's insurance awareness has improved. Many people have participated in social medical insurance, and at the same time, many people buy commercial medical insurance as a supplement to medical insurance. However, no matter what kind of insurance, people should apply for reimbursement according to the hospitalization reimbursement process when they have medical expenses. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: how to use social security medical insurance? 1. Teach you how to apply for reimbursement!

Social medical insurance hospitalization reimbursement process

Social medical insurance is an insurance that compensates medical expenses when the insured is sick. When the insured falls ill, the medical expenses incurred need to be compensated according to the hospitalization reimbursement process. At this time, the patient should prepare relevant materials, including: the original hospitalization invoice, the summary list of medical expenses (not a one-day list), the discharge summary, the certificate of hospital charge level, and the patient's own medical insurance manual. The summary table of medical expenses must be truthfully listed. List, discharge summary and proof of hospitalization expenses grade must have the official seal of the hospital.

1. When a patient is hospitalized or discharged, he/she needs to go to the medical insurance management window of a designated hospital with a medical insurance card to register for admission and discharge.

At the time of hospitalization, patients should pay 2000 yuan in advance for medical expenses, and when they leave the hospital, they will refund more and make up less. Before going through the hospitalization registration formalities, the medical expenses incurred are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the patient should go through the hospitalization formalities at the medical insurance management window with the emergency certificate on the second day after hospitalization, and other overdue medical expenses shall be borne by the patient himself.

2, the insured after hospitalization as a whole fund deductible is divided into three files:

Level III Hospital 1000 Yuan, Level II Hospital 600 yuan, Level I Hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3. If the insured person needs referral due to illness, he/she shall put forward a referral (hospitalization) opinion after being diagnosed by the deputy chief physician or chief physician of the designated hospital (level 3 or above), and the unit to which he/she belongs shall fill in the application form, and go through the referral (hospitalization) formalities after being approved by the medical insurance management department of the designated medical institution. The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When leaving the hospital, the designated medical institution will calculate the reimbursement amount and the amount that the individual should pay according to the relevant policies. The amount of reimbursement shall be settled by designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by designated medical institutions and insured persons.

Commercial medical insurance hospitalization reimbursement process

Commercial medical insurance, under normal circumstances, will produce claims, commercial medical insurance claims will be reimbursed. The hospitalization reimbursement process roughly includes five steps: 1. Report the case in time. The insured shall promptly report the accident to the insurance company. Because the insurance company reported the case after the time specified by the insurance company, the insurance company has reason to refuse to pay compensation. 2. Claim acceptance. The beneficiary shall submit the claim materials according to the terms or requirements agreed in the agreement, and the insurance company shall accept the claim if it meets the acceptance requirements. 3. Claim review. Professional claims adjusters of insurance companies review cases and make claims decisions. If the reimbursement of commercial medical insurance is approved by the insurance company, the insured can get compensation within a few working days. The materials to be prepared for reimbursement of medical insurance for commercial hospitalization are: 1. A copy of the identity certificate of the insured; 2. A copy of the medical record shall be stamped with the seal of the hospital (the original ID card of the injured person shall be copied to the medical department of the hospital); 3. The original receipt of medical expenses and the original details of hospitalization medical expenses; 4. Original medical manuals, prescriptions, lists and laboratory tests; 5. Discharge summary (provided and stamped by the hospital); 6. If there is social security reimbursement, a social security reimbursement list shall be provided. Which insurance company is stronger? I just sorted out the relevant content, hoping to help you: the latest list! Top Ten Insurance Companies in China

Understand the hospitalization reimbursement process, and the insured can prepare relevant materials and apply for medical expenses when he is hospitalized. Thereby alleviating certain economic pressure.