Can emergency hospitalization be reimbursed?

The reimbursement ratio of emergency hospitalization and outpatient hospitalization is different. The emergency expenses incurred by the insured in the designated medical insurance institutions shall be included in the general outpatient department for overall settlement and reimbursement after being audited by the medical insurance management department of the designated medical institutions. However, the emergency medical expenses of designated medical institutions incurred by the insured in the general outpatient service of non-medical insurance designated institutions shall not be paid. Emergency hospitalization and hospitalization are both hospitalizations, but they are different. For example, emergency hospitalization is an act of disease injury or diagnosis and treatment at night, which belongs to outpatient service. The expenses are the same as the general outpatient service, and the scope of reimbursement also belongs to the outpatient service. Hospitalization is a way of observation and treatment in peacetime because of illness, which belongs to the scope of hospitalization reimbursement. Medical insurance policies vary from place to place. Whether or not to reimburse, and how much to reimburse, should consult the social security agency in the jurisdiction.

Medical insurance reimbursement process:

1. Before each month 10, the designated medical institutions will report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency, which will be used as the basis for monthly pre-allocation and year-end final accounts after review.

2, medical insurance agencies monthly pre dial last month's hospitalization and special disease outpatient co-ordination fees.

3. Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly accounted for and settled immediately.

Emergency settlement procedure:

1. The medical expenses incurred by the insured for emergency rescue in non-designated medical institutions and medical institutions in different places in this Municipality shall be paid in advance by individuals or units.

2, after the emergency rescue, with emergency medical records, inspection, laboratory reports, invoices, medical expenses list until the medical insurance agencies in accordance with the provisions of the reimbursement procedures.

To sum up, emergency expenses can be reimbursed in medical insurance, and the medical insurance pooling fund can pay for emergency rescue and hospitalization, and the medical expenses within 7 days before hospitalization will be observed.

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.