How to reimburse medical insurance for hospitalization for surgery?

Medical insurance reimbursement for hospitalization surgery usually needs to follow certain procedures and regulations to ensure that patients can enjoy the medical security they deserve.

First, preparation before hospitalization

Before preparing for hospitalization for surgery, patients should ensure that they have participated in medical insurance and understand the medical insurance policies they have participated in. At the same time, patients also need to prepare personal identification, medical insurance cards and other necessary documents in order to successfully apply for medical insurance registration when they are hospitalized.

Two, medical insurance registration and payment

Patients should go to the hospital medical insurance office for medical insurance registration as soon as possible after admission. In the process of registration, patients need to show their personal identification and medical insurance card, and fill in the relevant medical insurance application form. After completing the registration, patients need to pay a certain hospitalization deposit or prepaid expenses according to the requirements of the hospital.

Third, the surgical expenses reimbursement

Surgical expenses are an important part of hospitalization expenses. For patients who participate in medical insurance, the cost of surgery can be partially or completely reimbursed through medical insurance. After the operation is completed, the hospital will calculate the amount to be reimbursed according to the patient's medical insurance type and surgical items, and include it in the patient's medical insurance settlement list.

Four, medical insurance settlement and reimbursement collection

When the patient leaves the hospital, he should go to the medical insurance settlement window of the hospital to settle the expenses. In the settlement process, the hospital will deduct part of the reimbursed expenses according to the patient's medical insurance settlement list, and the patient only needs to pay the remaining unreimbued expenses. For some of the expenses that have been reimbursed, the hospital will directly settle with the medical insurance department, and the patient does not need to do any additional surgery.

In addition, for some special surgical items or high-value consumables, there may be restrictions on medical insurance payment or a high proportion of out-of-pocket payment. In this case, patients need to know the relevant policies in advance and make economic preparations.

To sum up:

Medical insurance reimbursement for inpatient surgery requires patients to be prepared before hospitalization, understand medical insurance policies and prepare relevant documents. During hospitalization, patients should register for medical insurance in time and pay the expenses to ensure that the operation expenses can be partially or completely reimbursed. When leaving the hospital, patients need to go to the medical insurance settlement window to settle expenses and receive reimbursement. At the same time, patients should also pay attention to the payment limit of medical insurance and the self-payment ratio of special surgical items or high-value consumables.

Legal basis:

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

Article 27 provides that:

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

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

Article 28 provides that:

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.

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

Article 29 provides that:

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.