How much is the medical insurance reimbursement for accidental falls?

The amount of medical insurance reimbursement for accidental falls is as follows:

1, different hospitals have different reimbursement rates for medical insurance, with 80% employees reporting and 50% retired or unemployed;

2. Except for the self-funded part, the expenses of Class B shall be paid 10% first, and the part exceeding the deductible expenses of hospital medical insurance shall enjoy the proportion of overall payment. The proportion of medical insurance for employees is 80%, the proportion of medical insurance for residents is about 70%, and the social supplementary medical insurance for retirees under 70 years old is 50%. All reimbursement rates can only be reimbursed above the deductible line.

What is the reimbursement process for accidental falls? Details are as follows:

1. Medical insurance patients should show their ID cards and medical insurance when going through hospitalization procedures for accidental falls, and then go through hospitalization procedures and register for hospitalization to ensure that part of hospitalization expenses are included in the scope of medical insurance reimbursement. There are four main steps for reimbursement of accidental medical treatment:

(1) First, inform the insurance company in detail as soon as possible;

(2) Prepare relevant claim materials;

(3) It is the insurance company that reviews the claim data;

(4) It is the insurance company that gets the insurance money after the audit.

2. When applying for reimbursement of accidental medical insurance, the applicant for reimbursement must prepare all the application materials, and the insured must ensure that the accident must be unintentional, non-disease, sudden and foreign. In addition, this part of medical expenses must be caused by accidents, such as heatstroke, sudden death, pregnancy, food poisoning, etc., which are not covered by medical insurance, so it is impossible to reimburse the related medical expenses caused by it.

To sum up, accidental falls that require surgery and medical insurance can be reimbursed. The specific reimbursement ratio has a great relationship with the nature of the hospital and medical insurance, and you can consult the hospital.

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 30

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.