Proportion of reimbursement for hemorrhoid medical insurance

Clinically, hemorrhoids are treated by surgery, and hospitalization expenses can be reimbursed through social security. Under normal circumstances, the reimbursement rate of residents' medical insurance is about 50%-60%, employees' medical insurance is about 70%-80%, and provincial medical insurance is about 90% or more. At the same time, the reimbursement ratio is directly related to the drugs and consumables used in the hospital, because some drugs and consumables are self-funded items and cannot be reimbursed by social security, but most drugs can be reimbursed by social security.

Therefore, taking the 3A hospitals as an example, the hospitalization expenses in hemorrhoids surgery are about 1 10,000 yuan, and most patients only need to pay about 2,000-3,000 yuan. During hospitalization, patients should insist on dressing change to avoid postoperative infection, otherwise the hospitalization expenses may increase.

1. What is the medical insurance reimbursement process?

1. The agent submits the reimbursement documents and other materials to the Dark Grey Insurance Fund Administration for acceptance;

2. After receiving the application materials, the accepting department shall complete the examination, settlement and payment on the same day;

3. After the Social Insurance Fund Administration has reviewed the materials and approved the application, the applicant will receive the "Social Medical Insurance Medical Expense Reimbursement Form" and be reimbursed.

Note: If the application materials are incomplete and all contents need to be corrected, the applicant shall correct the materials within 5 days from the date of receiving the Notice of Corrected Materials. If no correction is made within the time limit, the application shall be deemed to have been withdrawn.

2. What information do I need to carry for medical insurance reimbursement?

1, original ID card or social security card.

2, the original disease diagnosis certificate issued by the designated medical institutions.

3, outpatient medical records, inspection, test results report and other original medical information.

4. The original receipt of outpatient charges of medical institutions with unified finance and taxation.

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors.

6. Designated pharmacies: unified original invoices and computer-printed sales lists of tax-controlled commodities.

7. If it is an agent, you need to provide the original ID card of the agent.

3. When will the medical insurance reimbursement arrive?

According to the medical insurance regulations, if the local medical reimbursement is generally 15 working days, the medical reimbursement in different places is generally within 30 working days. As long as the hospitalization summary and expense list are submitted to the medical insurance center, the staff responsible for their business will check out and sign for approval, and they can punch in in about two weeks.

At present, the arrival time of medical insurance reimbursement usually has the following two situations. First of all, it will arrive in a short time, immediately at the time of reimbursement settlement or within a few days. As long as the insured brings all relevant materials to the designated place for reimbursement, the reimbursement fee will be paid directly in cash or remitted to the account designated at that time.

The other is a long time, usually within 1-2 weeks or even 1-3 months. If medical insurance is settled in different places, medical insurance reimbursement can be received in real time. Whether the medical insurance patients in different places in the province can directly settle the hospitalization expenses in the hospital depends on the actual credit card information of the patient's medical insurance card. In the process of handling, if there is anything unclear, you can go to the hospital medical insurance office for consultation.

legal ground

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

Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.