Holding the Beijing social security card on the invoice of the designated hospital shows that the medical insurance has been settled in real time, and there is no self-payment, but I still have to pay

Holding the Beijing social security card on the invoice of the designated hospital shows that the medical insurance has been settled in real time, and there is no self-payment, but I still have to pay. Why? Mr. Chen, a Beijing reader, asked: I am insured by medical insurance for urban workers in Beijing. I recently went to the hospital for acute gastroenteritis, and even spent more than 400 yuan on medicine and injections. The words "medical insurance has been settled in real time" are written directly above and in the lower right corner of the special receipt for outpatient expenses in Beijing given to me by the hospital. At the bottom, what medicine was prescribed and how much money was paid. There is a "charge level", most of which says "not at my own expense", but I didn't pay less. Why? What should I think of this statement?

The staff of Beijing human resources and social security service hotline 12333 replied: This reader may be that the outpatient fee has not reached the deductible line this year, so although it was settled in real time, it still cannot be reimbursed. The accumulated amount within the scope of medical insurance shall be clearly marked on the special receipt for outpatient charges in Beijing (hereinafter referred to as "receipt"). As long as it exceeds the standard of working 1.800 yuan and retiring 1.300 yuan stipulated by Beijing, it can be reimbursed in real time.

At present, the receipt has increased the deductible line, self-funded and personal account balance and other related contents. The revised bill consumption details are more clear and easy to understand. The receipt is roughly divided into three parts: upper, middle and lower. The first part is the categories of expenses such as drugs, examination and treatment. The second part is related to medical insurance. The first two items in the first line are very important. "Personal cash payment" refers to how much you bear, and "medical insurance fund payment" refers to how much you can reimburse for this visit, which adds up to the total cost of your visit. If the deductible is exceeded, then the latter is not "0".

Speaking of the deductible line that everyone is most concerned about, it depends on the comparison between the "accumulated amount within the scope of medical insurance" and the deductible line. Exceeding 1.800 yuan can be reimbursed. "Amount within the scope of medical insurance" refers to the amount within the scope of medical insurance reimbursement, but it is different from the amount that can be reported this time. "Annual outpatient large-sum cumulative payment" refers to the total amount paid for you by medical insurance this year. Retired workers also have an "annual large medical expenses mutual fund balance", which refers to the amount of money that the state can reimburse this year, with an upper limit of 20,000 yuan.

In the third column, you can see "self-pay one", "self-pay two" and "self-pay", respectively. The first two drugs are in the medical insurance catalogue, while the latter can enjoy full coverage, be included in the medical insurance base in proportion and pay all. Among them, Class B, that is, "self-payment", Beijing stipulates that in addition to special Class B drugs, individuals must pay 10% of the expenses first, and the remaining 90% should be included in the medical insurance fund; Except for special provisions, 8% of personal needs for Class B treatment and examination shall be paid first, and the remaining 92% shall be included in the medical insurance fund.

The third part is a detailed description of all the items you brought, treated and examined this time. If the last marked fee level says "No Pay", it means that this is a Class A drug, that is, the drug directly included in the scope of medical insurance reimbursement, and it is fully reimbursed.

Finally, I need to remind you that if you show your medical insurance card when you see a doctor, but you just left your job and didn't renew your insurance, the words "blacklist" will be displayed above the receipt and you can't submit an expense account; The receipt is stamped with the producer seal of Beijing Financial Bills, which means it is equivalent to an invoice and can be used as a reimbursement voucher.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.