Can cancer chemotherapy be reimbursed for medical insurance?

Whether cancer chemotherapy can be reimbursed by medical insurance, I suggest you consult the relevant policies and regulations of the local medical insurance department or social security bureau. The reimbursement ratio of tumor surgery expenses and other treatment items is not clear. The reimbursement rate of different levels of chemotherapy drugs is also different, and imported chemotherapy drugs are generally not reimbursed. Pay attention to the doctor's advice when choosing chemotherapy drugs and ask if there are alternative reimbursable drugs.

I. Reimbursement rate

First of all, we are glad that the Ministry of Health has adjusted the focus of rural medical security. What benefits the majority of patients most is that the state has included more than 20 serious diseases such as lung cancer and gastric cancer into the scope of medical insurance. The actual reimbursement rate of hospitalization expenses for seriously ill patients is not less than 70%, and the highest can reach 90%. According to the proportion of medical reimbursement, that is to say, for cancer patients within the scope of reimbursement, 65% can be reimbursed for spending 8,000 to 50,000 yuan, 80% for spending 50,000 to 80,000 yuan, and 90% for spending more than 80,000 yuan.

It is reported that in this medical insurance reform, radiotherapy, chemotherapy and analgesic drugs for tumors have been included in the scope of medical insurance. While this is gratifying, there are still many questions in the hearts of the people. For example, is the cost of tumor surgery also reimbursed? Are all radiotherapy and chemotherapy drugs for tumors within the scope of reimbursement? What are the analgesic drugs? There is no exact explanation for this medical rectification.

In tumor treatment, targeted drugs, endocrine therapy drugs, biological immunotherapy and other conventional treatments and Chinese medicine treatment items are commonly used, but the reimbursement ratio is not clear. These treatment items are an important part of comprehensive tumor treatment, and the cost is relatively expensive.

Second, the scope of reimbursement for chemotherapy

In general, chemotherapy drugs can be reimbursed by medical insurance, but the reimbursement ratio of different levels of chemotherapy drugs is different. However, it is worth noting that imported chemotherapy drugs are generally not covered by medical insurance reimbursement, so it is recommended to consult a doctor or medical insurance office before use.

In China's medical insurance special needs clinics, the cost of radiotherapy and chemotherapy for various malignant tumors has long been included in the scope of medical insurance reimbursement. This time, targeted drugs for the treatment of malignant tumors were included in the reimbursement scope for the first time in the Technical Scheme for Compensation of New Rural Cooperative Medical Fund (revised 20 16). For patients with chronic myeloid leukemia and gastrointestinal stromal tumors, imatinib capsules (tablets) (trade names: GexKe, GexWei, Xin-Wei), Nilotinib capsules (trade names: Daxene), Dashatinib tablets (trade names: Eneshu, ShixSai) and Sunitinib capsules (trade names: Solotinib) were used. In addition, rg3, a traditional Chinese medicine used in combination with chemotherapy, is now included in medical insurance.

Third, matters needing attention:

It should be noted here that imported chemotherapy drugs are not reimbursable, and each type of chemotherapy drugs does not have the nature of common diseases. When choosing chemotherapy drugs, you should follow the doctor's advice. On this premise, ask if there are any alternative drugs that can be reimbursed.

Applying for medical insurance to reimburse cancer chemotherapy expenses needs to follow certain procedures. First of all, you need to bring relevant medical documents and expense details to the local social security bureau or medical insurance office to apply for registration. In the application process, you need to provide identity certificates, medical insurance cards, hospitalization invoices, diagnosis certificates, prescriptions issued by doctors and other related documents. When applying, you must ensure the authenticity and integrity of the documents. The medical insurance department will review your application, including checking the reasonableness of your illness and expenses. Once approved, the medical insurance department will reimburse according to the prescribed proportion. It should be noted that the reimbursement ratio and application process may be different in different regions. It is recommended that you consult the relevant policies and regulations of the local medical insurance department or social security bureau to ensure the smooth application.

Legal basis:

Regulations on the handling of medical accidents:

Chapter II Prevention and Disposal of Medical Accidents

Article 9 It is strictly forbidden to alter, forge, conceal, destroy or rob medical records.