ICU intensive care costs, according to the actual items needed, in the health insurance reimbursement catalog can be reimbursed by health insurance, does not belong to the scope of reimbursement, is not reimbursed.
I. ICU reimbursable items:
Cardiac monitoring fees, respiratory fees, injection fees, diagnostic fees and other items in the medical insurance reimbursement catalog. If you use imported drugs that are not in the medical insurance reimbursement catalog, you will not be reimbursed. The catalog of medical insurance has been set by the local social security bureau.
Second, the icu medical insurance reimbursement
ICU ward expenses can be reimbursed by the medical insurance, but generally only about 40% of the cost. ICU is generally used in the drug is also expensive new drugs or imported drugs, the medical insurance is not reimbursed. So the reimbursement from the medical insurance is very little, and if the patient's condition improves a bit, he can be transferred to the general ward.
Three, does not belong to the scope of medical insurance reimbursement mainly include the following four categories:
1, mainly including people in the doctor's visit to pay the registration fee, consultation fees, and the cost of cases and so on. In addition to these, it also includes consultation fees, quality premiums and a series of medical services to improve their hospitalization conditions.
2, mainly including people due to beauty or cosmetic surgery costs, but also due to weight loss or increase the height of the program and other costs. In addition, the cost of routine medical checkups also falls into the category of non-disease treatment programs, and is therefore not covered by medical insurance.
3. This includes the cost of using large-scale equipment for checkups, rehabilitation equipment and therapeutic devices.
4, including most of the organ transplantation, myopia correction and auxiliary treatment programs. As long as the costs incurred due to the above circumstances are not reimbursed.
Four, ICU medical insurance reimbursement process:
First of all, we must be in the designated hospital in order to get direct settlement, and then we follow the steps can go to the local social security office for reimbursement:
1, first of all, in the name of the insured person to write a letter of application to the social security management office of the domain to which the account belongs.
2. Bring the relevant documents, such as outpatient medical records stamped with the official seal of the hospital, test reports and so on.
3. Go to the local social security center with all the information and apply for the program.
4, as long as the audit, the information is complete and meet the conditions, then you can carry out timely processing.
What you need to know is that when applying for reimbursement of health insurance, the amount of money transferred to the health insurance personal account will be deducted first in the current social security year, and then the amount of reimbursement will be approved.
Legal basis
The People's Republic of China Social Insurance Law
Article 2: The State establishes a social insurance system for basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, and so on, and guarantees the right of citizens to obtain material assistance from the State and society according to the law in the event of old age, illness, industrial injury, unemployment, or maternity. society in cases of old age, sickness, industrial injury, unemployment and maternity, in accordance with the law.
Article 26 The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.
Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.