Legal analysis: Whether medical insurance can reimburse for plate removal surgery should be judged based on the reason for the injury during the surgery. If there is a third party due to a car accident or man-made injury at the time, medical insurance will not reimburse. If the injury was caused by oneself at the time and there was no other third party, medical insurance can reimburse the injury in this case. Therefore, whether medical insurance can reimburse you is mainly directly related to the cause of your first injury and surgery. Of course, if your first surgery was reimbursed, you should be able to get it reimbursed now.
Legal basis: "Regulations of the People's Republic of China and the National Basic Medical Insurance for Urban Employees" There are five categories of diagnosis and treatment items that are not covered by the basic medical insurance.
The first category is service items: some medical service fees, out-of-hospital consultation fees, medical record costs, etc.; consultation fees, expedited examination and treatment fees, roll-call surgery surcharges, roll-call surgery surcharges, high-quality and premium services Fees, self-recruitment of special nurses and other special medical services.
The second category is non-disease treatment items: see the analysis below for details.
The third category is diagnostic and treatment equipment and medical materials: examination and treatment projects using large-scale medical equipment such as positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy equipment, etc. . Glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitation equipment. Various self-use health care, massage, examination and treatment equipment. The price departments of various provinces stipulate that disposable medical materials are not charged separately.
The fourth category is the treatment item category: organ sources or tissue sources for various types of organ or tissue transplantation; other organs or tissues except kidney, heart valve, cornea, skin, blood vessel, bone, and bone marrow transplantation. Transplantation; orthopedic surgery for myopia; Qigong therapy, music therapy, health nutritional therapy, magnet therapy and other auxiliary treatment projects.
The fifth category is other categories: various scientific research and clinically verified diagnosis and treatment projects, etc.
In addition, the expenses that are not covered by basic medical insurance include: transportation fees, emergency vehicle fees; baby incubator fees, food incubator fees, nursing fees, cleaning fees, outpatient decoction fees; meals Fees and other special living service expenses, etc. Patients must pay for the above-mentioned items themselves when seeking medical treatment.
The non-disease treatment items include the following:
1. Various beauty and plastic surgery items: such as acne, scar beauty, laser beauty, cosmetic tooth cleaning, hair transplantation, etc.
2. Orthopedic treatment items: stuttering, irregular dentition, denture repair (including post crowns, crowns, and installation of dentures), dental implants, snoring surgery (except respiratory distress syndrome), flat feet, etc. (Except for congenital torticollis, cleft lip and palate, and sequelae of poliomyelitis).
3. Various bodybuilding treatment projects: such as weight loss, weight gain, height gain, etc.
4. Various health examination items: such as employee physical examination, disease census, etc.
5. Various preventive and health-care diagnosis and treatment projects: such as various vaccinations, fitness massage, etc.
6. Various medical consultations and health prediction diagnosis and treatment items: such as consultation fees for various diseases (except for psychological consultations carried out by second- and third-level mental health prevention and treatment institutions), finger pulse meters, microcirculation checkers, Meridian diagnostic instruments (including traditional Chinese medicine computer diagnostic instruments), life information diagnosis and treatment instruments, etc.
7. Various medical appraisal projects: such as labor ability appraisal (employee labor, work-related injury, occupational disease diagnosis and appraisal), judicial appraisal of mental patients, medical accident appraisal, various injury examination fees, etc.