Under normal circumstances, the highest reimbursement rate of fracture patients can reach 70% to 80%, and the reimbursement rate is different in different regions. The rural cooperative medical insurance clinic can report a little. If the hospitalization time exceeds 3 days and the medical expenses exceed 1000 yuan, it can be reimbursed by 60%. Medical hospitalization of urban workers can only be reported, and outpatient clinics are generally not reported. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription fee is 100 yuan; The reimbursement for medical treatment in secondary hospitals is 30%, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. The typical manifestations of fracture patients are local deformation after injury, abnormal limb movement and bone friction when moving limbs. In addition, the wound has severe pain, local swelling and congestion, and dyskinesia occurs after the injury. The ultimate goal of fracture treatment is to restore the function of the injured limb to the maximum extent. The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. Medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, with large project scale and coverage, but limited compensation for major diseases or accidents. It is suggested that the insured can purchase commercial medical supplementary insurance and social security to reduce their economic losses.
The basic insurance does not pay the cost of the diagnosis and treatment project scope is as follows:
(1) service items. Special medical services such as registration fee, out-of-hospital consultation fee, medical record fee, house call fee, expedited fee for examination and treatment, surcharge for roll call operation, and self-invited special care fee;
(2) Non-disease treatment projects. Various beauty and bodybuilding projects, as well as non-functional cosmetic surgery, plastic surgery, various weight loss, weight gain and height increase projects, and various health checkups;
(3) Diagnostic equipment and medical materials. Large-scale medical equipment for inspection and treatment projects, rehabilitation equipment such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS, and various self-use health care, massage, inspection, rehabilitation and treatment equipment;
(4) Treatment items. Sources of organs or tissues for various organ transplants or tissue transplants, organ or tissue transplants other than kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow transplants, auxiliary treatment items such as myopia orthopedics, qigong therapy, music therapy, healthy nutrition therapy and magnetic therapy.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.