petct for positron emission computed tomography imaging of the English abbreviation, is an examination program, generally can be used to screen for cancer, the cost is relatively high, the whole body of the petct examination cost tens of thousands. It is understood that at present petct has not been included in the scope of medical insurance reimbursement, the cost of this examination needs to be borne by the individual, the medical insurance will not be reimbursed. Because of the petct examination before the injection of a developer, some hospitals can reimburse this part of the cost.
Medicare reimbursement process:
1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their own treatment items belong to the scope of reimbursement of medical insurance;
2, collect reimbursement materials: collection of the relevant records of treatment, drug receipts, medical cost lists and other related materials;
3, the social security department to handle the reimbursement: submit the relevant materials to the local social security department to handle the reimbursement.
4, wait for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receive the reimbursement payment: after the audit, you can receive the medical insurance reimbursement payment at the designated bank.
Medicare reimbursement standard:
1. Reimbursement rate for residents: town health center reimbursement of 60%; secondary hospital reimbursement of 40%; tertiary hospital reimbursement of 30%;
2. For urban residents, in a billing year, the starting standard for tertiary hospitals is 659 yuan for medical expenses up to 100,000 yuan which are eligible for reimbursement; the reimbursement rate for tertiary hospitals is 50% with a ceiling of 2,000 yuan; second-level hospitals hospitalization starting standard is 300 yuan, reimbursement rate of 55%; first-level hospitals do not set a starting standard, reimbursement rate of 60%;
3, foreign reimbursement, reimbursement needs to go back to the old place of insurance, reimbursement rate of 35-65%, depending on the level of the hospital and the proportion of different.
Summary of the above, petct medical insurance generally can not reimbursement. petct is not included in the scope of medical insurance, most of the reimbursement is not available, this test can check out the patient appeared to be benign or malignant tumors, you can observe the effect of the tumor after treatment.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical services and facilities, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.