How is the process of reimbursement of medical insurance?

When an insured person is sick and goes to the hospital, the doctor will ask if he has medical insurance. For those who have medical insurance, the medical expenses are usually not advanced by the individual when he is hospitalized. When you are hospitalized, you need to submit your social security card or ID card to the hospital, and pay the threshold fee, which is the starting standard, according to the hospital's regulations. The threshold is determined by the level of the hospital, which is divided into four levels: township community hospitals, first-class hospitals, second-class hospitals, and third-class hospitals, with the higher the level, the higher the threshold.

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The scope of reimbursement for hospitalization expenses means that above the starting standard, after deducting the individual's first out-of-pocket expenses, the co-ordination fund pays a proportionate amount according to the hospital level. According to Chengdu's regulations, 85 percent for third-level hospitals, 90 percent for second-level hospitals, 92 percent for first-level hospitals, and 95 percent for community health service centers that have signed inpatient medical service agreements with medical insurance agencies.

According to Chengdu city's regulations, the first out-of-pocket expenses for individuals include four areas of cost expenditures. First, the use of non-surgical single price of more than 200 yuan of examination, treatment items 20% of the cost; second is the implementation of a single price of more than 1,000 yuan of surgical fees 10% of the cost; third is the use of the national and provincial provisions of the "basic medical insurance drug list" in the cost of 10% of the cost of Category B drugs; fourth is the use of special medical materials and the implementation of the integrated fund to pay part of the cost of diagnostic and treatment items should be paid by the individual The fourth is the use of special medical materials and the implementation of the coordinated fund to pay part of the cost of diagnostic and treatment items should be paid by individuals.

According to current regulations, hospitalization costs do not require the insured to pay the full cost of the hospitalization, and then go to the medical insurance department for reimbursement after being discharged from the hospital. The process of reimbursement is the same regardless of whether you are enrolled in employee health insurance or urban and rural residents' health insurance, as long as you are hospitalized in a hospital within the same coordinating area. The patient only needs to pay the threshold fee (the starting standard), the personal payment, and the medical insurance fund pays the rest of the expenses above the starting standard on a pro rata basis. All of this is settled in real time at the hospital, without the need for hospitalized patients or their families to run around.

In summary, the inpatient hospital in the discharge procedures, the hospital to the unified settlement of hospital costs, in the settlement of costs, the hospital will print a list to the inpatient or family members, which indicates the total cost of how much, which the health insurance reimbursement of how much money and other information. In the settlement of hospitalization fees, the reimbursement of the costs have been advanced by the hospital, the patient no longer need to handle the reimbursement procedures after discharge. This is to simplify the reimbursement process, eliminating the patient's family to run back and forth for reimbursement procedures is very meaningful.