Strictly speaking, laser surgery is not therapeutic surgery, but corrective surgery, so it is not covered by medical insurance reimbursement. The main reimbursement scope of medical insurance includes medical treatment, medication, hospitalization and surgery to treat diseases. The non-reimbursement scope of medical insurance includes registration fee, medical record fee, home visit fee, various beauty and bodybuilding projects, orthopedic surgery, various weight loss and weight gain projects, etc.
The scope of diagnosis and treatment items for which the basic insurance does not pay.
(1) service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects;
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
To sum up: the classification of medical insurance reimbursement is very fine, and when many drugs are reimbursed, it is necessary to check what diseases the patients have, that is, whether they are within the scope of indications. The same medicine, used in one disease, is within the scope of reimbursement, while used in another disease, may be self-funded medicine. Therefore, if the doctor thinks that the patient really needs to use a certain drug, but the drug is at his own expense, he will discuss it with the patient, and if the patient agrees, he will sign an agreement at his own expense.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
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. 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.