Coronary heart stents are used to treat myocardial ischemia caused by narrowing of the coronary arteries. Stents are covered by Medicare, but the reimbursement rates vary. The difference is generally reflected in the geographical differences. Reimbursement rates vary from region to region, and there are also differences between urban and rural health insurance. As for the reimbursement rate, it depends on the reimbursement program set by the medical insurance bureau in the patient's location. If it is a reimbursable domestic cardiac stent medical insurance, it is generally included in the medical insurance reimbursement scope at 50%. But imported cardiac stents, social security is not reimbursed. There is also reimbursement from the state for off-site cardiac stent surgery. The reimbursement rate is different for different levels of hospitals. County hospitals are reimbursed 40 percent, city hospitals 35 percent and provincial hospitals 30 percent.
Medical insurance reimbursement rates are as follows:
1. Hospitalization: medical insurance can reimburse hospitalization due to illness or accident, including medical service fee, medicine fee, material fee, examination fee, etc.
2. Outpatient treatment: medical insurance can reimburse outpatient treatment medical fee, including registration fee, consultation fee, examination fee, medicine fee, etc.
3. Medical checkups: Medical insurance can reimburse individuals for medical checkups at their own expense.
It is important to note that regulations may vary from region to region and policy to policy, and the specific scope and standard of reimbursement is subject to local policy.
Medical insurance reimbursement process:
1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their treatment items belong to the scope of reimbursement of medical insurance;
2, collection of reimbursement materials: collect the relevant records of treatment, drug receipts, medical cost lists and other related materials;
3, to the social security department to handle the reimbursement: submit the relevant materials to the local social security department for reimbursement;
3, to the local social security department for reimbursement.
4. Waiting for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receiving the reimbursement payment: after the audit is approved, you can receive the reimbursement payment of the medical insurance at the designated bank.
In summary, cardiac stents are reimbursed by the medical insurance, but the stents used for the operation must be domestic, if they are imported stents, then the medical insurance is not reimbursed. As for how many stents can be reimbursed, it needs to be determined according to the previous year's average salary of the city's employees about four times. The reimbursement rate is determined by the level of the hospital, because the reimbursement rate is different for different levels, and the maximum reimbursement is 50%.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in accordance with the basic medical insurance drug list, diagnostic and treatment items, standards of medical services and facilities, as well as those for emergencies and salvages, shall be paid out of 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.