Is minimally invasive hemorrhoid surgery reimbursed by health insurance?

The minimally invasive hemorrhoid surgery is included in the national health insurance, can be reimbursed, the reimbursement rate may be related to the local health insurance policy. In general, if the new rural cooperative medical insurance, the reimbursement ratio is relatively low, about 60%-70%. The reimbursement rate for the Employee's Major Disease Coordination is around 80%-85%. Before reimbursement, there will be a starting line, which is usually around 800-1000 RMB, meaning that the reimbursement will be made in accordance with the previously mentioned ratio if the amount exceeds the starting line. It should be noted that some minimally invasive hemorrhoid surgery will use disposable instruments, instruments are not currently included in the national health insurance, belong to the out-of-pocket expenses.

Minimally invasive hemorrhoid surgery is a resection procedure that uses an anastomosis down to the mucosa. The anastomosis is a consumable material that needs to be paid for out of pocket. However, due to the health care reform, the price of the equipment has been adjusted, so these devices are now included in the scope of reimbursement, but the reimbursement rate will vary depending on the type of equipment.

Minimally invasive surgery for hemorrhoids, such as PPH or RPH, will be relatively expensive because of the instruments used during the surgery, which are not included in the scope of the medical insurance, and the cost may be around 4,000-5,000 yuan at your own expense.

Legal basis:

The People's Republic of China Social Insurance Law

Article 26 The standard of treatment of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.

Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.

Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third party;

(3) those that should be borne by the public ****health;

(4) those that are sought outside the country.

Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.