The cost of hospitalization examination can be reimbursed by medical insurance.
Medical insurance can generally reimburse hospitalization examination fees, but if it is a self-paid expense similar to CT, then medical insurance cannot reimburse it, and the insured must bear it. It should be noted that most medical insurances have restrictions on deductibles, limits, etc. Therefore, the deductible and the portion exceeding the limit need to be borne by the insured.
How to use medical insurance is as follows:
1. See a doctor or be hospitalized in a designated hospital. Medical expenses that are not within the scope of medical insurance reimbursement and need to be borne by individuals can be paid with the personal account of medical insurance;
2. Get vaccinated with preventive immunity class II vaccines at designated medical institutions. Medical expenses such as cervical cancer/HPV vaccine, influenza vaccine, etc. can be paid with a personal medical insurance account;
3. At designated pharmacies. When purchasing medicines, medical equipment and disinfection supplies, you can pay with your medical insurance personal account.
The scope of medical insurance reimbursement includes:
1. Medical expenses during rescue;
2. Medical expenses during hospitalization;
3. Surgery Materials and auxiliary equipment;
4. Bed fee: according to local medical insurance standards. Exceptions are made for those who need to be admitted to the ICU due to acute brain trauma or compound visceral injury, but they should be transferred to a general ward immediately after being out of danger;
5. Rehabilitation physiotherapy fees: according to local medical insurance standards. In principle, there should be no more than 3 types, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;
6. Dressing changes and rehabilitation function guidance training: determined according to local medical insurance standards and combined with the needs of the disease;
7. Ambulance fees: Calculated according to the standards approved by the local health department and price department;
8. Other expenses: Compensation will not be made for expenses that are not compensable according to regulations;
9 . Renewal medical expenses: If the insured closes the case in advance, the injured person’s future determinable and necessary continued medical expenses can be paid in advance. The doctor in charge must have a clear record on the discharge certificate or diagnosis certificate that the patient needs to continue treatment or to remove the internal fixation after half a year or one year or to have a regular review or record the cost of follow-up treatment, and at the same time, the compensation payment certificate provided by the insurance records that the payment has been made. Only after the follow-up expenses have been paid can the renewal medical expenses be reviewed. The review of continued medical expenses will be based on the needs of the patient's condition, and no compensation will be given if the medical expenses obviously exceed the needs of the patient's condition.
To sum up, my country's basic medical insurance is divided into two categories: basic medical insurance for employees and basic medical insurance for residents. In terms of reimbursement for hospitalization examination expenses, basic medical insurance usually reimburses examination items that comply with the medical insurance policy.
Legal basis:
Article 29 of the "Social Insurance Law of the People's Republic of China"
The medical expenses of the insured persons shall be included in the basic medical expenses The portion paid by the insurance fund shall be settled directly between the social insurance agency and medical institutions and pharmaceutical business units.
The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.
Article 7
The social insurance administrative department of the State Council is responsible for the management of social insurance nationwide, and other relevant departments of the State Council are responsible for relevant social insurance work within the scope of their respective responsibilities.
The social insurance administrative departments of the local people's governments at or above the county level are responsible for the social insurance management work in their respective administrative regions. Other relevant departments of the local people's governments at or above the county level are responsible for relevant social insurance work within their respective scopes of responsibility.