The reimbursement range of femoral head replacement is about 60% to 70%, and the specific reimbursement should be decided according to the local medical insurance policy. Under normal circumstances, there will be some differences in the scope of reimbursement in different hospitals and grades. However, the artificial femoral head and related bone cement are medical materials and are self-funded. The reimbursement of femoral head replacement medical insurance shall be treated in designated hospitals, and the basic medical insurance for urban residents shall be combined with individual contributions and government subsidies.
Expenses not reimbursed by medical insurance:
1, service category:
Registration fee, out-of-hospital consultation fee, medical record fee, etc. ; Special medical services such as visiting fees, expedited fees for examination and treatment, surcharge for roll call surgery, surcharge for roll call surgery, high quality and good price, and self-invited special care;
2, diagnosis and treatment equipment and medical useful materials:
Large-scale medical equipment such as positron emission tomography (pet), electron beam ct and ophthalmic excimer laser therapeutic apparatus are used for examination and treatment. Glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation appliances. All kinds of self-use health care, massage, examination and treatment equipment. Disposable medical materials that are not charged separately as stipulated by the provincial price department;
3, treatment project category:
The organ source or tissue source of various organ or tissue transplants; Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow; Orthopedic surgery for myopia; Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
To sum up, generally speaking, the replacement of femoral head can be reimbursed, but it should be noted that the artificial femoral head and the bone marrow mud it needs belong to the expected materials, so this part belongs to the self-funded project, so this part cannot be reimbursed. And the scope of reimbursement is mainly to provide certain insurance for related expenses such as free auxiliary inspection or handling fees.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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.