First, understand the designated medical institutions
First of all, we need to know what a designated medical institution is. Designated medical institutions refer to medical institutions that are recognized by the medical insurance department and meet certain conditions. Only when the insured seek medical treatment in these medical institutions can they enjoy medical insurance reimbursement. The accreditation standards of designated medical institutions usually include the qualification, service quality and management ability of medical institutions.
Second, the importance of designated medical care
The reason why insured persons are required to seek medical treatment at designated places is mainly to ensure medical quality and safety, control medical expenses and facilitate management. Through designated medical care, the medical insurance department can supervise medical institutions to ensure that they provide quality medical services; At the same time, it can also control the excessive growth of medical expenses and reduce the burden of medical insurance funds. In addition, designated medical care can also help reduce medical disputes and safeguard the legitimate rights and interests of insured persons.
Third, how to choose designated medical institutions
When choosing a designated medical institution, the insured can choose according to their actual situation and needs. Generally speaking, public hospitals are usually designated medical institutions with high medical level and credibility. At the same time, some qualified private hospitals may also become designated medical institutions, providing more medical choices for the insured. When choosing, the insured can pay attention to the qualification, equipment and doctor level of the medical institution, so as to choose the most suitable medical institution.
Fourth, medical reimbursement under special circumstances.
Although it is generally necessary to go to designated medical institutions for reimbursement, in some special circumstances, the insured can also go to non-designated medical institutions for medical treatment and enjoy reimbursement. For example, in emergency, rescue, referral and other special circumstances. The insured may seek medical treatment in non-designated medical institutions, but the relevant vouchers shall be kept for subsequent reimbursement. In addition, for those who work or live in other places for a long time, they can also apply for reimbursement for medical treatment in other places.
To sum up:
Hospitalization requires fixed-point reimbursement, and insured persons need to seek medical treatment in designated medical institutions to enjoy reimbursement treatment, which is stipulated in China's medical insurance system. When choosing a designated medical institution, the insured should pay attention to the qualification, equipment and doctor level of the medical institution in order to choose the most suitable medical institution. Special circumstances, such as emergency, rescue, referral, etc. The insured can seek medical treatment in non-designated medical institutions and enjoy reimbursement, but the relevant documents need to be kept.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.