Expense items for pacemaker reimbursement:
1, the bed fee is the highest in township hospitals1one day in 2 yuan, and one day in municipal and above medical institutions 15 yuan.
2, drug costs, scope of use, the implementation of the provisions of the provincial drug list.
3, inspection fees, inspection fees, etc. , limit 600 yuan.
4. The treatment fee shall be settled in 300 yuan according to the facts, and the above part of 300 yuan shall be included in the reimbursement scope by 50%.
5. The operation fee shall be charged according to the prescribed charging standard.
6, blood transfusion surgery or rescue, the maximum hospitalization 500 yuan each time.
7. The maximum cost of materials for each hospitalization is 2000 yuan.
8, all kinds of tumor patients with radiotherapy, chemotherapy and renal failure need dialysis outpatient expenses, as hospitalization expenses for compensation.
The medical insurance reimbursement process is as follows:
1. local medical insurance reimbursement: after seeing a doctor in a designated medical institution, people who meet the requirements for medical insurance reimbursement can directly use the medical insurance card to make reimbursement settlement in the settlement window of the medical institution;
2. Reimbursement of medical insurance in different places: if the insured person has difficulty in diagnosis or has no treatment means in medical institutions in this city, he can apply for hospitalization in different places, fill out the Application Form for Transfer to Different Places, report to the municipal medical insurance agency for examination and filing, and then transfer to different places for treatment;
3. If the insured person needs to be hospitalized in different places due to sudden illness, he can report to the municipal medical insurance center in time (usually within three days) after admission. The insured person needs to pay the medical expenses for transfer and emergency treatment in different places first, and then go to the municipal medical insurance center for reimbursement after discharge. It is recommended to go through the reimbursement procedures within one month.
To sum up, although pacemakers are within the scope of medical insurance reimbursement, the reimbursement ratio needs to be determined according to the specific medical insurance situation, because the reimbursement standards and systems of hospitals at all levels are different, and some pacemakers are self-funded projects, so the specific reimbursement ratio should be directly inquired by the local medical insurance department.
To sum up: the reimbursement rate of pacemaker medical insurance is about 60% to 80%.
Legal basis:
Scope of national basic medical insurance diagnosis and treatment projects
Two, the basic medical insurance fund to pay part of the cost of the diagnosis and treatment project scope and the proportion of self payment.
(a) diagnosis and treatment equipment and medical materials
4. Disposable medical materials (including implantable materials) whose single price exceeds 1500 yuan (including 1500 yuan) for artificial organs such as pacemakers (the maximum payment limit is 20,000 yuan), artificial lenses, artificial joints, artificial larynx and artificial femoral heads. Individuals pay 10% for domestic products, 15% for sino-foreign joint venture products and 20% for imported products.
People's Republic of China (PRC) social insurance law
Article 24
The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25
The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.