To medical expenses are generally reviewed from several aspects?

Everyone feels that it is expensive to see a doctor and difficult to see a doctor, many people feel that the medical cost how can be so expensive, how to identify the medical cost is reasonable? To the medical expenses generally from several aspects of the review? A general visit to the doctor must include registration fees, examination fees, drug costs, and even hospitalization fees, surgical fees, you can review against these aspects to see if the medical fees are ultimately reasonable. A review of the principles of medical costs, including registration fees, inspection fees, laboratory fees, surgical fees, treatment costs, hospitalization costs and medication costs, whether these costs should be established in conjunction with the medical records and diagnostic certificates and other relevant evidence to determine, pay attention to the review: (1) review of the medical costs of treatment of injuries suffered by the cost. The injured person unauthorized purchase of medical expenses unrelated to the injury such as treatment in addition to its own inherent disease, does not belong to the scope of compensation. If the medical treatment at public expense has been reimbursed by the organization, it should not be included in the scope of compensation. (2) The amount of medical expenses shall be determined by the amount actually incurred prior to the conclusion of the first instance court proceedings. Rehabilitation costs necessary for organ function recovery training, appropriate cosmetic surgery costs, and other follow-up treatment costs may be sued separately when they are actually incurred. However, expenses that are determined to be necessarily incurred based on medical certificates or appraisal conclusions may be compensated together with medical expenses that have already been incurred. (3) a review of the specific costs of medical expenses: 1) generally should be the location of the hospital, the transfer of foreign hospitals for treatment should be really necessary and subject to the consent of the local hospital, without consent and unauthorized transfer of hospitals are generally not compensated (this provision is open to question?), the hospital should be transferred to the local hospital. Forced transfer to the hospital led to shock late case, so the operation is not conducive to the case). 2) medical expenses must be the treatment of trauma or damage caused by disease expenses, treatment and trauma-related medical expenses, not compensation (this provision is not reasonable, basic diseases and trauma after all, often for the first control of the basic condition and then outside the treatment, at this time, the treatment of the basic condition of the cost of the author believes that the cost of reasonable). (3) the parties in the treatment of hospitals other than medical, pharmaceutical units to buy drugs, must be necessary, and should be approved by the treatment of hospitals, the injured person privately purchased is not necessary for the treatment of drugs will not be compensated. (★: really necessary, and necessary for the treatment can be, whether approved by the hospital I do not necessarily require, the key to look at the purpose of buying drugs privately, often: for convenience, in order to save money and other reasons) 4) review of hospitalization costs, hospitalization of the premise is limited to serious injuries need to be hospitalized to determine the injuries and the surgical treatment of the case of living in high-grade wards, should be calculated according to the general ward costs. (But the room cost is not part of the identification of forensic clinical) 5) examination, diagnosis and auxiliary examination costs should be examined to see if there is a duplication of the examination and the high cost of the examination. (This appraisal often involves the relationship between the patient and the hospital, should be handled with caution) 6) follow-up treatment costs are the cost of the need for re-treatment or not yet recovered future costs, should be subject to a valid certificate issued by the medical institution or the relevant appraisal organization issued the appraisal. (The current practice is that the medical institution issues a certificate to the appraisal organization for further confirmation, but often the appraisal organization is left to formality without substantive review) 7) If the insurance contract agrees that the medical expenses are limited to the scope of the medical insurance, the agreement should be interpreted as a reasonable medical expense. The insurance company applies for a review of the reasonableness of the medical expenses, which can be determined in accordance with the law. For the identification of the reasonableness of medical expenses, the court may hire a forensic doctor to conduct an examination based on the agreement of the parties, and the conclusion of the examination may be adopted as expert testimony. If the parties have different opinions on the examination opinion of the forensic doctor, they may apply for forensic identification. Second, the review of matters (1) the use of drugs and the reasonableness of the review: recommended the use of medical insurance medication, medication to master the symptomatic, the right amount, reasonable, timely principle, when dealing with the plaintiff is required to provide prescriptions and doctor's orders, so as to avoid the occurrence of ride-along prescribing and impostor, but also to facilitate the review of the cost. Only the hospital charges invoice, but no doctor's orders should not be protected. (Nutritional support drugs, energy combining agents, etc., should be applied or not, should be decided by the situation of the injured person and the physical condition after the injury, such as the injured person has a large amount of blood loss or the old and frail, in order to promote the early recovery of the injury can be used appropriately for the use of nutritional support drugs, and the rest of the situation should not be used in large quantities. The use of antibiotics is quite common in injuries and accounts for a large proportion of the cost of drugs, the review should follow a ladder from low to high level within the scope of the medical insurance drugs, the combination of applications should strictly control the indications, such as serious infections or mixed infections of undetermined causes; need to use drugs for a longer period of time, there is a risk of drug resistance or the possibility of secondary infections; need to play a synergistic effect of the combination of drugs, etc., the combination of drugs that do not meet the indications. Combinations that do not meet the indications are not protected and only one of them can be recognized as reasonable. At the same time, the dosage of medication is reviewed to see if the medication is in accordance with the regular dose, and whether the medication prescribed per unit of time can be used up. (2) For comprehensive instrument and equipment examinations, expensive instrument examinations and duplicate examinations that do not have examination indications are, in principle, recognized as unreasonable medical expenses. If there is an indication for examination and the result of the repeated examination is negative, only the cost of the first examination can be protected. (This provision is not reasonable.) (3) Re-expenses: common cranial bone repair, foreign eye, the installation of foreign teeth, take the internal fixation, etc., should be the standard of the local medium level of medical care can be carried out; cosmetic surgery, elimination of visceral adhesion surgery must have the original doctor's approval; for the question of whether scars need to be restored, should be the standard of whether it affects the function of scars, such as scar adhesion to affect the function of the joints or organs need to be carried out. If the adhesion of the scar affects the function of joints or organs, then it should be repaired, otherwise the expenses incurred should not be protected. (This provision is not reasonable) (4) the relationship between injury and disease: 1) injury and disease has nothing to do with, after injury in the treatment process, injury and disease **** treatment, medical expenses can only protect its treatment of the injury part; 2) injury and disease have a certain relationship, i.e., the injury has a certain aggravation of the disease, the treatment of the injury part of the full recognition of the reasonable and treatment of the disease expenditure usually according to the approximate percentage of the degree of participation in the compensation, but not more than 50%; 3) injury induced a certain disease, induced by the reasonable part of the cost of the cure of the disease, the author believes that the victim should be compensated for the total amount of 20-30% of the appropriate. Reasonable compensation for the recurrence of the original disease caused by trauma, should refer to the trauma-induced disease. Third, review the method of calculation of medical costs, according to the relevant provisions of the law and judicial interpretations, medical fees according to the medical institutions issued by the medical fees, hospitalization fees and other receipts, combined with medical records and diagnostic certificates and other relevant evidence to determine. It should be noted that the collection vouchers here are legal vouchers in accordance with the relevant national financial management norms, and if the collection vouchers are not obtained by proper means, the court is likely to reject the request for medical expenses on the grounds that the evidence does not prove the medical expenses. For example, if the person concerned is treated in a black clinic or a black medicine point, and lacks legitimate fee vouchers, and only has receipts from the person who handles the treatment, such evidence will not have sufficient probative power. Regarding the reasonableness of the expenses, the evidence of medical expenses are mainly the fee receipts, prescriptions, medical advice and diagnostic certificates of the condition of the medical institution and so on. In determining the amount of medical expenses, special attention should be paid to the two consistencies of the evidence, that is, the consistency of the items of fee receipts and prescriptions as well as the consistency of the diagnosis of the condition and prescriptions. The former means that the medical expenses should be in line with the diagnosis and treatment plan proposed by the doctor, rather than the patient's own decision on how to buy medicine or whether to be hospitalized. The latter means that the hospital's diagnostic program and the patient's own condition is consistent with the patient's own condition, rather than a light disease, the treatment plan is clearly more than the general medical common sense, for example, only minor injuries, but the hospital's diagnosis and treatment program contains a long-term hospitalization, multiple expensive equipment diagnosis, etc., resulting in high costs, these medical expenses will be rejected by the court request. Personal injury claims disputes in the medical costs are generally based on the actual expenses, the judicial interpretation of the provisions: "the amount of compensation for medical expenses, according to the court of first instance before the end of the debate to determine the amount of the actual occurrence. The right to compensation for rehabilitation costs necessary for organ function restoration training, appropriate cosmetic surgery costs and other follow-up treatment costs may be sued separately after they have actually been incurred. However, costs that are determined to be necessarily incurred on the basis of medical certificates or appraisal conclusions may be compensated together with the medical costs already incurred." For the subsequent medical expenses, the party can claim based on the medical institution's certificate, or wait for the subsequent treatment to be incurred and then sue separately based on the actual expenses. If the subsequent medical expenses are determined to be necessarily incurred by medical certificates or appraisal conclusions, the court may directly support the party's claim for the subsequent medical expenses based on the certificates. If the reasonableness and necessity of the medical expenses are disputed in the litigation, the burden of proof for the necessity and reasonableness of the treatment is on the indemnifier. In other words, if the indemnifier is not satisfied with the medical expenses, he/she has to prove that the expenses are unreasonable and unnecessary. In judicial practice, the common manifestations of unreasonable medical expenses are mainly in the following areas: (1) non-traumatic injury medication, injury after injury **** treatment. (2) unreasonable use of antibiotics, injury cases more need to use antibiotics, many injuries overdose, overtime use, minor injuries using high-grade antibiotics, a variety of antibiotics joint application, etc.; (3) nutritional supportive medicine, treatment of injuries at the same time a large number of nutritional supportive drugs; (4) mild injuries after a long time to wait for the treatment; (5) part of the dispute parties have no obvious injuries, but the complaint of symptoms of heavy, the (6) the need to install prosthetic limbs or other substitutes, as well as the need to use internal fixation in surgery, in violation of the provisions of the use of high-grade imports, such as an internal fixation of intramedullary needles, home-made only 2,000 or 3,000 yuan, while imports of more than 10,000 yuan; (7) at present, new high-grade inspection instruments, projects continue to increase, and many of the injured to carry out a comprehensive examination, repeat examinations, expanding the medical cost of expenditure; (8) do not follow the provisions of hospitalization and transfer, making the According to the provisions of the hospitalization and transfer, so that unreasonable expenditure expansion; (9) ride on the prescription of drugs, impostor occurs from time to time. For unreasonable expenses, the following aspects can be considered for review: The Supreme People's Court's "Opinions on the Implementation of Several Issues" stipulates that compensation for medical treatment costs should generally be based on the diagnostic certificate of the treating hospital in the location and the bills of medical and hospitalization fees. Expenses incurred in finding another hospital for treatment without the approval of the medical department are generally not compensable, nor are expenses incurred in purchasing medicines unrelated to damages or in treating other illnesses; (Opinions of the Supreme People's Court on Several Issues Concerning the Implementation and Enforcement of the General Principles of the Civil Law of the People's Republic of China (for trial implementation), arts. 88, 94, 115, 117, 118 and 177). (Article 19 of the Interpretation of the Supreme People's Court on Several Issues Concerning the Application of Law in the Trial of Cases of Compensation for Personal Injuries, adopted by the Trial Committee of the Supreme People's Court on January 26, 1988, conflicts with the relevant provisions of the Property Law) stipulates that: "Medical expenses shall be determined on the basis of the receipts of the medical expenses and hospitalization fees issued by the medical institution, in combination with the medical records and diagnostic certificates and other relevant evidence. Where the person liable for compensation disputes the necessity and reasonableness of the treatment, he or she shall bear the corresponding burden of proof." The explanation for the first time clearly stipulated the compensation obligations of the burden of proof, but because the relevance of medical behavior and disputes, the reasonableness and necessity of medication are specialized issues, according to "Civil Procedure Law" Article 72 of the provisions of the "People's Court of the specialized issues need to be appraisal, it shall be referred to the statutory appraisal department; there is no statutory appraisal department, the People's Court If there is no statutory appraisal department, the appraisal department shall be designated by the people's court. Article 61 of the Provisions of the Supreme People's Court on Evidence in Civil Proceedings provides that: "A party may apply to the people's court for one or two persons with specialized knowledge to appear before the court to give an explanation of the specialized issues in the case. If the people's court grants the application, the relevant costs shall be borne by the party making the application." -- "Expert Witnesses " Therefore, it is usually not appropriate to leave the issue concerning the medical expenses in dispute entirely to the mind of the judge. The burden of proof on the person liable to pay damages is not sufficiently fulfilled by his/her statement alone, and should be accomplished with the help of the appraisal department's findings or the testimony of expert witnesses. Although the supreme people's court on civil litigation evidence of a number of provisions of the expert witnesses can appear in court on the relevant specialized issues to provide expert opinion, but in practice, very few experts on the reasonableness and necessity of medical expenses to testify in court. Compensation obligations is difficult to complete the burden of proof, resulting in the legal reality and the objective truth often deviate from, is not conducive to the settlement of the dispute. The defendant objected to the method, mainly combined with "medical records" and "diagnostic certificate" to infer the reasonableness of the expenses, the defendant such as the medical expenses have objections, you can apply to the court on the "reasonableness" of the medical expenses, in order to avoid the "reasonableness" of the medical expenses, the defendant can apply to the court on the "reasonableness" of the medical expenses. The defendant can apply to the court for an appraisal of the "reasonableness" of the medical fees if he disagrees with the medical fees, so as to avoid unnecessary compensation. Therefore, the relevance, reasonableness and necessity of medical expenses should be examined by initiating the judicial appraisal procedure. As you can see from the above, how many aspects of medical fees are generally examined? Not only from the registration fee inspection fees and other costs to query, but also from the reasonableness of the medication, medical fee calculation method, medical equipment and other aspects of the identification, if you encounter unreasonable places, should be put forward in a timely manner, listen to the hospital side of the explanation, if you still think it is not reasonable, choose the legal process it.