1. Commercial medical insurance: painless gastroscopy as an outpatient medical expenses, in the outpatient clinic, can be reimbursed by outpatient emergency insurance; if in the hospitalization or hospitalization before and after the outpatient emergency, can be reimbursed by health insurance.
2. Basic medical insurance: outpatient painless gastroscopy is generally not reimbursed, but can be paid for by the individual account of the medical insurance; painless gastroscopy during hospitalization can be reimbursed by the coordinated account.
3. Drugs: If the drugs needed for painless gastroscopy are covered by medical insurance, they can be reimbursed; anesthesia is usually paid for out of pocket, and can be reimbursed for up to 500 RMB.
4. Examination fee: Gastroscopy is usually self-paid, but prescription medication after the examination is partially reimbursed in township health centers.
The cost of painless gastroscopy is composed of:
1. Equipment use fee: it involves the cost of depreciation and maintenance of the gastroscopy machine;
2. Drugs: it includes the cost of drugs for analgesia, anesthesia, etc.
3. Doctor's operation fee: it is the fee for the doctor's technical service for performing the painless gastroscopy;
4. Auxiliary materials: such as the cost of single-use endoscope kit, disinfectant, etc.
5. Site fee: the cost incurred by the use of the examination room and other related facilities.
In summary, painless gastroscopy can be reimbursed as an outpatient or inpatient medical expense in commercial medical insurance; basic medical insurance has limited reimbursement for outpatient painless gastroscopy but it can be paid for by individual account, while during hospitalization it can be reimbursed by the integrated account; the cost of medication for painless gastroscopy can be partially reimbursed but anesthesia is usually self-paying, most of the cost of the exams are out-of-pocket, and the prescription medication is partially reimbursed at the township health center.
Legal basis:
The People's Republic of China*** and the State Social Insurance Law
Article 23
Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employing unit and the employees in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.