1, the drugs are divided into class A, B and C drugs, of which class A drugs are necessary for clinical treatment, widely used, the cost of this type of drugs are all reimbursed in accordance with the proportion of medical insurance. Class B drugs are first paid a certain percentage, and then reimbursed by the health insurance, the specific reimbursement rate is different in different places of the health insurance bureau regulations are different;
2, diagnosis and treatment items refers to the hospital for treatment, the use of medical instruments, equipment and medical materials, mainly two ways to reimbursement of the full co-ordination of all the items are all included in the health insurance reimbursement, according to the prescribed proportion of payment. The first part of the integrated project, is to pay a part of the first, and then reimbursement according to the prescribed proportion;
3, medical service facilities standard, refers to the hospital bed fee, outpatient hospital bed fee and so on, the reimbursement scope and standard is different from place to place. If the social security of the medical insurance reimbursement scope is for the medical insurance catalog within the project reimbursement, including drugs, diagnostic and treatment items and medical services facilities.
Medicare reimbursement process:
1, the applicant submits the reimbursement documents and other materials to the social security institutions for acceptance;
2, the acceptance of the department since the receipt of the application materials, audit, settlement, payment work;
3, social security institutions to approve the application, the applicant receives social health insurance medical expense reimbursement claim to be reimbursed. At the time of medical treatment, the medical insurance card is presented to the designated hospital to prove the identity of the insured, and at the time of settlement, the part that the individual pays out-of-pocket will be paid by the individual with the medical insurance card or in cash, and the part that is reimbursed by the medical insurance will be settled by the medical insurance and the hospital, so that the individual doesn't need to pay first and then be reimbursed.
In summary, the health insurance reimbursement scope of psychotherapy refers to the acceptance of standardized psychotherapy training psychiatrists or obtain psychotherapy professional and technical qualifications of health professionals, in the appropriate independent treatment space, for the mental disorder patients eligible for psychotherapy, the application of standardized psychotherapeutic techniques and individualized treatment program for psychotherapy, eliminate or alleviate the patient's manifestations of mental disorders.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with 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.