Breast cancer chemotherapy can be reimbursed, but because of the reimbursement of this aspect is not all the costs can be, some are related to the use of instrumentation for the examination of this situation, is not able to report. Breast cancer is one of the major illnesses, so you will be reimbursed about 60% of the cost, and you will have to bear the remaining 40%. Medical insurance has clear rules about the medicines that are eligible for reimbursement. Imported drugs are also reimbursed if they have to be imported and there is no alternative in the country. Generally, imported drugs do not belong to the scope of reimbursement. Specific reimbursement matters can be found in the local regular hospital or pharmacy. The medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue medical expenses will be paid from the basic medical insurance fund in accordance with national regulations.
Medical insurance reimbursement process:
1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their treatment items belong to the scope of reimbursement of medical insurance;
2, collect the reimbursement materials: collect the relevant records of treatment, drug receipts, medical cost lists and other related materials;
3, to the social security department to handle the reimbursement: submit the relevant materials to the local social security department, and then submit to the local social security department for reimbursement.
4, wait for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receive the reimbursement payment: after the audit, you can receive the medical insurance reimbursement payment at the designated bank.
Medicare reimbursement standard:
1. Reimbursement rate for residents: town health center reimbursement of 60%; secondary hospital reimbursement of 40%; tertiary hospital reimbursement of 30%;
2. For urban residents, in a billing year, the starting standard for tertiary hospitals is 659 yuan for medical expenses up to 100,000 yuan which are eligible for reimbursement; the reimbursement rate for tertiary hospitals is 50% with a ceiling of 2,000 yuan; second-level hospitals hospitalization starting standard is 300 yuan, reimbursement rate of 55%; first-level hospitals do not set a starting standard, reimbursement rate of 60%;
3, foreign reimbursement, reimbursement needs to go back to the old place of insurance, reimbursement rate of 35-65%, depending on the level of the hospital and the proportion of different.
In summary, breast cancer is a malignant tumor, in the health insurance is reimbursed, we recommend that you can consult your local health care department, according to different diseases will have different reimbursement rates, and if it is a serious disease, the outpatient costs are also reimbursed, we recommend that you go to the regular public hospitals, and actively cooperate with the doctor for treatment.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as emergency and rescue, shall be paid from 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.