Gastroenteroscopy can only be paid for by the individual account of the medical insurance when it is performed on an outpatient basis and cannot be reimbursed by the integrated account of the medical insurance; however, it can be reimbursed by the integrated account of the medical insurance if it is performed during hospitalization due to serious illness. Gastroscopy is usually not reimbursable on an outpatient basis, but it is reimbursable on both an outpatient and inpatient basis if the test is indicated during hospitalization or if the patient is suffering from a specific disease such as gastric cancer or malignant lymphoma of the stomach, and if the disease is included in the coverage of the local chronic disease or major disease health insurance.
Determination of medical insurance reimbursement scope:
1. medical insurance policy regulations: local medical insurance policy will stipulate which medical services and medicines can be included in the scope of medical insurance reimbursement;
2. medical service categories: usually including outpatient services, inpatient hospitalization services, and special examinations and treatments;
3. drug catalog: the medical insurance drug catalog lists reimbursable medicines, which are categorized into Class A and Class B;
4. Restrictions: some services and medicines may have restrictions such as frequency of use, indications, etc.
5. Regional differences: the reimbursement policies and rates of the health insurance may vary in different regions;
6. Updates and adjustments: the health insurance catalogs and policies will be updated regularly to adapt to the changes in the market of healthcare services and medicines.
In summary, gastroscopy and colonoscopy can be utilized by health insurance, but the exact reimbursement depends on the scenario of the examination and the specific condition of the disease.
Legal basis:
The Law of the People's Republic of China on Social Insurance
Article 28
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.