ICU room expenses can be reimbursed by health insurance, but usually only about 40%, and the remainder often needs to be covered out-of-pocket. If you have commercial medical insurance, you can seek reimbursement from commercial insurance. If you are not covered by medical insurance, you will also need to pay out-of-pocket, which is the same as for a general ward. The main thing is the cost reimbursement conditions and proportion, although it is the same as the ward, Class A drugs are fully reported, Class B is not the same according to the region, some 60%-80%, but Class C can not be reported. Due to the intensive care unit some testing methods, some disposable consumables and some materials are not reimbursed by the medical insurance policy restrictions. So the overall reimbursement rate for the intensive care unit is lower than the general ward.
Medicare reimbursement process:
1. Under normal circumstances, when you are sick and need to be hospitalized, take your medical insurance card and medical records to your designated hospital, and then you can use your medical insurance card to settle the bill. That is, the self-pay part of their own payment, reimbursement part of the health insurance center and the hospital settlement;
2, if by their own designated hospitals to secondary or tertiary hospitals, with the health insurance card settlement;
3, the condition of the critical, hospitalized in a hospital that is not their own designated hospital resuscitation, within five days to the municipal health insurance center for the emergency medical resuscitation of the type of disease identified as an emergency rescue disease, identified as an emergency rescue disease, you can use the card in the The medical insurance card can be used to settle the bill at the hospital after it is recognized as an emergency rescue hospital;
4. If you are transferred to a foreign country for treatment, you can go through the referral procedures with the consent of the hospital and the medical insurance center. The expenses incurred in the field will be settled at one's own expense first, and after the end of the treatment, all the information will be reimbursed by the community labor security workstation;
5. The reimbursement of the medical insurance is calculated according to the proportion, which is generally ranging from 70%. The reimbursement rate and the amount of reimbursement are related to the examination and medication, medical grade and other factors;
6. When reimbursement is made, the insured person needs to prepare the relevant information used in the hospitalization, such as outpatient medical records, discharge records, discharge diagnosis (disease diagnosis), hospitalization invoices (outpatient invoices for those who can report outpatient treatment), the total list of hospitalization expenses, the settlement of the medical insurance bill and the hospitalized person's medical certificate, CT, ultrasound, ECG, etc. If hospitalization has been done, the insured person will be reimbursed.
7. Discharge settlement, after the submission of the relevant information, in the health insurance reimbursement window for reimbursement, after the audit, the amount of reimbursement will usually be in about 15 working days to the account.
Summary, the cost of ICU ward can be reimbursed by the medical insurance, but usually only about 40%, if it does not belong to the scope of the medical insurance is also required to pay, which is the same as the ordinary ward.
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 treatment items, standards of medical services and facilities, 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.