Medical insurance has specific provisions for reimbursement of bed fees in single wards. Even if the cost of a single ward is within 600 yuan, medical insurance will only be reimbursed according to the standard of ordinary beds, and the excess needs to be borne by patients themselves. The specific reimbursement ratio and amount depend on the local medical insurance policy and the level of the hospital where the patient is located. Usually, the ordinary bed expenses in tertiary hospitals are within the scope of medical insurance reimbursement, but for advanced beds or single wards, medical insurance is only responsible for part of the expenses, and the rest is paid by patients themselves. Therefore, patients should know the local medical insurance policy in advance when choosing a single ward, so as to arrange the hospitalization expenses reasonably.
Basis for formulating reimbursement standards for medical insurance:
1, the policy stipulates that local medical insurance bureaus shall formulate reimbursement standards according to national and local medical security policies;
2. Budget: consider the balance of income and expenditure of the medical insurance fund to ensure the sustainability of the fund;
3. Medical service price: refer to the market price of medical service and reasonably determine the reimbursement ceiling;
4. Medical needs: adjust the scope and proportion of reimbursement according to the medical needs and disease spectrum of the insured population;
5. Level of medical institutions: The service prices and reimbursement standards of different levels of medical institutions may be different.
To sum up, although the cost of a single ward is within 600 yuan, the medical insurance is only reimbursed according to the standard of ordinary beds, and the excess is paid by the patients themselves. The proportion and amount of reimbursement are affected by local medical insurance policies and hospital grades. Therefore, patients should know the relevant policies in advance and plan the hospitalization expenses reasonably.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.