At present, 543 medical institutions in the city have declared themselves as the competent department of diabetes health, and promised to provide diabetes health management services including disease monitoring, complication screening, therapeutic drugs and referral for diabetic patients by themselves or in cooperation with other medical institutions. Since its implementation, nearly 30,000 diabetic patients in this city have chosen the health authorities independently, which has run smoothly and received good response.
The policy is clear. After choosing the competent health department, diabetic patients receive diabetes diagnosis and treatment in the competent health department and its cooperative medical institutions, and the scope of reimbursement is not limited by the payment scope of diabetes projects in this city. According to the actual situation of diabetic patients, the health authorities and their cooperative medical institutions shall choose appropriate medical services within the scope of payment of basic medical insurance in this Municipality, and formulate standardized drug use plans for the diagnosis and treatment of diabetes and complications. The medical expenses incurred shall be reimbursed by medical insurance according to the treatment standard for diabetic patients. Diabetes patients who have not yet selected the competent health department can still continue to see a doctor in designated medical institutions, and the expenses incurred in the process of diabetes diagnosis and treatment will be reimbursed in strict accordance with the payment scope of special diabetes projects in this Municipality.
First of all, diabetes health authorities can choose which insured patients:
Insured patients who enjoy the medical insurance benefits for urban workers and residents and are identified as diabetic patients can choose one as their own health authorities, except for long-term residents who have gone through the settlement procedures for medical treatment in different provinces.
Two, how to handle the registration formalities of diabetes patients selected health authorities:
Diabetic patients hold social security cards or medical insurance electronic certificate to the health authorities to be selected, and go through the registration procedures of the health authorities under the guidance of the staff of the health authorities. After handling the selected registration procedures, it will take effect on the following natural month 1 day, and the registration period is long-term.
How to settle the personal account of diabetic patients treated by health authorities;
In principle, the medical expenses incurred by diabetic patients in the health authorities and their cooperative medical institutions shall be directly settled online. If it is impossible to settle due to special reasons such as network failure, the medical institution can settle the expenses by delaying the credit card. Medical expenses incurred due to diabetes are reimbursed according to diabetes treatment standards and are not limited by the scope of diabetes payment.
Legal basis:
Notice of the Municipal Human Resources and Social Security Bureau on Further Improving the per capita payment and settlement methods for specific diseases in diabetes clinics Article 1 The per capita expenses of diabetes in designated service institutions shall be paid by the individual patients and the medical insurance fund. Among them, the individual payment of patients is calculated according to the actual medical expenses and the current medical insurance reimbursement policy to ensure that the personal burden of patients will not increase and the level of medical insurance benefits will not decrease after the reform; The difference between the patient's personal payment and the head fee is paid by the medical insurance fund according to the facts, and does not occupy the original medical insurance budget quota of the designated service institutions.