Category A expenses are all included in the basic medical expenses; category B expenses include 10% and 90% are paid out of pocket; category C expenses are self-paying.

The National Drug Catalog of Basic Medical Insurance divides drugs into three categories: Category A, which can be fully reimbursed by medical insurance and is reimbursed according to the proportion of medical insurance; Category B, where the use of such drugs requires individuals to bear a certain proportion first.

After expenses, the remaining part enters the scope of medical insurance reimbursement and is reimbursed according to the medical insurance proportion; in the third category C, this part of the medicine is not reimbursed and is entirely borne by the individual.

1. Category A drugs refer to drugs that are basically unified across the country and can ensure the basic needs of clinical treatment.

The cost of such drugs is included in the payment scope of the basic medical insurance fund, and is paid according to the payment standards of the basic medical insurance.

2. Category B drugs refer to drugs for which the basic medical insurance fund is partially able to pay. These drugs are first paid by employees at a certain proportion of the cost, and then are included in the payment scope of the basic medical insurance fund and paid according to the basic medical insurance payment standards.

cost.

3. Category A drugs refer to drugs that are 100% within the scope of medical insurance payment; 4. Category B drugs refer to drugs that require a certain percentage to be paid out of pocket first, and the remaining part is within the scope of medical insurance payment.

5. But now with the expansion and full coverage of insured persons, Class A drugs for one group of people may be Class B drugs or Class C drugs for other groups of people. For example, in some places, all therapeutic Western medicines for retired cadres are

Category A drugs, but the western medicines used by employees for medical treatment are divided into Category A, B and C, so specific analysis must be carried out on a case-by-case basis.

Complaints about hospitals should be made to the local municipal or district health supervision department, or by calling the health department’s complaint hotline or the national unified health hotline 12320. If there is a charging issue, you can go directly to the local price bureau.

There are currently three methods of settlement, namely: negotiated settlement, administrative mediation and judicial litigation.

Negotiation and settlement: Negotiate with the relevant doctor leaders to resolve the problem. The hospital has a hotline for complaint supervision. If you call the corresponding person to complain, you can report your personal situation to the hospital's medical insurance department or hospital leaders, and negotiate with them to safeguard your own interests. Patients and medical care

A medical dispute occurred in the institution.

Administrative mediation: Report the matter to the relevant health bureau or department of health through the media, so that they can pay attention to intervention in mediation.

Judicial litigation: Go to court for litigation, which is organized by the court. Both parties to the medical dispute resolve the dispute through legal channels.

Legal basis: "Interim Measures for the Administration of Drug Scope of Basic Medical Insurance for Urban Employees" Article 8 When basic medical insurance participants use drugs in the "Drug Catalog", the expenses incurred shall be paid according to the following principles.

The expenses incurred for using drugs in the "Category A Catalog" shall be paid according to the provisions of basic medical insurance.

The expenses incurred for using drugs in the "Category B Catalog" will first be paid by the insured at a certain proportion, and then paid according to the provisions of the basic medical insurance.

The specific proportion of personal out-of-pocket payments shall be stipulated by the coordinating region and reported to the labor and social security administrative department of the province, autonomous region, or municipality directly under the Central Government for record.

The expenses incurred in using traditional Chinese medicine pieces, except for medicines that are not covered by the basic medical insurance fund, will be paid according to the provisions of the basic medical insurance.