However, the specific situation needs to be determined according to the local medical insurance policy. The medical insurance policy in some areas stipulates that if the balance of personal accounts is insufficient, the medical insurance fund will reimburse part of the expenses and the rest will be paid at its own expense. In other areas, it is required to pay at one's own expense first, and then compensate through medical insurance reimbursement.
The scope of medical insurance reimbursement includes the following items:
1, reimbursement of basic medical insurance drugs, both Class A and Class B drugs included in the basic medical insurance scope can be reimbursed;
2, the basic medical insurance treatment project reimbursement. The scope of basic medical insurance payment items must be determined in accordance with the scope of basic medical insurance diagnosis and treatment items stipulated by the state. The diagnosis and treatment project that belongs to the basic medical insurance to pay part of the expenses can be paid by the insured person in advance and then paid in accordance with the provisions of the basic medical insurance;
3. Reimbursement of basic medical service facilities. The reimbursement scope of medical service facilities of basic medical insurance covers the service facilities that the insured person must live in during the process of diagnosis and treatment, including bed fees for outpatient and emergency observation and bed fees for hospitalization. For some referral transportation expenses, emergency transportation expenses, infant incubator expenses, food incubator expenses, nursing expenses and escort expenses, the basic medical insurance fund cannot reimburse them.
To sum up, it is recommended to consult the local medical insurance service center or hospital medical insurance Commissioner before seeing a doctor to understand the local medical insurance policy and specific operation process. This can avoid the unnecessary economic burden brought by medical insurance reimbursement.
Legal basis:
"Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law" Article 8.
The medical expenses incurred by the insured in the agreed medical institutions that meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards shall be paid from the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.