Each medical insurance patient will receive a hospitalization medical insurance settlement form when he is discharged from the hospital, which records the patient's total cost of hospitalization, out-of-pocket expenses and medical insurance billing reimbursement.

However, because many citizens do not have a clear concept of some medical insurance, they are often confused by the large numbers on the bill when looking at it.

According to the person in charge of the Medical Insurance Office of the Cancer Hospital Affiliated to Guangzhou Medical University, it is actually not difficult for citizens to understand the hospitalization medical insurance settlement form.

Although the medical insurance hospitalization settlement statements and reimbursement ratios are different in different places, they are similar. The key is to understand the meaning of a few keywords.

Total amount: The total cost of hospitalization, that is, all the expenses spent by the patient during the hospitalization.

Out-of-pocket expenses: expenses beyond the scope of the medical insurance catalog.

Out-of-pocket expenses for some items: For Category B items within the scope of the medical insurance catalog, the insured must first pay a proportion of the expenses out of pocket.

For example, Class B drug A costs 100 yuan, and based on a 5% out-of-pocket rate, there will be an out-of-pocket expense of 5 yuan = 100 × 5% for some items.

Deposit line: that is, the expenses below the deductible standard. The Medical Insurance Bureau has set corresponding deductible standards according to different categories of insured persons and hospital levels.

Coordinated *** payment segment expenses: Basic medical expenses are paid by the medical insurance and the insured together. Calculation method = total amount - self-pay expenses - out-of-pocket expenses for some items - threshold payment line, of which *** payment segment

Medical insurance payment = (total amount - self-payment - out-of-pocket expenses for some items - starting payment line)

Pay line)×14%.

For some employee insured persons who have purchased the "enterprise supplement", they can also enjoy the accounting of the enterprise supplement. The calculation method = (deductible payment line + the insured person's payment in the *** payment period) × 70%.

At this time, the total medical insurance accounting = (total amount - out-of-pocket expenses - out-of-pocket expenses for some items - deductible payment line) × 86% + (deductible payment line + expenses paid by the insured in the *** payment period) × 70%.

Critical illness subsidy: means that when the insured’s cumulative basic medical insurance payment exceeds the limit for that year during the social security year, the system automatically transfers the critical illness subsidy account to the account.

The Guangzhou Municipal Medical Insurance Bureau stipulates that for hospitalization in hospitals of different levels, the reimbursement ratio and bed fee settlement standards are different; different types of insured persons have different minimum payment standards.

Therefore, for the convenience of readers, hospitals generally print relevant policy information on medical insurance payment ratios and minimum payment standards on medical insurance bulletin boards or brochures.

It should be noted that the medical insurance billing amount is not simply "total hospitalization expenses × reimbursement ratio", but after excluding self-pay expenses, minimum payment standards, and out-of-pocket expenses for some items, it is based on the basic medical insurance overall payment segment

Expenses will be reimbursed by medical insurance on a proportional basis.