Hospital funds come from the hospital's financial budget, social donations and medical service income. The name and scale of funds in different hospitals may be different. Generally speaking, the object of hospital fund payment is patients who see a doctor in the hospital, and patients need to provide relevant supporting materials, such as medical records and invoices. And the fund payment can only be obtained after review. It should be noted that hospital fund payment is limited to funds established within the hospital, which is not within the scope of medical insurance and is different from medical insurance reimbursement, so there is no legal protection for patients.
Hospital fund payment is a special fund set up by the hospital to reduce the economic burden of patients, but in the process of enjoying fund payment, we need to pay attention to the following matters:
1, scope of fund payment: the scope of hospital fund payment is medical expenses beyond the scope of medical insurance or subsidies for the part with insufficient proportion of medical insurance reimbursement, and the scope and standard of fund payment need to be approved according to specific circumstances;
2. Provide relevant certification materials: when applying for fund payment, patients need to provide relevant certification materials, such as medical records and invoices, for hospital review;
3. Fund payment restrictions: hospitals have restrictions on the amount and frequency of fund payment, and different hospitals may have different restrictions on fund payment, so it is necessary to know the specific situation in advance;
4. Priority of fund payment: Hospital fund payment is made after medical insurance reimbursement, so it is necessary to reimburse medical insurance first, and then make fund payment. At the same time, patients with other preferential policies or social assistance need to enjoy other preferential policies or social assistance first;
5. Openness and transparency of fund payment: hospitals need to ensure the openness and transparency of fund payment, and hospitals need to formulate corresponding fund management systems, regularly disclose the income and expenditure and use of funds, and accept social supervision.
To sum up, hospital fund payment is limited to funds established within the hospital, which is not within the scope of medical insurance and is different from medical insurance reimbursement, so there is no legal protection for patients. Patients need to know their rights and obligations while enjoying the fund payment.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.