In China's medical insurance system, residents need to pay certain medical insurance fees to become medical insurance participants. Residents who need medical services in hospitals, clinics and other medical institutions can settle their expenses through the payment of basic medical funds. Medical institutions declare expenses to the medical insurance fund, and the medical insurance fund pays the expenses that meet the medical insurance catalogue after examination, while residents only need to pay part of the expenses outside the medical insurance catalogue. The payment method of basic medical fund aims at ensuring the basic medical needs of medical insurance participants, reducing the burden of medical expenses and improving the level of medical security.
Hospital fund payment process:
1, the hospital makes a list of medical service expenses: when providing medical services for patients, the hospital needs to make a list of medical service expenses, including treatment expenses, examination expenses and medicine expenses.
2. The hospital submits the expense list to the fund management institution: the hospital submits the patient's medical service expense list to the medical insurance fund management institution for review;
3. Audit of the expense list by the fund management institution: The fund management institution shall audit the expense list submitted by the hospital to confirm the authenticity, rationality and standardization of the expenses;
4. The fund management institution pays fees to the hospital: after approval, the fund management institution pays fees to the hospital, and the hospital collects medical expenses from patients according to the actual situation.
To sum up, the hospital fund payment process may be different due to different regions and medical insurance policies, and the specific details need to be inquired and handled according to the actual situation. At the same time, patients should consult the relevant policies of hospitals and fund management institutions to understand their medical insurance benefits and payment methods, so as to better manage their medical expenses.
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.
Medical insurance is one of the five social security in China. Medical insurance fund refers to the monetary fund that enterprises, institutions, organizations or individuals who participate in medical insurance raise and pay the prescribed amount of medical insurance premiums in the form of laws or contracts to provide basic medical insurance for the insured. The collection and management of medical insurance fund is compulsory.