For some minimally invasive instruments, the reimbursement ratio of ultrasonic scalpel, punching card and minimally invasive instruments is not the same, some are high, some are low, and some are only the highest limit. After exceeding the maximum limit, it will not be reimbursed. Generally, medical insurance in all hospitals is capped. No reimbursement after exceeding the upper limit, and reimbursement within the upper limit.
Medical insurance reimbursement process:
1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;
2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;
3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;
4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.
Medical insurance reimbursement standard:
1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;
2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;
3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.
To sum up, minimally invasive surgery can be reimbursed if it is a natural disease, but it cannot be reimbursed for some unnatural diseases or patients who require cosmetic surgery. For example, some people who have had double eyelid surgery, breast augmentation and cosmetic surgery are all within the scope of reimbursement. Therefore, if patients want to reimburse these operations, they must communicate or consult with people in medical institutions in detail to avoid that the expenses cannot be reimbursed and affect the patients' 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.
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.