First, the medical process.
When trauma occurs, patients need to go to designated medical institutions for medical treatment first. In the process of seeking medical treatment, patients should keep all medical expense invoices, diagnosis certificates, medical records and other related materials as an important basis for subsequent reimbursement.
Second, prepare reimbursement materials.
Patients need to prepare complete reimbursement materials according to the requirements of the medical insurance department. Usually includes:
1. Original or photocopy of medical expense invoice;
2. Diagnosis certificate;
3. Medical record book;
4. Medical insurance card and valid identity documents;
5. Other supporting materials that may be needed, such as the proof of the cause of trauma.
Third, submit an application for reimbursement
After the patient or family members prepare the reimbursement materials, they need to submit the reimbursement application to the medical insurance department or the designated reimbursement window. When submitting the application, you should ensure the authenticity and completeness of all materials, so as to avoid the failure of reimbursement due to incomplete or false materials.
Fourth, the audit settlement
After receiving the application for reimbursement, the medical insurance department will review it. The contents of the audit mainly include the authenticity and completeness of the materials and whether they conform to the medical insurance reimbursement policy. After approval, the medical insurance department will settle the expenses and calculate the medical insurance benefits and reimbursement amount that patients should enjoy.
Verb (abbreviation for verb) refund of fees
After the audit settlement is completed, the medical insurance department will return the reimbursement amount to the patient in the prescribed way. The return method can include directly entering the bank account designated by the patient, issuing cash or recharging the medical insurance card. Patients should pay attention to check the relevant notices to ensure timely reimbursement.
To sum up:
The reimbursement process of trauma medical insurance involves medical treatment, preparation of reimbursement materials, submission of reimbursement application, audit and settlement, and refund. Patients should keep relevant materials during medical treatment, prepare reimbursement materials according to the requirements of medical insurance departments, and submit applications at designated places. The medical insurance department will conduct audit and settlement, and finally return the reimbursement amount to the patient. In the whole process, patients should keep in touch with the medical insurance department to ensure the smooth reimbursement process.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.