Is cataract surgery reimbursable? Is cataract surgery covered by Medicare?

For cataract surgery, medical insurance and agricultural insurance can be reimbursed, and the reimbursement policy is different in each place, and the reimbursement ratio ranges from 30% to 80%. Generally speaking, the out-of-pocket expenses after reimbursement for ordinary cataract surgery are almost a few thousand yuan.

If you are doing flying white surgery, or choose high-end lenses, the out-of-pocket amount is relatively high, tens of thousands.

You can directly handle cataract surgery with the NCMS medical insurance card, and you can use the NCMS card to deduct the reimbursement part directly in the hospital, as for the total cost, it depends on the crystal you choose, the domestic one is cheaper, the imported one is higher, and the payment yourself is larger.

Yes, I saw that my colleague's father had surgery at Kunming Huashan Ophthalmology, and not only recovered well, but also reimbursed part of it by medical insurance. Now the old people are praising Huashan ophthalmology and policies when they meet people

I did it at Egger Ophthalmology, and last year, it cost a few thousand, and the medical insurance can reimburse most of it. **Not expensive, and the cataract surgery on the market is almost the same, mainly to choose a hospital with good technology and good service, just like I chose Egger Eye Hospital, which is very worry-free and recovers well.

The cost of cataract surgery depends on the choice of intraocular lens**, which generally ranges from a few thousand to one or two thousand. Reimbursement policy: This depends on the local reimbursement policy.

Hello, you can. Cataract surgery involves the artificial removal of a portion of the lens that has become cloudy and replacing it with an intraocular lens to restore vision. Generally, it will recover in about 3 to 4 weeks, and during this period, wash your face and hair so that no sewage enters the surgical eye to prevent infection.

Try to avoid coughing vigorously after surgery. It is strictly forbidden to collide, press, bow the head, rub the eyes of the surgical eye, lie flat or lie on the side of the non-surgical eye during napping and night sleep, and wear an eye mask to prevent eye injury. Avoid heavy lifting and strenuous exercise.

Eat plenty of vitamin-rich foods and don't smoke or drink alcohol.

However, the reimbursement fee is different in different regions. The cost of cataract surgery is about 6,000 to 8,000 yuan, and if the reimbursement rate is relatively high, it may be reduced by half. In addition, the intraocular lens used in cataract surgery is also within the scope of medical insurance reimbursement, but the reimbursement amount of intraocular lens has a certain upper limit, the upper limit of reimbursement for general imported folding intraocular lens is 1000 to 1500 yuan, and the surgical costs and related consumables generated by cataract surgery can be reimbursed by medical insurance in proportion, and medical insurance reimbursement is roughly divided into three categories, one is that the reimbursement ratio of employee medical insurance is relatively high, which can be reported more than 80% to 85%. The reimbursement rate of urban cooperative medical care, also known as urban cooperative medical care, is relatively low, and can be reported about 50% to 60%.

There is also the original reimbursement of the rural cooperative medical insurance, which is now classified as urban and rural cooperative medical care, also known as urban and rural medical care, and its reimbursement ratio is higher than that of urban cooperative medical care, about 65% or more, so cataract surgery can participate in medical insurance, and you can enjoy the medical insurance reimbursement of cataract surgery by using the ID card and medical insurance agricultural cooperative medical insurance for hospitalization procedures.

Legal basis] Social Insurance Law of the People's Republic of China

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance ** payment.

Cataract surgery is reimbursable through Medicare.

The scope of reimbursement includes preoperative examination, preoperative and intraoperative, postoperative medication and hospitalization nursing costs and surgical expenses before cataract surgery, but the intraocular lens required in the operation, the intraocular lens is a consumable, and the cost of the intraocular lens fluctuates greatly, ranging from hundreds to thousands to tens of thousands, some hard intraocular lenses can be reimbursed, and some intraocular lenses can be partially reimbursed or not reimbursed, according to the relevant medical insurance regulations. The rest of the expenses are basically reimbursed.

Cataract is a disease that is covered by the district and municipal medical insurance. Whether it is the rural cooperative medical insurance for urban and rural residents or the medical insurance for urban employees, the cost of cataract surgery can be reimbursed.

However, the exact reimbursement rate depends on your hospital, the type of medical insurance, and the cataract intraocular lens you choose.

The cost of cataract surgery consists of two parts: the cost of the operation itself and the cost of the intraocular lens. Femtosecond laser cataract surgery and phacoemulsification cataract surgery are more expensive than phacoemulsification cataract surgery.

The lenses used in cataract surgery also include different types, some lenses can only solve the cataract problem alone, while some imported lenses can solve various problems such as presbyopia, myopia, astigmatism and so on at the same time in addition to cataract, and the cost of imported lenses is of course more expensive.

Legal Analysis: Yes. Cataract is covered by medical insurance.

Whether it is the New Rural Cooperative Medical Insurance or the medical insurance for urban workers and residents, the cost of cataract surgery can be reimbursed. However, the specific reimbursement rate depends on the hospital, the type of medical insurance, and the cataract lens chosen. Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease matching.

Legal basis] Social Insurance Law of the People's Republic of China

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards to Pei Qin stupid and emergency, rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance ** type of payment.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Cataract surgery can be reimbursed through Medicare, but not all expenses are reimbursed.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, the medical insurance institution will give them certain economic compensation.

The establishment and implementation of the basic medical insurance system gathers the economic strength of the unit and the members of the society, coupled with the first funding, which can enable the sick members of the society to obtain the necessary material help from the society, reduce the burden of medical expenses, and prevent the sick members of the society from "becoming poor due to illness".

Medical insurance, in the traditional sense, refers to the management of medical insurance by a specific organization or fraudulent organization, through mandatory policies and regulations or voluntary contracts, in a certain area of a certain insured population**.

Reimbursement-based medical insurance means that the medical expenses incurred by patients in the hospital are reimbursed by the insurance company, and generally distinguish between outpatient medical insurance and inpatient medical insurance.

1. Reimbursement process of medical insurance for urban employees:

1) Applicant: The patient or his/her spouse, parents and children. If the participating patient is unable to apply in person and does not have a spouse, father, mother, or child, his brother or sister shall apply on his behalf;

2) If there are no brothers or sisters, the person in charge of the unit shall apply on their behalf. If the application is made by the **person, a copy of the ID card of the **person and the supporting materials of the relationship with the participating patient shall be submitted;

3) Acceptance institutions: designated medical institutions below the county level (including county level, the same below);

4) Application Result:

1) If the identity certificate materials of the participating patients applying for reimbursement are true and the submitted materials are complete, they shall be accepted on the spot;

5) If there is any doubt about the identity materials of the participating patients, they should be handed over to the cooperative medical management agency for verification;

6) If the submitted materials are incomplete, all the materials that need to be completed should be notified in writing at one time.

2. Medical insurance reimbursement standards for urban employees:

1) Outpatient reimbursement standards:

a. Minimum payment line: The starting line for medical insurance reimbursement for retirees is 1,300 yuan, and the starting line for in-service employees is 1,800 yuan.

b. Cap line: 20,000 yuan;

Reimbursement ratio: 70% for in-service employees; 85 per cent for retirees under 70 years of age and 90 per cent for those over 70 years old.

2) Hospitalization reimbursement standard: Wang Chanshen.

a. The minimum payment line is 1,300 yuan for the first hospitalization at the end of this year, and 650 yuan for the second and subsequent hospitalizations;

b. Cap line: 100,000;

Extended Information: Precautions for Medical Insurance Reimbursement for Urban Employees:

1) The following expenses are not included in the scope of reimbursement: ** fee, out-of-hospital consultation fee, medical record production cost, house visit fee, ** urgent examination fee, roll call surgery surcharge, special medical services, health examination fee; Medical consultation, medical appraisal, bed fee, ambulance fee, myopia eye orthopedics, magnetic therapy, cosmetic plastic surgery, infertility (pregnancy), sexual dysfunction and other medical insurance will not be reimbursed;

2) Payment method of medical insurance reimbursement for urban employees: in-service personnel are paid by medical insurance to the financial account of the unit, and the financial department of the unit pays to themselves, and retirees are paid by medical insurance to their bank cards;

3) Reimbursement method for medical expenses in other places:

a. Except for those who are resettled in other places, the emergency expenses incurred in other places during business trips or family visits can be reimbursed in accordance with the relevant regulations of Beijing;

b. The manager of the unit shall go through the reimbursement procedures at the district and county medical insurance center. At the same time, it is also necessary to submit a description of the unit of emergency expenses in other places (with the seal of the unit).

Of course, if you have a need, it is recommended to go to a big hospital for consultation, Aier Eye Hospital Group is an ophthalmic medical group with the scale of hospitals and high-quality medical capabilities in China and around the world, which can better help you solve eye problems and be your eye steward. <>