Why is the amount of money for medical reimbursement always less than you think?

Because a lot of things are not reimbursed.

In my opinion, medical reimbursement is 70 percent. For example, if I spend 10,000, I will be neatly quoted 7,000. But after my hospitalization and my mother-in-law's hospitalization, I found that it was not as simple as I thought.

When I gave birth, I spent about 5,000 yuan on living in an incubator, but the reimbursement was about 1,000 points. I asked the doctor about this matter, and the doctor said that the expenses in the incubator would not be reimbursed. Only the cost of your child's medicines will be reimbursed.

I spent a total of about 10,000 yuan with my children, but I was reimbursed more than 3,000. I don't really feel that much reimbursement is made, but I can only console myself that it is better than paying in full.

The same is true for my mother-in-law's illness, and many medicines are not reported. I made a point to see if the drug was reimbursed. For example, needles, imported medicines, and many other appliances are not reimbursed. The reimbursement is only part of it.

So the reimbursement money must be less than you imagined, because even you don't know which drugs the doctor prescribes are imported and not insured. And there is a limit to the amount of reimbursement, which does not mean that you can be reimbursed for as much as you spend.

That's because there are a lot of things that he doesn't reimburse, first of all, there is a threshold fee, because my mother has been hospitalized several times, I know that the threshold fee is very high, even if the threshold fee is not reimbursed when you reimburse later, and there are also some things that are not allowed to be reimbursed when you choose to import drugs.

Because there are a lot of things that are not reimbursed, so in your opinion, why is the money reimbursed in the end so little.

I remember when I was pregnant and gave birth, because I had a caesarean section, because my family had a special explanation, the drugs used belonged to the better one, so in the final reimbursement, I only reimbursed 500 yuan, and the 500 yuan was only reimbursed because I was a caesarean section, so I was reimbursed 500 yuan, and if I was a natural birth, then I could only be reimbursed 300 yuan.

So, that's why so many people are afraid to go to the doctor now, because the cost of seeing a doctor is very high, and these expenses are not reimbursed.

No, the level of medical insurance payment is mainly related to the local income and consumption level.

The higher the fee paid, the higher the reimbursement rate. Because the payment of health insurance is based on the age of the individual. There are also some grades of medical treatment at Yuhe Hospital. The reimbursement of the bridge damage of the medical treatment insurance is based on whether you seek medical treatment in a different place or locally

The higher the medical insurance base, the higher the reimbursement ratio. The reimbursement ratio of medical insurance is constant, and the medical insurance base has a certain relationship with wages and length of service.

I really don't know, I haven't understood, and many people have big questions about this issue.

The so-called unreasonable and necessary expenses are generally as follows:

1.** or drugs that are not related to the illness or injury of this hospitalization, such as enteritis written in the medical record, but antihypertensive drugs and hypoglycemic drugs appear in the cost details; For example, a broken finger was performed with a chiropractic massage.

2.Although it is related to the medical condition, the dosage is obviously irrational, for example, it is generally considered that two boxes are needed but ten boxes are prescribed, of course, we will consult with the doctors of some partner hospitals, and if necessary, we will visit the attending doctor to confirm.

3.Non-inpatient hospitals prescribe non-medical insurance reimbursement drugs, this situation is mostly seen in some rare diseases, may be used in the hospital does not have, need to buy from outside pharmacies, this situation is theoretically not reimbursable, but in the past two years, some companies' products will also be reimbursed for these drugs at a low rate, but it is difficult to say.

4.There is also a situation that is less common than Jane Tea, some hospitals have some strange regulations, such as a reed core and some non-social security drugs can only be prescribed in Cong outpatient clinics, this situation is theoretically non-compliant, and it is reasonable to say that it cannot be reimbursed.

Medical insurance reimbursement is generally reimbursed in the following ways: general outpatient clinics or drug purchases in designated medical institutions are usually not reimbursed, but can be paid with money from the personal account of the medical insurance card; Inpatient medical expenses, surgical expenses, etc. incurred in designated medical institutions can be reimbursed and settled directly at the hospital settlement window. It should be noted that if it is a remote place to resist medical treatment, Hu Gaichun needs to go through the medical insurance record for medical treatment in a different place before it can be reimbursed.

Article 28 of the Social Insurance Law.

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations.

Article 30. The following medical expenses are not covered by basic medical insurance**:

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

The reason for the medical insurance rebate in these two months is that the return amount of the personal medical insurance account after the reform is only the personal payment part, and the rebate will be less in general. Although the money transferred to the personal account is reduced, it will not significantly reduce the medical insurance treatment of retirees, on the contrary, the outpatient medical expenses in various places can gradually be reimbursed, and the reimbursement ratio is generally not less than 50%. And because the new measures are generally classified according to the local per capita pension, for those whose pensions are lower than the local per capita level, the monthly medical insurance rebate treatment will increase, not all of them will be reduced.

Many people before the medical insurance personal account back more than 100 yuan or two or three hundred yuan a month, a year down there are thousands of yuan, many people's slim balance even more than 5000 yuan, is still a lot of money, now the medical insurance personal account reform, and will not clear the balance before, this can rest assured.

It's just that since January this year, there is not so much money allocated every month after the destruction of Xunbend, so it should be used reasonably, which is the key, such as relatively cheap, you can buy it at your own expense, but if you take long-term drugs, or those that are relatively high in themselves, it is recommended to go to the outpatient clinic for medical treatment and treatment, so that the reimbursement amount will be higher.

How much less money is in the personal account?

The reform of the medical insurance account crediting method is mainly aimed at the medical insurance of employees, including in-service employees and retirees, and has no impact on those who pay urban medical insurance.

1. In-service employees

Generally speaking, the employee medical insurance is composed of two parts: overall planning** (unit payment) and personal account (individual payment), and the proportion of the two contributions is % respectively (there are slight differences in local policies, and the specific proportion is subject to local policies).

Before the reform, the entire amount paid by individuals, as well as part of the amount paid by employers, would be transferred to personal accounts.

After the reform, only the part of individual contributions was transferred to the personal account, the part paid by the unit will be all included in the overall planning**.

This is equivalent to less of our "private money", and more money in the "big pool" of national medical insurance.

How much less money will I have in my personal account?

For example, the medical insurance payment base of Xiaowei is 5,000 yuan, and the amount allocated to Xiaowei's personal medical insurance account every month before the reform is:

5000 2% + 5000 yuan (the proportion of units in various places is different, only Xiaowei is taken as an example here).

After the reform, only 100 yuan (5000 2%) of the buried land liquid was transferred to the personal account.

In this way, Xiaowei learned that Sun Yue's "private money" was 40 yuan less, and 480 yuan less in a year, which is indeed a lot less over the years.