Is orthopedic surgery reimbursed by medical insurance, and can orthopedic social security be reimbur

Wuhan **** orthopedic surgery hospitalization can use Wuhan medical insurance, in March 2017 a new medical insurance policy, relevant regulations, medical insurance can be used nationwide,

Fracture medical insurance can reimburse about 70%. Under normal circumstances, the outpatient clinic of rural cooperative medical insurance can be reimbursed a little, and if the hospitalization exceeds three days, the medical expenses exceed 1,000 yuan, and the reimbursement can be given according to 60%. Only urban workers can be reported for medical hospitalization, but generally not for outpatient services.

The limit for each examination and surgery fee is generally 50 per visit, and the limit for prescription drugs is usually 100. "Opinions on Determining the Scope and Payment Standards of Medical Service Facilities for Basic Medical Insurance for Urban Employees" Basic medical insurance medical service facilities refer to the life service facilities provided by designated medical institutions, which are necessary for insured persons in the process of receiving diagnosis, ** and nursing, mainly including inpatient bed fees and outpatient (emergency) observation bed fees.

Social Insurance Law of the People's Republic of China

Article 2 The State shall establish a social insurance system of basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and so on, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 3 The social insurance system adheres to the principle of wide coverage, basic protection, multi-level, and sustainability, and the level of social insurance should be commensurate with the level of economic and social development.

If it is a designated hospital under medical insurance, the fracture can be reimbursed by medical insurance.

The general medical insurance card is used to purchase outpatient medicines, and the fracture should be treated with progressive hospitalization**, which may be reimbursed about 70%.

The social medical insurance card, referred to as the medical insurance card or medical insurance card, is a special card for medical insurance personal 100 accounts, with personal ID card as the identification code, storing and recording personal ID number, name, gender, account allocation, consumption and other detailed information.

The medical insurance card is undertaken by the local designated ** bank, which is a kind of multi-functional bank debit card. After the insured unit pays the fee, the local medical insurance department will entrust the bank to allocate the personal account money to the personal medical insurance card of the insured employee at the end of the month.

Legal analysis: Fracture medical insurance can be reimbursed, medical insurance can be reimbursed, and one's own fall injury cannot be reimbursed.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

Legal analysis: The steel plate used for internal fixation of fracture surgery is divided into several situations, including domestic, Sen joint venture and imported. General imports are not reimbursed at their own expense.

Domestic and suitable ones can be reimbursed according to the different medical insurance policies in different places, some places can be reimbursed 60%, and some places can be reimbursed 80%. For specific situations, you need to consult the hospital or local medical insurance department.

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 medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of the 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.

Legal analysis: Orthopedic surgery plate expenses are reimbursed by medical insurance, but they must be reimbursed on a pro-rata basis. The specific reimbursement cost of orthopedic surgery plate is still reimbursed according to the local medical insurance reimbursement standard.

The material cost is generally included in the reasonable cost range according to 80%, and the maximum cap of a single material fee is 20,000 yuan, and then reimbursed according to the level and proportion of medical institutions stipulated in the region.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

Legal analysis: The reimbursement ratio for hospitalization of fracture patients is generally between 70% and 80%, mainly depending on the reimbursement ratio in each region, which is different. Taking the reimbursement of up to 80% as an example, some ** and drugs for fracture patients cannot be reimbursed, and the total reimbursement is about 50% to 60%.

Legal basis: Article 29 of the Social Insurance Law of the People's Republic of China 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 machine and the drug business unit. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the insured to enjoy basic medical insurance benefits.

The six major items that are not reimbursed by orthopedics are: (1) non-designated retail pharmacies for drug purchases; (2) Non-Benyin is as good as a good person designated medical institution for treatment; (3) Work-related injuries and injuries caused by traffic accidents and other responsible parties; (4) Injury caused by illegal acts; (5) Committed due to suicide, self-harm, alcoholism, etc.; (6) Medical expenses incurred abroad and in Hong Kong, Macao and Taiwan.

There are still many forms of absolute deductible in the orthopedic system, that is, the system stipulates the minimum payment line for medical expenses, and the expenses within the minimum payment line are self-paid and not reimbursed; In addition, the system also stipulates that the part that needs to be fully paid by yourself, such as orthopedics does not reimburse the ** fee, the cost of medical records, the cost of magnetic card, the nursing fee of nurses, the cost of meals and other service expenses; Certain drugs (non-catalogue drugs, imported drugs, self-financed drugs, new drugs, expensive drugs), self-paid inspection fees (including special filming fees), imported equipment, and self-paid materials (imported steel nails, steel plates, etc.) are also required to pay in full.

The orthopedic system also has some out-of-pocket expenses, such as the part higher than the minimum payment line, and a certain proportion of outpatient and emergency and hospitalization expenses will be reimbursed in accordance with local policies and hospital regulations; Some tests are 10% out of pocket; Class B drugs in the drug list are required to pay 10% to 20% of the out-of-pocket cost. The specific scope and reimbursement amount of lead barriers are subject to the public information of the local orthopedic department.

Extended Information] 1. Sorting out medical expense documents. 1. The outpatient and emergency services of the insured units can be reimbursed. For active employees, only 1,800 or more can be reimbursed (if you can't make up enough within a year, you will enter supplementary medical care) Retirees can only be reimbursed if they are more than 1,300.

2. The reimbursement time is from the 1st to the 20th of each month, and the expenses of the current year shall be declared before January 20 of the following year. 3. When declaring, a settlement schedule with an official seal is required. B two copies of the approval form stamped with the official seal c outpatient oak, the original emergency receipt (if there is a prescription for medicine, the prescription of some hospitals is printed below the original document) d The details of the receipt, the details of each expense are needed E When seeing a doctor, except for the hospital written on the blueprint and other hospitals that do not need a blueprint, the remaining hospitals can only be seen for emergency treatment.

Legal analysis: The material cost is generally included in the reasonable cost range at 80%, and the maximum single material cost is 20,000 yuan, and then reimbursed according to the level and proportion of the medical mask institution stipulated in the region.

Article 23 of the Social Insurance Law of the People's Republic of China Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons can participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.