Can I apply for commercial insurance for medical treatment in private clinics?

This mainly depends on whether there is a clear provision for the place of medical treatment in the contract of the health insurance product purchased.

It is understood that there are many ordinary medical insurance products sold on the market, but in the insurance contract of this type of insurance, for the hospital where the insured is treated, it is usually required to seek medical treatment for a legally operated secondary or higher hospital in China in order to receive compensation.

If consumers have certain doubts about whether the hospital they seek medical treatment is covered by the insurance contract, it is generally recommended that they can contact the insurance company directly for confirmation to avoid disputes in the later stage of claims.

In addition, for injuries caused by accidents, there is no hard and fast rule that you must be treated in a secondary hospital or above.

Generally, after an accident occurs, we can choose to deal with it nearby**, and then consult the medical institutions that the relevant insurance companies cooperate. However, there are also regulations that ** hospitals, clinics, nursing, convalescents, alcohol rehabilitation, drug rehabilitation or similar medical institutions are not covered, which should also be noted.

Private hospital commercial insurance can be reimbursed, but the insurance company needs to visit a second-class hospital or above to reimburse. Of course, the emergency department is excluded (because the emergency department is the nearest medical treatment), but the emergency department should be transferred to a second-class hospital or above within 24 hours before the insurance company will recognize the bill. If it is medical insurance, it depends on whether the private hospital is a designated hospital for medical insurance, otherwise no claim will be made.

If it is a commercial insurance, depending on your contract, you can contact the claims adjuster to confirm. The vast majority of commercial insurance has clear requirements for the hospital to be visited, and the accident medical insurance is generally available in public hospitals above the second level. There are also designated hospitals for sickness medical insurance, and hospitalization in public hospitals that are not designated hospitals need to apply, otherwise no claims will be made.

Private hospitals and expensive hospitals are largely not reimbursed. Unless it is a high-end medical insurance. Insurance Law of the People's Republic of China

Article 95 The business scope of an insurance company:

1) Life insurance business, including life insurance, health insurance, accident insurance and other insurance business;

2) Property insurance business, including property loss insurance, liability insurance, credit insurance, guarantee insurance and other insurance business;

3) Other insurance-related businesses approved by the insurance regulatory authority.

Insurers shall not concurrently engage in life insurance business and property insurance business. However, insurance companies that operate property insurance business can operate short-term health insurance business and accident insurance business with the approval of the insurance regulatory authority.

Insurance companies shall engage in insurance business activities within the scope of business approved by the insurance regulatory authority in accordance with the law.

According to the relevant regulations, as long as it is a designated medical institution of social security, it can use the medical insurance card co-ordination account for reimbursement. However, medical insurance reimbursement is limited to inpatient medical expenses, special outpatient services, etc., if it is self-paid out-of-pocket expenses incurred in designated medical institutions, such as buying medicines, seeing general outpatient clinics, etc., although it cannot be directly reimbursed by the overall account of the medical insurance card, it can also be paid with the money in the personal account of the medical insurance card.

Reimbursement process for medical insurance:

1. The handler submits the reimbursement documents and other materials to the social security institution for acceptance;

2. Since receiving the application materials, the acceptance department shall review, settle and pay the work;

3. If the social security institution approves the application, the applicant shall be reimbursed after receiving the reimbursement form for medical expenses of the social medical insurance.

To sum up, medical insurance is not available for medical insurance reimbursement for medical treatment in private clinics, and if you need to be reimbursed for medical insurance, you must go to a big hospital. Medical insurance refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease.

Legal basis]:

Article 26 of the Social Insurance Law of the People's Republic of China.

The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

Article 28.

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 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 institutions and drug business units.

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.

Legal analysis: outpatient services can be reimbursed, and the reimbursement of 50%-70% is based on the Social Insurance Law of the People's Republic of China

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

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

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 **.