Can radiotherapy and chemotherapy be reimbursed by medical insurance, and is cancer radiotherapy and

OK.

Co-ordination** is primarily responsible for reimbursement of special outpatient and inpatient expenses. However, the cost of radiotherapy depends on the type of medical insurance you have, and it is a question of how much to pay. Special outpatient reimbursement refers to the reimbursement of ** expenses incurred in radiotherapy and chemotherapy for cancer and dialysis for uremia, excluding surgical costs.

Reimbursement of hospitalization expenses refers to the reimbursement of general hospitalization expenses and the reimbursement of hospitalization expenses in the first 7 days after the occurrence of the emergency department.

Co-ordination ** does not reimburse for general outpatient services, while the regulations for reimbursement for special outpatient and inpatient clinics are: reimbursement of 85%-97%, and the starting line is 1,300 yuan. The annual cumulative cost cap is 70,000 yuan.

Its reimbursement ratio is inversely proportional to the level of the hospital and directly proportional to the number of drugs prescribed. The higher the cost spent, the higher the reimbursement rate.

First, if the person concerned is part of the inpatient radiotherapy, it can be reimbursed, if it is outpatient, it cannot be reimbursed, and the medical insurance center must have a basis for refusing to reimburse, so that the relevant personnel can come up with the basis. If you refuse without reason, you can complain to the higher department.

Second, the reimbursement procedure for radiotherapy:

1. Radiotherapy medical insurance can be reimbursed, when hospitalized, if it is in the township hospital in the insured place**, there is no need to apply for reimbursement, and when discharged, the hospital will handle the medical insurance reimbursement procedures.

2. If it is an accident in a township hospital outside the insured place**, then after discharge, bring the medical record book, medical expense list, hospitalization invoice, discharge record, ID card, household registration book and other documents to the township hospital in the insured place for reimbursement.

Third, the reimbursement ratio of medical insurance for serious illnesses:

For inpatients who participate in medical insurance, the one-time or annual cumulative reportable medical expenses exceed 5,000 yuan, that is, 65% of 5,001-10,000 yuan, and 70% of 10,001-18,000 yuan. The annual compensation limit of town-level cooperative medical inpatient and uremia outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy is 10,000 yuan.

Fourth, medical insurance reimbursement instructions:

1. The use of special medical materials or disposable medical materials with a unit price of more than 1,000 yuan, as well as the installation and replacement of artificial organs, shall be co-ordinated by the basic medical insurance and paid 90% according to the domestic universal type;

2. The basic medical expenses of chronic renal failure in outpatient dialysis, anti-rejection drugs in outpatient clinics after organ transplantation, and malignant tumors in outpatient chemotherapy, radiotherapy, intervention** or radionuclide** shall be paid by the basic medical insurance**.

3. 80% of the cost of outpatient special examination is paid by the basic medical insurance, and 20% is paid by the individual;

4. Continuous payment is linked to the reimbursement ratio, the reimbursement ratio increases to 71% after the insured person has been insured for 2 consecutive years, and the reimbursement ratio increases to 72% after 4 consecutive years of insurance, and so on.

Legal analysis: The cost of chemotherapy can be reimbursed by medical insurance, but not in full. 1. If the cancer patient participates in the employee medical insurance, then only a certain proportion of the compensation and reimbursement can be made afterwards.

The maximum annual payment limit of medical insurance for urban employees is 500,000 yuan; If the cancer patient participates in NCMS, the reimbursement rate is generally 80%. 2. If cancer patients go to other places for medical treatment, the proportion of reimbursement is smaller, such as NCMS, 80% for local medical treatment and 30% for remote medical treatment. There may be cities where the reimbursement rate for medical treatment in other places will be lower.

3. In the special outpatient clinics of China's medical insurance, the costs of radiotherapy and chemotherapy for various malignant tumors have long been included in the scope of medical insurance reimbursement. However, it should be noted that for imported chemotherapy drugs, general medical insurance will not reimburse.

Legal basis: Regulations of the People's Republic of China on Basic Medical Insurance for Urban Employees

Article 23: Employers must not increase funds in their personal accounts for their employees or other personnel in violation of the provisions of these Regulations.

Article 29 The medical expenses above the minimum payment standard and below the maximum payment limit shall be mainly paid by the overall plan, and a certain proportion shall be borne by the individual. Appropriate consideration is given to the proportion of medical expenses borne by retirees. The scope of serious illness, the specific standard of the minimum payment standard and the maximum payment limit, and the proportion of medical expenses above the minimum payment standard and below the maximum payment limit shall be determined by the provincial people.

Legal analysis: Radiotherapy and chemotherapy medical insurance can reimburse part of the cost. Chemoradiotherapy is now a major means of cancer, and these chemoradiotherapy drugs are gradually included in the normal medical insurance scope by medical insurance, which greatly reduces the burden on patients.

Of course, it is best to go to the local hospital for consultation on the specific drugs used and the reimbursement ratio.

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 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.

Legal Analysis: Reimbursable Available! The general workers' medical insurance can reimburse about 60%, and the agricultural cooperative system is only more than 20%, except for self-financed drugs.

It is recommended to handle critical medical care, so that a hospital and a pharmacy can be designated, because medical insurance can only be reimbursed for hospitalization, with intensive medical care, the outpatient clinic of the designated hospital can also be reimbursed, and the designated pharmacy can also be reimbursed for buying medicines, and the reimbursement part is directly deducted when the payment is made.

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

According to the new medical insurance policy, patients with radiotherapy and chemotherapy can apply for medical insurance reimbursement.

At present, chemoradiotherapy can be reimbursed within the scope of medical insurance in China. Chemoradiotherapy, as a method of cancer, can effectively help patients control the growth and spread of cancer. Nutritional support for chemoradiotherapy helps to improve the patient's immunity, enhance physical strength, and help the patient get through the difficult period of chemoradiotherapy.

Radiotherapy and chemotherapy medical insurance can reimburse part of the cost. At present, radiotherapy and chemotherapy drugs are gradually being included in the normal medical insurance scope to reduce the burden on patients.

However, the specific drugs used in radiotherapy and chemotherapy and the proportion of reimbursement by medical insurance are generally different in different regions, so you need to consult local medical institutions. Radiotherapy and chemotherapy must go to a regular hospital, so that the possibility of reimbursement and the reimbursement rate will be higher. There are certain restrictions on the scope of medical insurance reimbursement, and reimbursement can only be made for purchases of drugs at designated medical institutions** and designated pharmacies.

For the purchase of drugs, not all drugs can be reimbursed, especially imported drugs, as well as drugs needed for major diseases, many of which are not reimbursed.

There is also a prescribed scope for service facilities, which can only be reimbursed within the prescribed standard range, mainly including hospitalization fees, outpatient expenses, etc., such as nursing fees and escort fees, which are not reimbursed.

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.

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 departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses for medical treatment in other places, so as to facilitate the insured persons to enjoy basic medical insurance benefits.

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 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.