Why is the outpatient fee not reimbursed by NCMS?

NCMS. The reimbursement of outpatient expenses is not reported because it is the outpatient medical expenses of non-designated hospitals in the district, except for the outpatient expenses of special diseases, the expenses arising from the failure to seek medical treatment in accordance with the regulations, and the purchase of drugs; Or the information is incorrect, etc.

The information required for reimbursement is as follows:

1. Outpatient reimbursement materials: outpatient invoices, cooperative medical certificates or medical records.

2. Hospitalization reimbursement materials: hospitalization invoices, cooperative medical certificates or medical records, detailed list of expenses, discharge summary, and other relevant certificates.

3. Outpatient special disease reimbursement materials: outpatient invoices, special disease cooperative medical certificates.

4. Carry information for special diseases: special disease outpatient proposals, cooperative medical certificates, medical records, relevant laboratory reports, and two documents.

Medical insurance is the basic welfare of the state, whether you are sick or not, you can buy it, but medical insurance.

The coverage is very limited, and the medical insurance reimbursement coverage.

The amount is limited, in the face of serious illness, medical insurance alone is not enough, you can consider matching your own commercial medical insurance on the basis of medical insurance to ensure that you can get more comprehensive protection. After all, in case of a serious illness, many drugs with quick effects or surgical instruments with good efficacy cannot be reimbursed. These costs are generally hundreds of thousands or even hundreds of thousands, which is a lot of pressure.

If you have a million medical insurance, you can be reimbursed directly.

Medical insurance refers to an insurance in which the insurance company agrees on medical expenses between the two parties and takes this as a condition for the payment of insurance benefits, and when the insured person seeks medical treatment in the event of illness or accident, the insurance company shall compensate the insured according to the agreement to compensate the corresponding proportion of the insurance money. The scope of coverage includes: medical expenses, hospitalization expenses, surgical expenses, medical equipment expenses, nursing expenses, etc.

However, it is necessary to pay attention to the protection liability and renewal conditions, the wider the renewal conditions, the better, and the deductible.

The lower the better, and pay attention to the value-added services as comprehensive as possible: purchased drugs, self-weighted ions, and out-of-hospital targeted drugs.

Reimbursement, as well as support for medical expenses advance payment function.

There is also critical illness insurance, which is critical illness insurance.

To put it simply, if you buy critical illness insurance and are diagnosed with a critical illness within the scope of the policy, then the insurance company will pay a lump sum payment. Among them, the China Banking and Insurance Regulatory Commission.

The 28 types of critical illnesses will be covered under the critical illness insurance to enhance the protection of the critical illness insurance policy.

Critical illness insurance and medical insurance are complementary to each other, with medical insurance being reimbursement and critical illness insurance being payout. It can help us play a vital role in the face of serious diseases.

NCMS reimburses inpatient medical expenses. For direct hospitalization in a municipal hospital, the reimbursement ratio of NCMS is higher than that of cross-city hospitals, the higher the reimbursement is for hospitalization in the original household registration, the lower the reimbursement for cross-city hospitalization, and the lower the reimbursement for inter-provincial hospitalization.

The health center of Nanwu Town, Yanling County, now goes to see a doctor and takes medicine, and the doctor says that the expenses are at his own expense and will not be reimbursed, why?

NCMS can reimburse outpatient clinics, however, NCMS outpatient clinics can only reimburse the prescribed expenses and proportions.

First, we first need to understand what is the new type of rural cooperative medical care

The new type of rural cooperative medical care (hereinafter referred to as "NCMS") refers to the system of mutual medical assistance and mutual aid for farmers that is organized, guided and supported, voluntarily participated by farmers, raised by individuals, collectives and multiple parties, and mainly based on the overall planning of serious diseases. It raises funds in the form of individual payment, collective support and funding.

In October 2002, China clearly proposed that all levels should actively guide farmers to establish a new type of rural cooperative medical system based on the overall planning of serious diseases. In 2009, an important strategic plan was made to deepen the reform of the medical and health system, and the status of the new rural cooperation as the basic medical security system in rural areas was established. On January 29, 2015, the National Health and Family Planning Commission and the Ministry of Finance issued a notice on doing a good job in the 2015 new rural cooperative medical work, proposing that the per capita subsidy standard for the new rural cooperative medical system at all levels will be increased by 60 yuan on the basis of 2014 to 380 yuan.

In 2017, the per capita subsidy standard for NCMS at all levels was increased by 30 yuan on the basis of 2016 to 450 yuan, of which: ** The new part of the government will be subsidized according to the proportion of 80% in the western region and 60% in the central region, and a certain proportion of subsidies will be provided to each province in the eastern region. The standard of individual farmers' payment will be increased by 30 yuan on the basis of Souzhou in 2016, and in principle, the national average will reach about 180 yuan.

Explore the establishment of a stable and sustainable financing mechanism commensurate with the level of economic and social development and the affordability of all parties.

Among them, we need to pay attention to the fact that in a person's life, disease is inevitable, and it is difficult for people to carry out the time, type and degree of disease occurrence, so participating in medical insurance can effectively share the risk of disease and improve the medical security capacity of the whole society.

2. The medical expenses that can be reimbursed by NCMS include:

1.Inpatient medical expenses within the regulations;

2.Outpatient medical expenses within the regulations, including outpatient clinics for special diseases, general outpatient clinics, statutory accident injury outpatient clinics for college and secondary school students, ordinary students and minor insured persons;

3.Subsidies for maternity medical expenses (including prenatal examination fees), etc.

The reimbursement ratio of NCMS outpatient clinics refers to the leakage (taking Changsha as an example):

1.The village clinic can be reimbursed 70% of the only knowledge, and 30% of the individual is responsible;

2.Township health centers and community health service centers can be reimbursed 60%, and individuals are responsible for 40%;

3.70% of the reimbursement can be made for college hospitals and infirmaries, and 30% of the insured college and secondary school students and ordinary students who are insured by the school as a unit.

The maximum reimbursement limit for outpatient medical expenses incurred within the scope of medical insurance in a billing year is 800

In addition to reimbursement of outpatient expenses, NCMS can also reimburse inpatient medical expenses, maternity medical expenses and serious illness medical treatment, while the reimbursement of NCMS in different regions is different, and the specific local laws shall prevail.

Legal Analysis: The following situations are not included in the scope of reimbursement for the new rural cooperative medical care:

1) Outpatient medical expenses of non-designated hospitals in the district (except for outpatient expenses for special diseases), expenses arising from failure to seek medical treatment in accordance with regulations, and self-purchase of drugs;

2) Expenses required for family planning measures and medical expenses in violation of family planning policies;

3) Dental prosthesis, orthodontics, optometry and glasses, hearing aids, artificial organs, cosmetology, cosmetic and orthopedic surgery, sexual medical treatment (such as qigong, massage, massage, physiotherapy, magnetic therapy, etc.), as well as various accompanying expenses, medical transportation expenses, home visit fees, other miscellaneous expenses during hospitalization, etc.;

4) Where there is third-party liability, the medical expenses arising from personal injury are to be borne by the third-party responsible party in accordance with law, such as traffic accidents, medical accidents, work-related injuries, and so forth;

5) Medical expenses incurred for injuries caused by illegal acts such as suicide, self-harm, drug use, drug use, and fighting, as well as intentional acts of their families;

6) Medical expenses incurred during the period of going abroad or in Hong Kong, Macao and Taiwan;

7) Drugs and items that are not reimbursed according to the provisions of the medical insurance system for urban employees;

8) Other expenses that are not to be reimbursed as determined by the District Hospital Management Committee.

Legal basis: Social Insurance Law of the People's Republic of China 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 national regulations.

Summary. Hello, thank you for your consultation, about your questions, for you to answer the following: NCMS is a social security system launched by the first to help rural residents improve their health and improve the medical environment of rural residents.

However, NCMS does not reimburse outpatient medical expenses for the following reasons: First, the reimbursement scope of NCMS is limited, and only reimburses inpatient expenses, not outpatient medical expenses. Second, the reimbursement amount of NCMS is limited, and the reimbursement amount is not enough to cover the cost of outpatient treatment.

Third, the reimbursement standard of NCMS is limited, and the reimbursement standard cannot meet the needs of outpatient treatment. Fourth, the reimbursement procedures of NCMS are complex, the reimbursement procedures are complex, and the approval time is long, which is not conducive to outpatient treatment. 殺

Hello, thank you for your consultation, about your questions, for you to answer the following: NCMS is a social security system launched by the first to help rural residents improve their health and improve the medical environment of rural residents. However, Xinnong does not reimburse outpatient medical expenses for the following reasons:

First, the reimbursement scope of NCMS is limited, and only inpatient expenses are reimbursed, and outpatient medical expenses are not reimbursed. Second, the reimbursement amount of NCMS is limited, and the reimbursement amount is not enough to cover the cost of outpatient treatment. Third, the reimbursement standard for Xinnong early fibrillation is limited, and the reimbursement standard cannot meet the needs of outpatient treatment.

Fourth, the reimbursement procedure of NCMS is complicated, the reimbursement procedure is complex, and the approval time is long, which is not conducive to outpatient treatment. 殺

Dear Peihuai, hello Slow Sen, thank you for your consultation, about your questions, for you to answer the following as follows: NCMS outpatient treatment is not reimbursed, due to the NCMS reimbursement scope, reimbursement amount, reimbursement standards, reimbursement procedures and other factors to determine the disturbance of the mu.

Dear, thank you for your consultation, may you be warm in winter, may you not be cold in spring, may you have lights in the dark, umbrellas in the rain, may you be accompanied by a lover on the road, and what you want can be realized. Talk

Because outpatient examinations do not use a social security card, they are generally not reimbursed.

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

Article 23 Workers and workers shall participate in the basic medical insurance for employees, and the employer and the workers 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 may 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.

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

Article 27 Individuals who participate in the basic medical insurance for employees and reach the statutory retirement age when the cumulative contributions reach the number of years prescribed by the state shall no longer pay the basic medical insurance premiums after retirement, and enjoy the basic medical insurance benefits in accordance with the provisions of the state; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state.

Summary. Hello dear, glad to answer for you. The reason why the reimbursement of NCMS outpatient expenses is not reported is that except for the outpatient medical expenses of special diseases, non-compliance with regulations, and self-purchased drugs, the expenses incurred in the outpatient medical expenses of the designated hospitals in the district; Or the information is wrong, etc.

Why NCMS does not reimburse outpatient treatment?

Hello dear, glad to answer for you. The reason why the reimbursement of NCMS outpatient expenses is not reported is that except for the outpatient medical expenses of special diseases, non-compliance with regulations, and self-purchased drugs, the expenses incurred in the outpatient medical expenses of the designated hospitals in the district; Or the information is wrong, etc.

Dear, NCMS is mainly to solve the problem of farmers' difficulty in seeing a doctor, and is mainly responsible for hospitalization, and is not currently responsible for outpatient reimbursement. It is believed that with the improvement of the national medical insurance system, it can be expected that the NCMS outpatient clinic will also be reimbursed in the future!