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Anonymous users2024-02-15Because of basic medical insurance.
Unlike commercial medical insurance, which sets a certain scope of coverage, as long as it is not a traffic accident or self-injury, it can usually be reimbursed. However, reimbursement is only available in the case of hospitalization, and it is not reimbursable if it is only in the outpatient setting.
In addition, it should be noted that if you want to be reimbursed by medical insurance, you must go to a designated hospital, and medical insurance must exceed the minimum threshold before you can be reimbursed, and you need to bear your own medical expenses below the standard of payment. There is also a cap on medical reimbursement, and the part that exceeds the cap line cannot be reimbursed.
The treatment of fall injuries should be based on the degree of the fall, and the specific treatment should be as follows:
1. If there is a broken wound after a fall, the wound should be cleaned and disinfected immediately, such as iodophor.
Iodine wine and alcohol should be used to clean the wound, and the wound can be properly bandaged after cleaning, and sutured if necessary;
2. If the pain is severe and swollen after the fall, it is recommended to go to the hospital immediately to determine whether there is a fracture.
If no fracture is caused, only soft tissue injury, cold compress can be applied within 48 hours, and cold ice packs or towels can be used to compress the affected area to achieve the purpose of constricting local blood vessels, reducing swelling and relieving pain;
3. If there is a fracture, it needs to be fixed with a plaster cast or surgery**, and a hot compress can be applied after 48 hours to help local congestion.
Absorb. In addition, oral pain medications can be taken appropriately, or sprayed ** bruises.
aerosols, etc.**.
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Anonymous users2024-02-14You're in an accident.
According to the scope of urban residents' medical insurance, we can clearly know that urban residents' medical insurance can reimburse medical expenses caused by accidents, but accidental injuries include accidental death and accidental disability, and this kind of reimbursement is not within the scope of urban residents' medical insurance.
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Anonymous users2024-02-13Legal analysis: If the situation of falling while riding a bicycle does not meet the content stipulated in Article 30 of the Social Insurance Law, and the expenses that need to be reimbursed fall under the circumstances stipulated in Article 28 of the Social Insurance Law, medical insurance can reimburse it.
Legal basis: According to Article 28 of the Social Insurance Law of the People's Republic of China, the 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.
According to Article 30 of the Social Insurance Law of the People's Republic of China, the following medical expenses are not included in the scope of payment of basic medical insurance**: (1) should be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall 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.
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Anonymous users2024-02-12Hello. Cycling and falling injuries cannot be reimbursed by medical insurance, generally because the patient is due to traffic accidents and other reasons, there is a third-party liability, in this case, a third party (that is, the victim) is required to bear the economic compensation liability, medical insurance does not reimburse, but if there is no third-party liability, that is, because of an accidental riding fall, then the medical insurance can be reimbursed. After being admitted to the hospital after a bicycle fall**, the attending doctor of the hospital will generally issue an admission application form, stating the patient's main injuries and the identification of the traffic police.
Among them, the content of the traffic police identification also needs to go to the local traffic management department (the place where the fall was injured) for identification, which is used to prove whether it is because of a traffic accident that causes a bicycle fall injury, or because of an accident that causes a riding injury, if it is because of an accident, you can directly reimburse it with medical insurance in the hospital.
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Anonymous users2024-02-11According to the provisions of relevant laws, if an employee or resident who participates in basic medical insurance is injured or sick due to the tortious act of a third party, the medical expenses shall be borne by the third party in accordance with the determined size of the responsibility. The medical expenses exceeding the liability of the third party shall be paid by the medical insurance** in accordance with national regulations. At present, there are 4 types of medical expenses that are not included in the scope of basic medical insurance** payment:
1.should be paid out of work-related injury insurance**; 2.It should be borne by a third party; 3.
should be borne by public health; 4.Those who seek medical treatment outside of China. Therefore, if the accident is injured, the tortfeasor shall bear the burden.
One of the reasons for non-reimbursement: the policy stipulates that the medical expenses of traffic accidents will not be reimbursed by medical insurance is reasonable, and the damage caused by traffic accidents is generally compensated by the infringer.
Legal basis: Article 119 of the Road Traffic Safety Law has a special interpretation of traffic accidents, and "traffic accidents" refer to the events of personal or property damage caused by the fault or accident of the vehicle on the road. Vehicles include bicycles, and falling on a bicycle is considered an independent traffic accident.
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Anonymous users2024-02-10Legal analysis: The reason why medical insurance cannot be reimbursed for cycling falls may be because the medical expenses do not meet the threshold standard.
According to the law, Article 30 of the "Medical Insurance Regulations" stipulates that the medical expenses below the minimum payment standard and the maximum payment limit shall not be paid by the overall planning.
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Anonymous users2024-02-09If the fracture is caused by a cycling injury, the cost of NCMS can be reimbursed.
Guidance: But.
When you are admitted to the hospital, you need to register according to the procedures of the agricultural cooperative system, and if you do not register at that time, you will not be reimbursed after discharge. If it was registered at that time, after discharge, the NCMS office will be able to reimburse the expenses according to the reimbursement ratio after investigation and evidence collection.
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Anonymous users2024-02-08Can medical insurance reimburse injuries caused by traffic accidents?
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Anonymous users2024-02-07NCMS reimbursement process:
Information required for reimbursement:
1.Outpatient reimbursement information: outpatient invoice, cooperative medical certificate (or medical record).
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 certificate records.
4.Handling special disease carrying materials: special disease outpatient ** proposal, cooperative medical certificate record, medical record, relevant laboratory report, ** two.
Reimbursement process:1After the insured household prepares the required materials for reimbursement, it will be handed over to the village (community) cooperative medical liaison, who will review and report to the town cooperative medical liaison, and the town liaison will send it to the district agricultural office settlement and reimbursement center for reimbursement. Guidelines for the reimbursement of new rural cooperative medical care.
2.Direct reimbursement by the hospital: When hospitalization due to illness goes through the hospitalization procedures, a new type of rural cooperative medical certificate will be issued to the hospital to directly participate in the reimbursement.
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Anonymous users2024-02-06Legal analysis: The traumatic injury of falling on a bicycle is hospitalized and the situation is an accidental fall and is covered by medical insurance. However, in order to be reimbursed by medical insurance, the premise is that you have been insured before the injury, and you have a full set of procedures for hospitalization** after the injury.
Legal basis: Article 2 of the Social Insurance Law The State shall establish a social insurance system such as basic chain pension 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 the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.
Urban and rural residents can be reimbursed for medical insurance outpatient services, but the insured also needs to go to the designated medical institutions for treatment, and the outpatient medical expenses incurred can be reimbursed. In addition, there are also minimum payment line standards and reimbursement limit for outpatient reimbursement of medical insurance for urban and rural residents, so if the outpatient expenses incurred are below the threshold or exceed the reimbursement limit, they cannot be reimbursed. Generally speaking, for reimbursement of medical insurance outpatient services for urban and rural residents, you only need to bring a special prescription for medical insurance and a social security card to the resident medical insurance settlement counter for reimbursement and settlement.
Legal analysis: Resident medical insurance can reimburse these items: medical insurance reimbursement is divided into four types, namely general outpatient, inpatient, chronic disease and outpatient specific items. >>>More
After the medical insurance reimbursement, you can also be reimbursed by insurance, because commercial insurance is part of the medical insurance, and the rest is commercial insurance, and the insurance can be reimbursed, so we don't have to be afraid, we must look at the terms of our insurance company, is it commercial insurance or what insurance class? After most insurance companies reimburse more than 10,000 yuan, and then the insurance company reimburses it very reasonably and reasonably.
No, the cost of medicine required for gastroscopy is covered by medical insurance, and the anesthetic part required for gastroscopy is a self-paid item, which can be reimbursed within 500 yuan. Gastroscopy is generally not covered by medical insurance, so this is at your own expense, and you can be partially reimbursed for taking a prescription to a township health center to get medicine after the examination. >>>More
The reimbursement scope of medical insurance refers to the scope of reimbursement of drug catalogs, diagnosis and treatment items and medical service facilities in order to ensure the basic medical needs of the insured and standardize the management of drugs, diagnosis and treatment and other aspects of basic medical insurance. The medical expenses incurred by the insured in the designated hospital in accordance with the three major catalogs shall be paid by the medical insurance** in accordance with the regulations. >>>More