Can medical insurance reimburse trauma and surgery go through medical insurance?

It cannot be said in general terms that trauma is not reimbursable, but only within the prescribed scope. Those who meet the prescribed conditions can be reimbursed.

According to the relevant provisions of the state's medical insurance: self-medical treatment (no designated hospital for medical treatment or no referral form), self-purchased drugs, drugs that cannot be reimbursed by publicly-funded medical regulations and medical expenses that do not meet the requirements of family planning; Outpatient fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition fees, and blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations).

Other expenses such as heating and cooling expenses, ambulance expenses, special care expenses, etc.; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents, and medical malpractice; Orthopedics, plastic surgery, dental prosthesis, prosthesis, organ transplantation, roll call surgery fees, consultation fees, etc., are not covered by the limit. None of them are covered by medical insurance.

In the end, medical insurance can reimburse trauma and surgical hospitalization, but medical insurance can only partially reimburse it.

Of course. As long as the injury is hospitalized**, it can also be reimbursed.

For accidental injuries, if a third party is liable, medical insurance cannot reimburse it. The "Accident Measures" stipulate that only the following situations can be included in the scope of social medical insurance** payment: accidental injury of the insured person without a responsible person; Accidental injuries for which the insured person is found to be partially responsible by the relevant departments; In a criminal or public security case where the insured person is injured due to the illegal acts of others, after the judgment or ruling of the people's court, the responsible person fails to compensate in full, or the case has not been solved within 6 months from the date of the injury and the responsible person cannot be determined; Others where the responsible person fails to make full compensation after a judgment or ruling by the people's court.

If there is a third party responsible, the medical insurance will not reimburse, if there is no third party responsible, you need to provide medical records, and you can be reimbursed after the medical insurance department verifies it.

Can medical insurance reimburse trauma and surgery go through medical insurance?

As long as you are in a designated hospital under medical insurance**, the cost exceeds the minimum payment standard, you can be reimbursed.

If there is a third party responsible, the medical insurance will not reimburse, if there is no third party responsible, you need to provide medical records, and you can be reimbursed after the medical insurance department verifies it.

Hello, I found out that the trauma cannot be covered by medical insurance because the trauma is not covered by medical insurance. Self-medical treatment (no designated hospital or no referral form), self-purchased drugs, drugs that cannot be reimbursed by publicly-funded medical regulations, and medical expenses that do not comply with family planning; Outpatient fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition expenses, blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations), air-conditioning and heating fees, ambulance fees, special care fees and other expenses; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents, and medical malpractice; Orthopedics, plastic surgery, dental prosthesis, prosthesis, organ transplantation, roll call surgery fees, consultation fees, etc., are not covered by the limit.

Legal Analysis: Bukaisong can generally say that trauma cannot be reimbursed, and needs to be reimbursed within the prescribed scope. Those who meet the prescribed conditions can be reimbursed.

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 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 **.

Trauma medical insurance reimbursement is subject to availability and is as follows:

1. Trauma medical insurance can be reimbursed. If there is no third party liability for the trauma, the medical insurance can reimburse it;

2. Trauma is to see how the party is injured, if there is a third party responsible, medical insurance can not be reimbursed, if there is no third party responsible, medical insurance can be reimbursed, but it is necessary to provide medical records and other materials, medical insurance departments need to pay for verification; Medical reimbursement is generally received within 30 working days. The documents to be brought with you at the time of reimbursement are as follows:

1) Original ID card or social security card;

2) The original certificate of disease diagnosis issued by a specialist doctor of a designated medical institution;

3) Original medical information such as outpatient medical records, examination and test result reports;

4) The original receipt of outpatient charges of the unified financial and taxation medical institutions;

5) The detailed list of outpatient expenses printed by the hospital computer or the original payment prescription issued by the doctor;

6) Designated pharmacies: the original uniform invoice for the sale of tax commodities and the computer-printed list;

7) If it is handled on behalf of the agent, the original ID card of the agent needs to be provided.

Legal basisArticle 2 of the Social Insurance Law of the People's Republic of China.

The State shall establish a social insurance system 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 the 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 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.

Trauma is to see how you are injured, if there is a third party responsible for the medical insurance can not be reimbursed, if there is no third party responsible, medical insurance can be reimbursed, but you need to provide medical records and other materials, the medical insurance department needs to check.

Can trauma medical insurance reimburse, it should be possible, because there will still be this and that kind of illness outside the human body, and what or the cause of the disease on the limbs may occur, which is also a condition of trauma. It is also outside the body, and it is still within the scope.

Summary. Hello dear Trauma cannot go to medical insurance because trauma is not covered by medical insurance. Self-medical treatment (no designated hospital or no referral form), self-purchased drugs, drugs that cannot be reimbursed by publicly-funded medical regulations, and medical expenses that do not comply with family planning; Outpatient fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition expenses, blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations), air-conditioning and heating fees, ambulance fees, special care fees and other expenses;

Hello dear Trauma cannot go to medical insurance because trauma is not covered by medical insurance. Self-medical treatment (no designated hospital or no referral form), self-purchased crude medicines, drugs that cannot be reimbursed by publicly-funded medical regulations, and medical expenses that do not meet the requirements of family planning; Outpatient treatment and treatment fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition fees, stool stoves, blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations), air-conditioning and heating expenses, ambulance fees, special care fees and other expenses.

Is a fall a surgical one? Is it a surgical injury inside the cervical spine?

Generally speaking, after the fall, it should be hung up in surgery or emergency imitation department, but with the current classification and refinement of hospital departments, it is more scientific and reasonable to hang the corresponding department according to the location of the fall injury.

Surgical medical insurance is reimbursable. According to the law, the medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

2. Legal basis for Yu Zi: 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 facilities standards, as well as emergency, rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance **.

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.