Chronic disease credit inquiry

When ordinary insured persons inquire about the reimbursement amount for chronic diseases, there are only four formal channels through which effective results can be obtained at the moment - the official online platform (mini program/APP) of the medical insurance bureau of the insured place, the medical insurance window of the designated hospital for chronic diseases registered by the insured person, the offline medical insurance handling hall of the insured place, and the medical insurance system of the designated retail pharmacy for chronic diseases bound by the insured person. All query results are subject to the real-time system data of the medical insurance agency. The results found through unofficial channels are for reference only and do not have the effect of calculating benefits.

Don’t think I’m being alarmist. Last week, I accompanied 62-year-old Aunt Zhang downstairs to prescribe antihypertensive medication. She checked on a life service APP the day before and found that her chronic disease limit was only 327 yuan. She thought that it would not be enough to prescribe medicine for two months, so she brought extra cash. When she swiped at the hospital window, the system showed that there was still 1,180 yuan left, which was a minor mistake. Later, after asking the staff at the medical insurance window, I learned that the data on the third-party platform was not synchronized in real time, and some even updated it only once every half a month, which was not accurate at all. It’s interesting to say that I was chatting with friends from the Medical Insurance Bureau before, and they said that eight out of ten people who come to check their credit limit are tricked by erroneous data from third-party platforms, so they now have prompts on the windows and only accept the results from official channels.

If you are used to doing things online and are too lazy to go offline, you can just search the official medical insurance applet of the insured place. For example, friends from Guangdong search for "Guangdong Medical Insurance", and people from Zhejiang directly search for the medical insurance section in the "Zhejiang Office" and click in to find the entrance to "Outpatient Chronic Disease Benefit Inquiry". Not only can you see the total annual limit and remaining available limit, but also the details of each chronic disease reimbursement this year, what medicines were prescribed, and how much was reported. However, a reminder, you may encounter data delays when checking within 24 hours after the medicine is prescribed. Last month, I helped my dad check the insulin reimbursement record. The medicine that was just prescribed in the hospital the afternoon before was only updated online the next morning. Don’t think there is a problem with the system just because the amount has not been deducted. It is in vain.

Of course, not everyone likes to do this online. My mother always feels that the things on her mobile phone are too empty. She always checks the limit as a convenience. Every time she goes to the designated chronic disease pharmacy downstairs to buy metformin, before checking out, she asks the teller to swipe the medical insurance card and the remaining limit can be reported immediately. If the limit is enough, she can directly use the medical insurance deduction, eliminating the need to go to the medical insurance bureau. However, there is a prerequisite for this method. The pharmacy you go to must be a designated chronic disease center that has been registered by you. Your chronic disease treatment information cannot be found in the system of pharmacies that have not been registered. Don’t just go to any pharmacy and ask, as they will not be able to check it for you.

I met someone at the Medical Insurance Bureau who complained before, saying that it was a waste of time to go to the window to check the credit limit, but you really have to go offline if the credit limit doesn't match. Last month, an uncle angrily ran to the medical insurance window and said that his high blood pressure credit had been stolen and he was about to run out of medicines even though he had not prescribed a few prescriptions. As a result, the staff gave him the reimbursement details for the past six months, and every payment was signed and recorded. Finally, he remembered that his wife had used his card to prescribe the same type of imported antihypertensive medicine last month. He turned around and forgot, and it was a waste of time. In this situation where details need to be checked, either the complete records cannot be found online, or the updates are not timely. The stamped details pulled from the offline window are the most accurate.

By the way, let me give you an easy pitfall: the chronic disease quota calculation cycle is not uniform at all across the country. Don’t just believe what is said on the Internet that it will be reset on January 1st every year. In some places, the calculation is based on the calendar year, cleared at the end of each year, and reset directly in the second year, but in some places, the calculation starts from the day your chronic disease registration is passed, and the period is pushed back 12 months. I met a young man who came to work here before. His chronic disease allowance in his hometown was calculated based on the filing period. He couldn't find it in the medical insurance system at the place where he worked. He directly called the 12393 medical insurance hotline in the insured place and found it in two minutes after reporting his ID number. There was no need to run back to his hometown.

To be honest, there are not so many bells and whistles about checking the credit limit for chronic diseases. If you just want to know something about it, you can check it online or go to the drugstore and ask casually. If you want to apply for special reimbursement, or feel that the credit limit is calculated incorrectly, go directly to the offline medical insurance window. Don’t click on those unofficial query links. Be careful of the information on your medical insurance card being spoofed. The loss outweighs the gain.