Chronic disease online declaration

At present, most medical insurance coordinating areas across the country have opened an online application channel for chronic disease (chronic special disease) treatment qualifications. There is no need to queue at the offline window. Applications can be submitted through the local medical insurance APP, official WeChat/Alipay applet, and national medical insurance service platform APP. The average processing time is reduced by more than 70% compared with offline applications. Some high-risk diseases can be processed on the same day. After the application is passed, you can enjoy outpatient chronic disease medical insurance reimbursement according to regulations.

Last year, when I helped my mother-in-law, who has suffered from type 2 diabetes for almost 10 years, to apply for the application, I was still half-believing. I heard from a neighbor in the community that when she applied for the application the year before last, she went to the community to get a certificate, went to the attending doctor to sign, and went to the medical insurance bureau to queue up with a stack of medical records. It took almost half a month to get it done. At that time, I uploaded her blood sugar monitoring records for the past six months and the discharge summary from a tertiary hospital as prompted by the provincial medical insurance bureau's mini-program. I filled in the basic information and submitted it. The next day, I received a text message confirming the approval. When I went to prescribe anti-diabetic drugs next month, I originally spent more than 300 yuan per month on medication, but I only paid more than 60 yuan for the chronic disease reimbursement, which really saved a lot of things.

Interestingly, the evaluations of different groups on the actual experience of online filing are quite different.

Most of the staff at the grassroots medical insurance handling window think this is a good thing. I went to the district medical insurance bureau to handle other business and had a chat with the window staff. She said that in the past few years, the declaration of chronic and special diseases accounted for at least 30% of the window's business volume, especially at the end of the year.

But on the other hand, many middle-aged and elderly patients have a lot to vomit. Last week, I chatted with Sister Zhang from a community medical insurance agency. She said that she now receives more than 20 calls every day for consultation on online declaration. Most of them are elderly people asking "how to upload photos" and "why I submitted and returned it" - many elderly people do not know how to use smartphones, and the medical records taken are either blurry enough to see the doctor's signature, or they do not know that the examination report of the past six months is to be uploaded, and the medical records from three years ago have been repeatedly rejected several times, but they feel that it is more troublesome than going offline. I came across a post from a netizen a while ago, saying that his online application was approved, but when he went to the pharmacy near his home to buy medicine, the system could not show his chronic disease qualifications. It took him two trips to the medical insurance bureau to fix it. The data in the two systems were not synchronized. This kind of occasional bug cannot be completely avoided now.

Public data from the National Medical Insurance Administration in 2023 show that the national coverage rate of online declaration of chronic special diseases has reached 87%. Among them, 12 types of high-incidence chronic special diseases such as hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors have achieved a nationwide "inter-provincial" online declaration port. However, the implementation models in various places are actually very different, and there is no "standard answer": Several pilot cities in Zhejiang are now promoting "no infection declaration". The medical insurance system uses big data to capture your hospital visits and drug purchase records. If you meet the criteria for chronic disease identification, you will be directly and proactively opened for qualifications without having to go through any procedures yourself. Last year, nearly 200,000 local patients directly and "passively" enjoyed the benefits. ； However, some medical insurance research scholars have expressed different opinions, saying that big data screening inevitably has errors. For example, some people only have a transient increase in blood sugar and are misjudged by the system as diabetes and included in the chronic diseases. This will instead waste medical insurance funds. Therefore, this model is currently only piloted on a small scale and has not been fully promoted. More cities are now taking a compromise route: after submitting the application online, if the materials are incomplete, the system will automatically remind you that you can go to the nearest community agency to resubmit the paper materials. You do not need to go to the district medical insurance bureau more than ten kilometers away. In our community, Sister Zhang now holds a one-hour free application assistance class in the activity room every afternoon. The old man brought the medical records, and she helped scan and upload them. In half a month, she helped process more than 70 applications. The pass rate is 60% higher than the old man who submitted it himself.

By the way, a reminder, don’t trust the kind of intermediaries on the Internet who charge hundreds of dollars to “prepare chronic and special disease qualifications on their behalf.” To put it bluntly, they just help you fill out a form and send information. Another tip is that medical insurance applets in most areas are now linked to the hospital's electronic medical records. If your examination report is lost, you don't have to go to the hospital to get it replaced. You can directly select "Retrieve Electronic Medical Records" on the declaration page to directly retrieve the medical records in the hospital system. This is what I did when I helped my aunt declare rheumatoid arthritis last time, which saved a lot of trouble.

In the final analysis, the online declaration itself is to implement "let the data escape", but it is still in the climbing period, and it is impossible to adapt to everyone's needs: if you can use a smartphone, take pictures of the relevant medical records and inspection reports of the past year clearly in advance, and follow the system prompts to upload them step by step, you can basically complete it smoothly.； If you really can't figure out the way, it is much better to go to the community and ask questions than to break your legs in the past. As for the different ranges of diseases and reimbursement ratios in different places, you can see the specific local rules directly on the declaration page, without having to look for information everywhere.