How to reimburse outpatient examination fees for chronic disease review

As long as the re-examination examination fees are carried out in designated medical insurance institutions and fall within the scope of the local chronic disease outpatient protection catalog, they can be reimbursed through the chronic disease outpatient service. In most scenarios, they can be settled directly at the hospital charging window, without the need for additional manual reimbursement processes.

A while ago, I accompanied my uncle who suffered from chronic obstructive pulmonary disease at home for a re-examination. He always thought that he could only get reimbursement for chronic diseases by prescribing medicine. This time, the lung function and chest CT done added up to more than 500. He directly paid more than 400 through the medical insurance at the window. He was stunned. He said that the examination fees for the previous two years of re-examination were all paid out of his own pocket, and he lost thousands of dollars in vain.

There is actually a prerequisite here, that is, you must first complete the chronic disease qualification certification in the insured place, have a valid chronic disease certificate in hand (many places have switched to electronic vouchers, no physical cards are needed), and the institution that performs the examination is a designated chronic disease medical institution that you have selected in advance. I helped a friend handle a reimbursement appeal before. He is a type 2 diabetic patient. He felt that the community hospital he chose was not well-equipped, so he went directly to a tertiary hospital for glycosylated hemoglobin and fundus examination. Because he did not go through the change of chronic disease designated area in advance, the examination fee of more than 1,000 was paid out of pocket, and he could only enjoy the benefits after changing the designated area in the second year.

As for which examinations can be reimbursed and which cannot, there is no unified catalog across the country, and the degree of tightness varies quite a lot from place to place. This is why many people feel that the reimbursement rules are confusing. For example, for the same review of hypertension, some provinces have included all complication screening items such as homocysteine ​​and carotid artery color ultrasound into the scope of reimbursement. Some places only recognize basic blood pressure monitoring, liver and kidney function, and blood lipids. If you encounter a situation where the prescribed items cannot be reported, don’t just assume that it is your own problem. Go to the hospital’s medical insurance department to check the local chronic disease catalog. If it is indeed outside the catalog, it is not too late to pay.

Speaking of this, friends who have lived abroad all year round must ask, I cannot return to the insured place for review, can I still claim the money? In the past two years, the country has been promoting direct settlement of chronic disease outpatient clinics in other places. As long as you register for remote medical treatment in advance with the medical insurance bureau of the insured place, and the hospital you go to has also opened the off-site chronic disease settlement authority for the corresponding disease, whether it is prescription or re-examination, you can directly swipe your card for reimbursement just like you would in the local area. At present, more than a dozen diseases such as hypertension, diabetes, and malignant tumor outpatient radiotherapy and chemotherapy have realized nationwide off-site settlement. If the chronic disease you suffer from is not within this range, you can also save the examination report, charge receipt, prescription and copy of the chronic disease certificate, and send it back according to the time required by the insured place for manual reimbursement. However, the arrival time will be slower, usually 1 to 2 months.

I have also seen many people step into the pitfalls of the validity period of the chronic disease certificate at the medical insurance agency. In many places, the validity period of the chronic disease certificate is 3 to 5 years. If the annual review is not done at the expiration date, the chronic disease benefits will be automatically suspended. Even if you have all the right projects and designated points, you will not be able to claim the fee. In fact, the annual review is very simple. In many places, it can be done in the medical insurance applet of WeChat or Alipay. You only need to upload the follow-up records for the past six months without going offline.

If you are really afraid of stepping into a trap, the next time you go to the doctor to write a review order, casually mention that you have chronic disease benefits and ask if the project can be reimbursed for chronic diseases. Doctors who often sit in outpatient clinics are familiar with the local directory and can help you avoid a lot of unnecessary expenses.