Can CT scans for chronic diseases be reimbursed?

There is really no one-size-fits-all yes or no to this question. Whether you can reimburse and how much you reimburse depends on your current specific situation and whether you comply with the reimbursement rules of medical insurance.

A while ago, I accompanied my uncle, who has suffered from hypertension for 12 years, to take a head CT scan. He has been feeling dizzy recently and is afraid of lacunar cerebral infarction. The examination order ordered at a designated community hospital was coordinated by the employee medical insurance clinic. The total cost was more than 280 yuan. In the end, I only paid 110 yuan, which is almost 60% of the cost.

Don’t think that this means that all CT scans related to chronic diseases can be reimbursed. My best friend’s father has had COPD for almost 8 years. Last month I went to a physical examination institution to make an appointment for a chest CT scan to check for pulmonary nodules, but I didn’t get paid a penny. The physical examination items themselves are not in the medical insurance reimbursement catalog. Even if you are really for monitoring chronic diseases, as long as you take a physical examination package and not a diagnosis and treatment examination at a designated hospital, you basically can’t get it.

There are still many people who have stepped into the pitfalls of chronic disease registration. I met a sister suffering from rheumatoid arthritis in the rheumatology department of the hospital. She wanted to take a joint CT to see the progress of the disease, but ended up paying for it all at her own expense. The reason was that in her chronic disease registration, this type of CT examination was not included in the reimbursement scope of the corresponding disease. Her general outpatient co-ordination quota had been used up that year, so naturally she could not apply. If you are insured by residents' medical insurance, you should pay more attention. In many areas, residents' medical insurance has very low or no general outpatient co-ordination, and only hospitalization can be reimbursed. In this case, you have to pay for outpatient CT scans unless you go through the chronic disease channel.

There is now a lot of discussion about the scope of reimbursement for CT scans for chronic diseases. Many patients with chronic diseases who need follow-up all year round feel that patients with pulmonary fibrosis, COPD, and coronary heart disease need to have CT scans 2-3 times a year, which costs several hundred each time. If they do not have special diseases, they have to pay for them out of their own pocket, which is really stressful. Follow-up CT scans necessary for such chronic diseases should be included in the reimbursement scope of general outpatient clinics.； However, some practitioners in the medical insurance system said that the medical insurance fund has such a large plate, and priority must be given to reimbursement needs for serious illnesses and hospitalizations. If all routine examinations are exempted from reimbursement, it may squeeze out more urgently needed security resources. How to balance this needs to be slowly explored.

If you are not sure whether your situation can be reimbursed, ask the doctor who issued the bill before taking the photo, or call the hotline of the local medical insurance bureau to ask for clarification, so as to avoid the worry of not being reimbursed in the end.