Can medical insurance reimburse outpatient visits at traditional Chinese medicine hospitals?

Medical insurance can reimburse outpatient visits in traditional Chinese medicine hospitals, but the reimbursement ratio needs to be determined according to the doctor's affiliation.

If you are hospitalized, the town health center will reimburse 60%; the second-level hospital will reimburse 40%; the third-level hospital will reimburse 30%.

The reimbursement process after individuals pay medical insurance is generally as follows: 1. Medical treatment: When visiting a medical institution or purchasing medicines, you need to present relevant documents such as medical insurance card and ID card; 2. Preparation of reimbursement materials: After the medical treatment, you need to request it from the medical institution

Diagnosis and treatment records, medical orders, prescriptions, receipts and other relevant materials, and fill in the relevant reimbursement application forms; 3. Submit reimbursement application: Submit the prepared reimbursement materials and application forms to the local social security bureau or medical insurance center for reimbursement application.

You can also choose to apply for reimbursement online; 4. Review the reimbursement application: The local social security bureau or medical insurance center will review the submitted reimbursement application. After passing the review, the reimbursement amount will be credited to the personal bank account.

Scope of use of medical insurance cards: 1. When insured employees go to designated hospitals or pharmacies to purchase medicines, they can swipe the card on the POS machine with their password, but they cannot withdraw cash or make transfers.

That is, the use scope of urban medical insurance cards and rural medical insurance cards are equally applicable.

2. Designated pharmacies: Medical insurance composed of two accounts: a personal account and a pooled account. The personal account can be used to buy medicines in designated pharmacies and is mainly responsible for the outpatient and hospitalization expenses paid by the individual.

The overall account managed by the medical insurance center will pay the insured's expenses that are in line with local medical insurance reimbursement; 3. Designated hospitals: When seeking medical treatment at a designated hospital, you must present your medical insurance card to prove your insured status and registration. Individuals do not need to pay first and then be reimbursed.

The reimbursement part of the medical insurance can be settled directly by the medical insurance and the hospital. Only at the time of checkout, the self-payment part must be paid by yourself with the balance of the medical insurance card or cash.

To sum up, in order to avoid problems such as inconvenient settlement of medical expenses and difficulties in reimbursement, medical insurance cards can usually only be used in the city where the card is issued.

For some special circumstances, such as sudden illness, business trip, etc. that require medical treatment in other places, cross-regional settlement and reimbursement can be carried out through the medical insurance network.

This requires going through the cross-regional medical insurance settlement filing procedures with the local Social Security Bureau before seeking medical treatment. The specific operating procedures need to be handled according to the regulations of different regions.

Legal basis: Article 8 of the "Detailed Implementation Rules of the Social Insurance Law of the People's Republic of China". If the medical expenses incurred by insured persons at agreed medical institutions meet the standards of the basic medical insurance drug catalog, diagnosis and treatment items, and medical service facilities, they shall be treated in accordance with national regulations.

Paid from the basic medical insurance fund.

If insured persons really need emergency treatment or rescue, they can seek medical treatment at non-agreed medical institutions; the scope of drugs necessary for rescue can be appropriately relaxed.

Specific management measures for emergency and rescue medical services for insured persons shall be formulated by the coordinating region based on local actual conditions.