What procedures do you need to go through for reimbursement of diabetes outpatient service?

It is necessary to provide the original and photocopy of the medical records of diabetes outpatients with a medical history of more than half a year (the medical records are not less than three times, and the interval between each time is not less than 1 month), three fasting blood glucose tests and 1 glycosylated hemoglobin test reports.

The expenses for treating diabetes, medical insurance for employees and medical insurance for residents in social insurance can be reimbursed. This is a disease that the elderly are prone to get. He may not need to be hospitalized all the time, but he needs to take medicine all the year round and cannot be cured. Medical insurance includes diabetes in the scope of special diseases. After handling the certificate of special disease, the cost of taking medicine out of the clinic can also be reimbursed.

Treatment of chronic diabetes in outpatient department must meet the following standards.

(1) conforms to the clinical diagnosis standard of diabetes, and there are clear outpatient or inpatient diagnosis records in secondary and above hospitals except for secondary diabetes.

(2) Diabetes only includes type I and type II as chronic diseases, and other types are not included as chronic diseases.

(3) Symptoms of diabetes: plasma glucose ≥11.1mmol/l (200mg/dl) or fasting plasma glucose (FPG)≥7.0mmol/L( 126mg/dl) or 2hPG level in OGTT test at any time.

Bring the following medical records to the medical insurance center of the insured area for handling (or acting as an agent).

(1) After applying for hospitalization, valid copies of hospitalization medical records, admission and discharge records, blood sugar and glycosylated hemoglobin test reports shall be provided.

(2) After applying for outpatient treatment, the original and photocopy of diabetes outpatient medical records with a medical history of more than half a year (the medical records are not less than three times, and the interval between each time is not less than 1 month), three fasting blood glucose and 1 glycosylated hemoglobin test reports are required.

The reimbursement rate is 60%, and the annual maximum payment limit is 600 yuan.

Outpatient special disease is an outpatient reimbursement policy implemented by the medical insurance department to reduce the economic burden of some insured people who need long-term outpatient treatment for chronic and special diseases (such as hypertension and diabetes).

What are the benefits of handling outpatient special diseases?

1, reducing the long-term treatment cost of patients. The treatment of special diseases in outpatient department is higher than that in general outpatient department.

2. Reduce the number of times patients go out to buy medicine. During the epidemic, support medical institutions to reasonably increase the single prescription dose according to the actual situation of patients, and extend it to 3 months at the longest. Long-term prescriptions issued by medical institutions according to regulations will be included in medical insurance reimbursement.

legal ground

People's Republic of China (PRC) social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior. Medical institutions shall provide reasonable and necessary medical services for the insured.