Is cervical spondylosis within the scope of medical insurance reimbursement?

No matter what disease you get, as long as you go to a designated medical institution to see a doctor, the medical expenses incurred are within the scope of reimbursement by the medical insurance institution, and you can pay by swiping the medical insurance card.

1, reimbursement scope of rural medical insurance:

A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

2, urban medical insurance reimbursement

Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is more specific, and the project scale and coverage are large.

But its compensation for major diseases or accidents is limited. At this point, the author suggests that the insured can purchase commercial medical supplementary insurance and social security to reduce their economic losses.

3. Employee medical insurance reimbursement

(a) diagnosis and treatment equipment and medical materials

1, using X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.

2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;

3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;

4, the provisions of the provincial price department can be charged separately for disposable medical materials.

(2) Treatment items

1, hemodialysis, peritoneal dialysis;

2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;

3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects. ? Hearing AIDS and other rehabilitation equipment;

3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.

(3) Treatment items

1, the organ source or tissue source of various organ transplants or tissue transplants;

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;

3. Orthopedic surgery for myopia;

4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.

(4) Others

1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;

2, all kinds of scientific research, clinical verification of diagnosis and treatment projects.

Extended data:

Settlement procedure:

(1) Settlement procedures for inpatient and outpatient treatment of special diseases

Designated medical institutions shall submit the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month.

Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

(2) Emergency settlement procedures

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

(three) resettlement procedures for resettlement personnel in different places

1. The personnel resettled in different places shall be designated as the designated medical institution of 1-2 by the unit to which they belong, and shall be reported to the medical insurance agency for the record.

2. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution in their place of residence shall be paid in advance by themselves or their units. After the treatment, the unit should hold the diagnosis, medical records and effective expenses of the insured.

Use bills, compound prescriptions, hospitalization expenses list, etc. Settle with the social medical insurance agency on the specified date.

(4) Referral and settlement.

1. If the insured person is transferred to other medical institutions for diagnosis and treatment due to the conditions of designated medical institutions or specialized diseases, the approval form for referral and transfer shall be filled in. The reason for referral and transfer is put forward by the attending physician, the director of the department puts forward the opinion of referral and transfer, the medical institution medical insurance office reviews it, the dean in charge signs it, and it can be transferred only after being reported to the municipal medical insurance center for examination and approval.

2. In principle, referrals should be made outside the city, inside the province and outside the province. The city's referral regulations are carried out between designated medical institutions. The referral outside the city is proposed by the designated medical institutions above Grade III in this Municipality.

3. The medical expenses incurred after the insured person is referred to another hospital shall be paid by the individual or unit in cash. After the medical treatment, the insured person or his agent will submit the referral approval form, medical record certificate, prescription and valid documents to the medical insurance agency for reimbursement of hospitalization expenses that fall within the scope of the overall fund payment.

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