Legal analysis: if it is a therapeutic dental disease, it belongs to the scope of medical insurance reimbursement. The expenses for tooth filling (basic materials and treatment fees), tooth extraction, treatment of periodontal disease, gingivitis, root canal treatment and other dental diseases have been included in the scope of medical insurance, such as the common wisdom tooth extraction, which belongs to the scope of medical insurance reimbursement. In addition, medical cosmetic repair is not within the scope of reimbursement. If it is in the field of tooth restoration and whitening, such as tooth inlay, porcelain restoration, orthodontics, tooth implantation, tooth whitening and so on. At present, it is listed as a medical beauty repair project and can only be reimbursed by medical insurance at its own expense. Because the relatively high cost of dental implants is mainly the cost of materials, such as porcelain teeth and dental implants, these expenses are generally approved by the price department and belong to special service expenses, so medical insurance reimbursement cannot be carried out. If the patient is admitted to the hospital due to illness and meets the hospitalization standard, other expenses can be settled according to the medical insurance except that the denture expenses cannot be paid by the medical insurance pooling fund.
In addition, dental operations such as tooth extraction and tooth filling are covered by medical insurance. In the dental clinic of the hospital, the proportion of medical insurance reimbursement is generally 50% above 1.800 yuan. To see a doctor, you need to go to a designated medical institution, such as a designated hospital stomatology department or a designated dental clinic. Medical expenses incurred in non-designated medical institutions shall not be reimbursed by medical insurance. Therefore, the reimbursement of dental treatment expenses such as outpatient tooth extraction will not be paid by the basic medical insurance pooling fund, but the balance of the personal account of the medical insurance card can be swiped; If the patient is hospitalized for tooth extraction due to illness, the cost of tooth extraction can be reimbursed through medical insurance within the scope of payment of the basic medical insurance pooling fund.
Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
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