In some cases, diseases cannot be reimbursed by medical insurance. Here are some common situations:
1. Diseases not covered by medical insurance: Medical insurance usually only covers certain diseases, such as some chronic diseases and infectious diseases. If your illness is not covered by medical insurance, you can't get medical insurance reimbursement.
2. Self-funded items: Some medical items or drugs may not be covered by medical insurance and are regarded as self-funded items. These items include plastic surgery, unnecessary physical examination and some high-end drugs. If you choose to accept these projects, you need to bear the expenses yourself and you can't reimburse them through medical insurance.
3. Exceeding the limit: Medical insurance usually has a certain limit, such as the upper limit of reimbursement amount per year or per visit. If the medical expenses exceed this limit, the excess medical insurance will not be reimbursed.
4. Failure to seek medical treatment according to regulations: Medical insurance requires patients to seek medical treatment in designated medical institutions and follow the prescribed procedures. If you don't seek medical treatment according to the regulations, such as choosing a designated medical institution without medical insurance, or if you don't have a doctor's referral, you can't get medical insurance reimbursement.
How to reimburse for medical treatment in different places:
1, recommendation certificate. If you want to use a medical insurance card for reimbursement when you go to a foreign country to see a doctor, you must first issue a referral certificate at the local hospital. This certificate needs to be in a slightly larger local hospital, at least above the county level;
2. The seal of the hospital. After the referral certificate is issued in a hospital at or above the county level, it needs to be stamped. This chapter is not only the chapter of the hospital, but also the chapter of the hospital social security window where the referral certificate is issued;
3. Social Security Bureau registration. After opening the referral certificate and the seal of the hospital, I went to the local instrument bureau to register with relevant information. This registration is mainly filed in the Social Security Bureau to facilitate reimbursement of medical insurance in different places in the future;
4. Hospital invoice. The reimbursement for medical treatment in different places is mainly hospitalization. Let the hospital make an invoice after seeing a doctor, and be sure to keep the invoice, which is the basis for reimbursement;
5. Reimbursement by Social Security Bureau. When you come back from illness, you should go to the local social security bureau for reimbursement, and bring relevant materials, including invoices, ID cards, household registration books, social security cards, etc.
6. Outpatient reimbursement. Generally, it is more troublesome to reimburse hospitalization expenses in different places, but if it is outpatient expenses in different places, you don't have to bother. Just bring the invoice back to the Social Security Bureau for reimbursement.
To sum up, diseases outside the scope of medical insurance reimbursement mainly refer to those diseases or medical items that do not meet the requirements of medical insurance policies, so you should be cautious when choosing treatment methods and items, and consult with medical insurance institutions for confirmation.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
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.