Whether minimally invasive surgery can be paid by medical insurance mainly depends on the nature of the operation and the local medical insurance policy. Under normal circumstances, medical insurance only reimburses hospitalization expenses related to illness, work injury or childbirth, such as minimally invasive wrinkle removal surgery. If it is an accident, the minimally invasive plastic surgery that must be done, such as minimally invasive skin grafting after a fire, may be reimbursed. In addition, if the patient is hospitalized, commercial medical insurance usually reimburses the surgery that belongs to the disease category. But medical insurance usually has a deductible, that is, only the part that exceeds the deductible can be reimbursed. However, accident medical insurance and critical illness insurance usually do not reimburse minimally invasive surgery. Whether it can be reimbursed specifically requires consulting the local human resources and social security bureau for detailed policies.
Medical insurance payment standard for minimally invasive surgery;
1. medical insurance payment scope: according to the local medical insurance policy, determine which minimally invasive surgery items can be included in medical insurance reimbursement;
2. Reimbursement ratio: the reimbursement ratio of minimally invasive surgery may be different in different regions and different types of medical insurance plans;
3. Audit requirements: When applying for medical insurance payment, minimally invasive surgery may need to go through a certain audit process to ensure the necessity and rationality of the operation;
4. Restrictive conditions: Some minimally invasive operations may have restrictive conditions, such as hospital level, doctor qualification or limited number of operations;
5. Self-funded part: Even if minimally invasive surgery is covered by medical insurance, patients may have to bear some expenses themselves, such as deductibles and * * * payment ratio.
To sum up, whether minimally invasive surgery is paid by medical insurance depends on the type of surgery and the local medical insurance policy. In general, only hospitalization expenses related to illness, work injury or maternity can be reimbursed. Commercial medical insurance may reimburse diseases, but medical insurance usually has deductibles. Accident medical insurance and critical illness insurance usually do not reimburse minimally invasive surgery. Please consult the local human resources and social security bureau for details.
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.