Cross-provincial outpatient clinics can be reimbursed directly, no need to pay and run errands
With the acceleration of the coordinated development of the Beijing-Tianjin-Hebei region, the phenomenon of working and living in different places and providing elderly care in different places is becoming more and more common in this region.
The reporter learned that since the beginning of this year, the direct settlement of general outpatient (emergency) medical expenses for medical treatment in different places across provinces in Beijing, Tianjin and Hebei has proceeded in an orderly manner.
This means that the insured persons in Beijing-Tianjin-Hebei region can directly enjoy medical insurance reimbursement after seeing a doctor across provinces in the region, without having to advance funds or run errands.
Starting from January this year, the medical insurance agencies in Beijing, Tianjin and Hebei have followed the principle of "urgent use first" and prioritized medical institutions with greater demand for elderly care in different places and medical treatment in different places into the scope of direct settlement.
The three places selected Peking Union Medical College Hospital, Tianjin TEDA International Cardiovascular Hospital, Nankai Hospital, Hebei Provincial People’s Hospital, Rongcheng County People’s Hospital, Xianghe County People’s Hospital and Handan Shexian Hospital as the first batch of pilot medical institutions. Security personnel, especially migrant workers, "migratory bird elderly" and "drifting elderly" provide convenience for medical treatment.
After the policy was introduced, many people enjoyed the convenience of medical treatment and reimbursement.
Uncle Zhao, 67, is one of them.
Not long ago, he just settled an outpatient fee at Peking Union Medical College Hospital.
In the past, Uncle Zhao, who retired from work in Tianjin and returned to Beijing for the elderly, had to travel to Tianjin once every six months, reimbursing the outpatient expenses manually, which was very inconvenient: "You have to advance all the expenses yourself, and then pay the bills to the unit regularly. What about the reimbursement? It will take a month or two."
Now, Uncle Zhao finds it much more convenient: "All the reimbursements are reimbursed, and the expenses that should be paid by themselves are paid directly, and there is no need to hold the medical bills like a baby!"
With the advancement of the first batch of pilot projects, the Beijing Municipal Medical Insurance Affairs Management Center issued the "Notice on the Direct Settlement of Medical Expenses for General Outpatient (Emergency) Clinics of Beijing-Tianjin-Hebei Trans-provincial Medical Insurance for Beijing-Tianjin-Hebei Basic Medical Insurance" at the end of June. Clarify issues related to direct settlement of outpatient services for insured persons in different places.
Among them, Beijing insured persons need to go through the procedures for direct settlement and filing of medical treatment in other places with a social security card.
Basic medical insurance can apply for filing for four types of insured persons who have retired from other places, long-term assignments to other places, long-term residence in different places, and medical treatment.
The first three categories of personnel can go to the agency for direct settlement and filing through the unit in their jurisdiction, or through the social security office if there is no unit; the transferees must go to the medical insurance agency of their jurisdiction for direct settlement and filing by themselves or their entrusted person.
For Tianjin-Hebei insured persons who directly settle and seek medical treatment in Beijing outpatient clinics, they need to go through (or not need to go through) the outpatient direct settlement and filing procedures in advance in accordance with the relevant regulations of the insured place.
For medical registration and settlement, the social security card must be presented for medical treatment.
At present, the medical directory of Beijing-Tianjin-Hebei is temporarily not unified.
The payment of the insured person’s outpatient visits in Beijing shall be settled in accordance with the payment scope and relevant regulations of the drug catalog, diagnosis and treatment items and medical service facilities stipulated by the Beijing medical insurance; the medical insurance fund minimum payment standard, payment ratio, maximum payment limit, etc. Guaranteed land policy.
Since the second half of this year, Beijing has successively transferred Peking Union Medical College Hospital, Beijing Chaoyang Hospital, Chinese People’s Liberation Army 307 Hospital, China-Japan Friendship Hospital, Fuwai Hospital, PLA Army General Hospital, Tiantan Hospital, Space Center Hospital, Beijing Ten third-level A hospitals, including the Friendship Hospital and the First Affiliated Hospital of the Chinese People's Liberation Army General Hospital, are included in the scope of designated medical institutions for direct settlement of ordinary outpatient (emergency) clinics in different places.
Grandma Wang is a native of Handan, Hebei. After retiring, she came to Beijing to settle with her children.
She suffers from chronic diseases such as high blood pressure and diabetes and requires tumor radiotherapy and chemotherapy. She regularly takes medicine at the outpatient clinic of Peking Union Medical College Hospital.
“In the past, you had to pay for medical expenses in advance after you went to the outpatient clinic. After you save a certain amount, you can bring the treatment expenses data and certificates back to Handan for manual reimbursement. Now it’s fine, you can settle directly! You can also use the funds in your personal account to directly pay for medical expenses. No longer have to run with a pile of materials." She said excitedly.
The reporter learned from the National Medical Insurance Bureau that as of the end of August, the 10 designated medical institutions with direct settlement of outpatient expenses across provinces in Beijing-Tianjin-Hebei had settled 1,867 person-times, total medical expenses were 944,800 yuan, and the medical insurance fund paid 299,100 yuan.
According to the person in charge of the Beijing Municipal Medical Insurance Bureau, after some migrant workers fell ill, they even dared not receive treatment in the city hospital after taking into account the high travel expenses reimbursed for their hometown.
Some elderly people who do not live in their hometowns have to go back to their hometowns to reimburse their expenses once they see a doctor.
The realization of online settlement of medical expenses in different places effectively solves the problems of "long reimbursement cycle, high pressure of advance payment, heavy personal burden, and tired travels", and provides great convenience for insured persons to see a doctor.
Li Danqing