Can it be used in chronic disease hospitals across the country?

Not all hospitals across the country can use chronic disease-related medical insurance benefits. Whether they can be reimbursed and whether they can be settled directly must meet the three prerequisites of local medical insurance policies, the hospital's medical insurance designated qualifications, and the scope of chronic disease registration. There is no unified statement that is "universal across the country."

Last week, I helped Lao Zhou, who lives in Taiyuan, Shanxi Province, handle this matter. He has applied for a chronic disease certificate for coronary heart disease. He usually gets 70% reimbursement for prescribing medicines at a tertiary A hospital in front of his home in Taiyuan. Last month, he went to Shenzhen with his son for a long-term stay. He forgot to register in advance and went directly to the public hospital near his home. When I was prescribed antihypertensive and lipid-lowering drugs, I found out that I couldn’t get reimbursed for chronic diseases when I was paying for them. I could only go through the inter-provincial settlement of general outpatient services, and the reimbursed rate was almost 30% lower than in Taiyuan. Later, I still applied for registration for living in another place, and when I prescribed medicines in the second month, I successfully used the chronic disease benefits.

There are also many patients who say that they can use it even if they go to other places without registration. In fact, they happen to be in a city that has canceled pre-registration, or their disease happens to belong to the five categories of chronic diseases that the country requires priority to open, and the hospital where they are treated is also connected to the national off-site settlement system, so there is no obstacle. But if you suffer from relatively rare diseases, such as Parkinson's disease and multiple sclerosis, many cities have not included these diseases into the scope of direct settlement across provinces. Even if you go to a public tertiary designated hospital, you have to pay for it yourself first, and then take the medical records, prescriptions, and payment vouchers back to the insured place for manual reimbursement. Whether and how much you can claim depends on the chronic disease directory of the insured place. It does not mean that a hospital that can accept medical insurance will definitely be able to receive chronic disease treatment.

In fact, in essence, our medical insurance is still under local unified management. To put it bluntly, the rules depend on where you pay for the medical insurance. The hospitals in other places just help you go through the settlement channels. It does not mean that the national unified rules can be used casually. At present, the National Medical Insurance Administration is also gradually promoting the inter-provincial direct settlement of chronic special diseases. As of the first half of 2024, more than 90% of the coordinated areas have opened inter-provincial direct settlement of five types of high-incidence chronic diseases, namely hypertension, diabetes, malignant tumor radiotherapy and chemotherapy, uremia dialysis, and organ transplantation resistance. More and more diseases and regions will be covered in the future, but there is still a long way to go before it can be used by all hospitals nationwide.

If you plan to go out of town to seek medical treatment for chronic diseases, it is best to call the 12393 hotline in the insured place two days in advance to find out. This will save you the trouble of traveling to another place only to find out that you can’t use it and have to pay for it yourself.