Do chronic diseases require annual review?

We often talk about the qualifications for medical insurance reimbursement of chronic diseases. In fact, there is no unified national requirement that it must be reviewed every year. The specific rules all depend on the regulations of the medical insurance department in the insured area. Currently, the review cycle in most areas in the country ranges from 1 to 3 years. Some chronic diseases with stable conditions and irreversible course can even be exempted from the annual review process.

In fact, the core purpose of setting up qualification review is also very practical. On the one hand, it is to screen out insured persons who have recovered and no longer meet the criteria for chronic disease identification. On the other hand, it can also plug some loopholes in fraudulent use of chronic disease qualifications to defraud insurance. After all, the outpatient reimbursement ratio and amount for chronic diseases are much higher than those for ordinary outpatient clinics. If someone has been cured long ago and continues to use the reimbursement amount for chronic diseases, the public medical insurance pool will be squeezed. In the end, the patients who really need long-term medication will suffer.

Two years ago, when I helped the elderly at home register hypertension and chronic diseases, I specifically asked the staff at the medical insurance window in my hometown. In the past few years, we in Taizhou, Jiangsu Province had a biennial review. Since last year, we no longer need to go offline to submit materials. As long as the elderly have had high blood pressure-related medical treatment and drug purchase records in the past, the system will automatically complete the verification, and the annual review will be passed quietly, and the elderly will not have to worry about anything.

Of course, not all places are so lenient. A friend of mine in Shandong said that they still require a reexamination report to be submitted for review every year for chronic active hepatitis, hyperthyroidism, and other chronic diseases that may be cured, to prevent people who have recovered from being still eligible. This matter has indeed always been controversial. Many people think that the annual review is too troublesome, especially many elderly people living alone who do not know how to operate the online verification process, and it is difficult to go to the offline service hall. ； Some people also think that regular audits are necessary. After all, medical insurance money should be spent wisely.

After talking about this, some people may ask, what should I do if I really forget the annual review? Uncle Zhang, who lives downstairs in my house, went through this trap last month. He applied for the chronic disease qualification of COPD. He was so busy last year that he forgot to do the annual review. When he went to prescribe daily inhalants in the spring of this year, the billing window said that he could not be reimbursed for chronic diseases. Then he remembered that he had not noticed the verification reminder issued by the medical insurance bureau. Later, he went to the medical insurance center with the pulmonary function report and medical records of the past six months to fill in the materials, and his benefits were restored the same day, without too much trouble.

If you are really not sure about the requirements for your insurance, just call the 12393 medical insurance hotline and ask for a few questions. There is no need to make blind guesses and delay things.