Can hospitalization for chronic diseases be reimbursed?

In most cases, hospitalization expenses for chronic diseases that comply with medical insurance regulations can be reimbursed normally, but not all hospitalizations for chronic diseases can be settled by medical insurance. The core depends on whether several prerequisites are met. Two months ago, I went through the hospitalization reimbursement process with my aunt who has been suffering from type 2 diabetes for 12 years. This time she was admitted to the hospital because of a diabetic foot ulcer and infection, which made her unable to walk normally. She spent 12,000, and the employee medical insurance reimbursed almost 9,000, and I only paid a little over 3,000. When I was going through the procedures, the window staff even told me a few things about the pitfalls here.

Many people think that as long as they have chronic diseases, they should be able to reimburse for hospitalization. In fact, it is not without controversy, and occasionally they may encounter refusals to reimburse. Last month, a netizen complained that he only had mild essential hypertension, which could be controlled by adjusting the dosage of medication in the outpatient clinic, but he had to find an acquaintance to be hospitalized for a full set of physical examinations. In the end, the medical insurance audit determined that the hospitalization was unindicated, and the expenses were refused to be reported. He also felt particularly aggrieved, saying that he did have a chronic disease, so why couldn't he apply for it? However, from the perspective of the medical insurance fund, the money in the pool is limited and must be given priority to seriously ill patients who really need to be hospitalized. Unnecessary hospitalization is a waste of public resources. Both sides of the argument have a foothold. The core criterion is whether the hospitalization is really medically necessary.

The most basic premise is that you have to go to a hospital designated by the medical insurance. If you have to go to a high-end private hospital that is not connected to the medical insurance in order to get better services, you will definitely not be able to apply for hospitalization even if you are hospitalized for an acute attack of a chronic disease. If you are hospitalized in a different place, you must register for medical treatment in another place in advance. Last year, my cousin had an acute attack of COPD when he was working out of town. He was rushed to the hospital and remembered that he had not registered. He could have reimbursed 70% of the expenses but ended up only reimbursing 40%, which cost him thousands of dollars more. In addition, if you used a lot of imported special medicines that are not in the medical insurance catalog and high-end nursing items at your own expense during the hospitalization, these are not within the scope of reimbursement. Whether it is a chronic disease or other diseases, you cannot be reimbursed. This is basic common sense, so don’t make a mistake when settling the bill.

If you are not sure whether your situation can be reported, call the 12393 medical insurance service hotline in advance and ask. With just a few words, you can not only save yourself from unnecessary trips, but also find out in advance how much you will have to bear, and feel at ease.