I thought I could reimburse the medical insurance card. Why do I have to pay cash?

The migrant worker Amin went to the hospital because of migraine and did several inspections. When paying the medical card, he found that he had to give some cash. He wondered: "I am a gear, and my personal account is rich. Why do I have to give cash?"

Back home, he inquired about the medical insurance card credit card consumption record at the personal online service system of the Municipal Medical Insurance Bureau (specific path: log in to the official website of the Municipal Medical Insurance Bureau "Personal Online Service System" → "Query Service" → "Treatment Information Query" → "Medical Insurance Card Swipe card query ").

After seeing the details of medical consumption, the small question mark on his head is more: What are the costs of "cash"? Is "bookkeeping" reimbursement of medical insurance?

Why do you still divide cash and bookkeeping in medical insurance?

First of all, let's take a look at this picture:

The medical consumption details we found on the system are mainly divided into two forms: cash payment costs and medical insurance accounting costs.

The cost that requires cash payment is mainly because the cost is a self -funded or paid part, and the cost of medical insurance accounting is mainly paid through the method of personal accounts and overall funds (the personal account is only available for medical insurance).

The medical insurance card is enough, why do you have to pay cash?

● Self -funded part: When the insured person is medical, the cost of the scope of the medical insurance directory may be incurred, that is, the cost of self -funding. For example, medical insurance cannot be reimbursed, drugs, and medical consumables, these expenses cannot be reimbursed with medical insurance coordinated funds nor a personal account of medical insurance.

From this consumption details, it can be seen that Amin, a medical insurance, medical treatment at a general outpatient clinic in a hospital, at the self -funded fee of 137.43 yuan (including the self -funded diagnosis and treatment items, medicines, etc.) as "cash"; Reimburseed by personal account deductions or coordinated funds, showing "bookkeeping".

● Payment part: In addition to the cost of self -funded, the insured receiving medical insurance for outpatient examination (such as CT, MRI, etc.), some expenses have been reimbursed through the prescribed proportion (displayed as "bookkeeping"), and the remaining remains, the remaining remaining The cost is a self -payment part.

From this consumption details, it can be seen that Amin, a medical insurance, received a special inspection of outpatient clinics in a hospital (a reimbursement of 80%of the reimbursement of the insured person's overall funds). 160 yuan is the personal payment part, which is displayed as "cash".

What are the methods of "bookkeeping" in the details of medical expenses?

● Medical insurance personal account

According to the "Shenzhen Social Medical Insurance Measures", the personal account of the basic medical insurance for the insured person is used to pay the basic medical expenses of the insured's outpatient clinic, the local supplementary medical expenses, and the designated retail pharmacy. Phase the cost of drugs within the range of medical insurance directory.

When the insurer involves the payment of personal accounts of medical insurance, the medical consumption details of the system will be displayed as "bookkeeping" when the medical insurance personal account is paid.

From this consumption details, it can be seen that Aming, a medical insurance, has a registration fee of 11 yuan (belongs to the basic medical expenses of outpatient clinics) in a hospital, and is expelled by personal accounts to show "accounting".

● Medical Insurance Coordinating Fund

一档参保人在门诊就医，也存在医保统筹基金按规定报销的情况，比如门诊特检（统筹基金报销80%，见例子2）、门诊特定病种开药（分为三类待遇）、 Ordinary outpatient blood transfusion (90%of the reimbursement fund reimbursement) and so on.

Participants enjoy outpatient treatment and involve the payment of medical insurance overall funds. The medical consumption details of the system will also be displayed as "accounting".

Simply put, after a clinic medical card, the medical insurance card is checked in the system. The "cash" includes the cost of self -funding and the cost of self -payment.

Source | Shenzhen Medical Insurance

- END -