In recent years, new anti-cancer drugs have emerged in an endless stream, and the emergence of targeted drugs and PD-1 antibody immunotherapy drugs has made a qualitative leap in the survival of many patients with advanced solid tumors.
The continuous advancement of new drugs and new technologies, the continuous extension of the survival period of tumor patients, and the continuous improvement of the cure rate are a good thing in themselves, but at the same time, they also pose new and huge challenges to the economic ability of patients' families.
Fortunately, since 2018, the former "sky-high" anti-cancer drugs have gradually begun to be included in medical insurance, and different provinces, cities and regions have also introduced a variety of support policies, but the names and specific details of these policies vary greatly from place to place.
For example, some areas are called major illness medical insurance, some areas are called special disease insurance, and some areas are called outpatient major illness... Patients in different regions have different reimbursement methods.
For example, this is an outpatient diagnosis certificate for cancer patients in Shenzhen. After filling in similar documents, signing by the doctor in charge, and stamped by the hospital where they visit, most of the various treatments such as radiotherapy and chemotherapy received by cancer patients in the outpatient clinic can be reimbursed like hospitalization.
This is the approval form for the reimbursement of special diseases in Cangnan County, which is displayed by patients in Cangnan County, Wenzhou City, Zhejiang Province, and ranks first in the "special diseases" that receive special treatment. The implication is that as long as such a special disease confirmation form is prepared according to the requirements, medical insurance reimbursement can enjoy more benefits.
In order to improve the reimbursement ratio and medical convenience of cancer patients as much as possible, there are actually some corresponding reimbursement policies that are different from ordinary diseases, but unfortunately most patients are not familiar with them. Today, we summarize the medical insurance reimbursement strategies for cancer patients according to various types of information summary, please save it.
1. Urban and rural residents' insurance, employee medical insurance and new agricultural cooperative insurance
These three types of insurance are actually the most common types of insurance for patients, and they are also the basis for our medical expense reimbursement. Within the scope of medical insurance and policies, the reimbursement amount of expenses incurred by cancer patients in hospitalization can be up to 70%. The reimbursement methods for these three types of insurance are also the simplest.
Reimbursement methods
The patient is hospitalized and discharged normally;
Prepare these materials and go to the hospital's medical insurance window or medical insurance office for reimbursement settlement: list of hospitalization expenses, relevant documents of the insured (such as identity card, medical insurance card and other relevant certification documents), discharge summary (with official seal), inpatient medical records, etc. (the materials required in different regions may be different, but they are generally the above materials)
After the material review is passed, the medical insurance reimbursement can be successfully completed.
For these three types of insurance, the most important first step is to first go to the hospital's medical insurance window for consultation, which can generally be completed in the hospital, and the processing process is relatively simple, which is the first step of reimbursement that cancer friends need to master.
2. Medical insurance for serious illness
In addition to the above three medical insurances, the most important secondary medical insurance reimbursement policy for cancer patients is the major medical insurance.
The so-called secondary reimbursement is actually after the reimbursement of urban and rural medical insurance, employee medical insurance or new rural medical insurance, and still needs to bear a large treatment cost. If you exceed the amount, you can enjoy medical insurance for serious illness.
Its reimbursement condition is: within one year, the patient's medical expenses (self-funded part) is greater than the per capita income of local residents in the previous year, and it can be reimbursed. (The insured must have urban and rural medical insurance or employee medical insurance)
For example, the hospitalization expenses of Mr. Li, a cancer friend, spent 80,000 yuan at his own expense after being reimbursed by medical insurance. Assuming that the per capita disposable income of Mr. Li's area was 40,000 yuan in that year, the excess of 40,000 yuan can be reimbursed for major illness medical insurance.
This part of the reimbursement amount is reimbursed in a stepwise manner, and the more self-payment, the higher the reimbursement ratio:
For patients with self-payment of 20,000-50,000 yuan, the reimbursement rate is 50%;
For patients who pay 50,000-100,000 yuan at their own expense, the reimbursement rate is 60%;
For patients with more than 100,000 yuan of self-payment, the reimbursement ratio is 70%;
The maximum reimbursement limit is $300,000.
The patient also needs to consult the inpatient hospital first, determine which hospital is the designated hospital for major illness medical insurance, and submit relevant information to the medical insurance window or office of the hospital (the required case information is roughly the same as that of urban and rural residents' insurance). The designated hospital shall report to the relevant medical insurance institution for review after review, and then the relevant medical insurance institution shall issue reimbursement.
3. Outpatient "chronic disease" reimbursement
The reimbursement methods we mentioned above are all hospitalizations. But cancer patients who are familiar with the hospital may be more aware that sometimes it is not so easy to apply for hospitalization.
For those patients who cannot be hospitalized and can only be diagnosed and prescribed on outpatient basis, there is a type of policy in various places, called "outpatient chronic disease reimbursement". Health care departments everywhere have a list of "chronic diseases" and cancers are included. Cancer friends need to bring the following information:
ID card, medical insurance card, a copy of their own inpatient medical records (must be stamped with a copy of the hospital inpatient medical records); relevant imaging materials to the hospital for application, eligible cancer friends can get an outpatient chronic disease booklet, and even if the drug is prescribed in the outpatient clinic in the future, as long as the chronic disease booklet is presented, you can enjoy the chronic disease outpatient reimbursement.
In some areas, the reimbursement for outpatient chronic diseases is once a year, and in some areas, it can be reimbursed after the end of the outpatient clinic on the same day. The reimbursement of chronic disease outpatient clinics usually has a threshold (600 yuan in most areas), and the part beyond the threshold can be reimbursed for chronic disease outpatients.
In addition to the above three most important reimbursement methods, cancer friends may also have two special reimbursement methods to know:
4. Charity policy for anti-cancer drugs
The Medicare reimbursement we mentioned above refers to the drugs included in the scope of Medicare reimbursement.
Some drugs are very good anti-cancer effects, but they are not included in the medical insurance list for the time being, what should these drugs do?
For such drugs, many drug manufacturers will cooperate with the Charity Federation to introduce charity policies. Usually a certain number of times at your own expense, the Charity Federation will give the patient a certain number of times of free use of the drug, until the next self-funded cycle begins, the cycle.
For such charitable policies, different drug charity policies often vary. Cancer friends can consult their attending doctor, they may have a certain understanding of the anti-cancer drug charity policy issued; in addition, contact the drug representative of the drug or consult the customer service of the drug factory (through the public number, customer service telephone, etc.) can understand the specific requirements of the charity policy.
5. Off-site medical insurance settlement
Cancer patients often have a special health insurance reimbursement need: off-site health insurance settlement.
For China, the level of cancer treatment varies considerably from region to region. Top hospitals in Beijing, Shanghai, Guangzhou and other places have considerable advantages in the level of cancer treatment.
Therefore, the demand for cancer patients to seek medical treatment in different places has also been generated accordingly, and for this part of the patients, the reimbursement of medical insurance has become a crucial matter. There is also a corresponding set of procedures for off-site medical insurance reimbursement, including:
01
First of all, we need to apply for off-site medical treatment at the Social Security Office of the "insured local" area. That is, it is necessary to apply for medical treatment in a different place in the city where the patient pays medical insurance, rather than the city where the patient is about to go for treatment.
02
After completing the application procedures for off-site medical treatment in the "insured local area", patients can directly take the medical insurance card to the hospital in the other place where they applied for medical treatment, and the medical insurance reimbursement can be directly settled when discharged.
03
For patients who have not applied for medical treatment in different places in advance, the reimbursement of off-site medical insurance is more troublesome, and the reimbursement ratio is lower and the starting point is higher. Patients who have not applied first need to pay medical expenses in advance, prepare all medical records when discharged, and then go to the declaration bureau of the "insured local" to apply for off-site medical insurance reimbursement, but usually the procedures are more complicated and the reimbursement rate is lower. If cancer friends have the need to seek medical treatment in a different place, they must first apply for medical insurance in a different place.
Regarding the exquisite medical insurance reimbursement, this article can only make a summary, which is far greater than our above content, and welcomes all patient friends to leave a message at the end of the article after reading this article, leaving you to share your experience in medical insurance reimbursement.
Hand in hand to fight cancer, in order to overcome the cancer demon!
Source | Boom cancer circle