If you liked this article, please click "Follow" in the top right. Thank you for your support and encouragement, and hope to bring you a comfortable reading experience.
Medical insurance is an indispensable part of life. It can share part of our medical expenses when we are sick and reduce our financial burden.
It is like our umbrella, giving us peace of mind in the wind and rain.
But, did you know that health insurance is not a panacea, it has its own rules and limitations.
In some cases, medical insurance is not reimbursed, which is what we often call "six non-reimbursement". If you don't understand these situations, you may unknowingly cause your own losses.
So, what are the "six non-reimbursements" of medical insurance? What do they mean? What impact will they have on our medical expenses? Next, let's take a look.
1. Those that do not meet the standards of diagnosis and treatment are not reported
Medical insurance is to protect our health, so it requires us to follow certain diagnosis and treatment norms when seeking medical treatment.
Medical insurance has the requirement of hierarchical diagnosis and treatment, that is, we must choose the appropriate hospital level according to our own condition.
Medical insurance has a certain catalogue and scope, which stipulates which diagnosis and treatment items can be reimbursed and which ones cannot be reimbursed.
Generally speaking, medical insurance only reimburses items related to disease treatment, and does not reimburse items unrelated to health management, beauty, rehabilitation, etc.
If we choose an item that is not covered by the medical insurance list, the medical insurance will not reimburse us.
Medical insurance requires us to follow the doctor's guidance and use medical resources rationally when seeking medical treatment.
2. Do not report those that do not meet the drug specifications
Medical insurance not only regulates the diagnosis and treatment items, but also regulates the use of drugs.
Medical insurance has a drug list, which stipulates which drugs can be reimbursed and which cannot. Generally speaking, medical insurance only reimburses drugs related to the treatment of diseases, and does not reimburse drugs that are not related to health care, beauty, weight loss, etc.
If we choose a drug that is not covered by the medical insurance list, the medical insurance will not reimburse us.
Medical insurance requires us to use drugs reasonably according to the doctor's prescription when we use drugs.
If we exceed the necessary dosage of medication, or reuse the same medication, Medicare may consider it a waste and will not reimburse us.
Pay attention to the choice of drugs, dosages and types that meet the medication specifications, otherwise, the medical insurance may refuse to pay for us.
3. Those who do not meet the hospitalization norms are not reported
Medical insurance requires us to arrange the hospitalization time reasonably according to the doctor's advice when we are hospitalized.
If we stay in the hospital for longer than the doctor recommends, or if there is no clear medical evidence, the health insurance may consider it unnecessary and will not reimburse us.
Medical insurance requires us to reasonably control the cost of hospitalization when we are hospitalized.
If the cost of our hospitalization exceeds the standard of medical insurance, or includes unnecessary items, medical insurance may consider it too high and will not reimburse it.
Medical insurance requires us to choose the hospitalization conditions that are suitable for our condition when we are hospitalized.
It is important to choose the time, cost, and conditions that meet the hospitalization specifications, otherwise, the medical insurance may refuse to pay for us.
Fourth, do not report if you do not meet the reimbursement regulations
Medical insurance not only regulates medical treatment, medication, and hospitalization, but also stipulates reimbursement. The medical insurance requires us to submit a reimbursement application within the specified time when we make a reimbursement.
If we miss the reimbursement time, or do not keep the relevant bills, certificates, etc. in time, the medical insurance may consider it invalid and will not be reimbursed.
Medical insurance requires us to reimburse in accordance with the prescribed method when we make reimbursement. Medical insurance requires us to provide necessary reimbursement materials when making reimbursements.
If we do not provide the necessary reimbursement materials, such as the doctor's diagnosis certificate, prescription form, cost details, etc., the medical insurance may consider it incomplete and will not reimburse.
Therefore, when reimbursing, it is necessary to pay attention to choosing the time, method and materials that meet the reimbursement regulations.
5. Non-compliance with laws and regulations is not reported
Medical insurance is to protect our legitimate rights and interests, so it requires us to comply with national laws and regulations when seeking medical treatment and reimbursement.
If we violate medical safety laws and regulations, Medicare may consider it illegal and will not reimburse us.
Medical insurance requires us to use the medical insurance card in good faith when reimbursing, and not to lend, sell, or fraudulently use the medical insurance card.
Do not use the medical insurance card to commit fraud, fraud, etc., and do not collude with medical institutions or other personnel to make false reimbursements.
If we violate the laws and regulations governing medical insurance, medical insurance may consider it illegal and will not be reimbursed.
Medical insurance requires us to comply with other laws and regulations related to medical insurance when seeking medical treatment and reimbursement, such as not using illegal drugs and devices, and not participating in illegal medical activities.
If we violate other relevant laws and regulations, the medical insurance may consider it illegal and will not be reimbursed.
6. Failure to report if it does not meet personal responsibility
Medicare is meant to protect our health, so it requires us to take a certain amount of personal responsibility when seeking medical treatment and reimbursement.
Medical insurance requires us to pay attention to protecting our health when seeking medical treatment, and not because of our own negligence, negligence, illegal and other reasons.
Causing illness or injury, such as drunk driving, drug use, fighting, etc.
If we suffer from an illness or injury caused by our own reasons, the medical insurance may consider it self-responsible and will not reimburse it.
epilogue
Medicare is our good friend, it can provide us with financial support when we are sick, so that we do not have to worry about medical expenses.
However, medical insurance is not unconditional, it has its own rules and requirements, and we must abide by them in order to enjoy the benefits of medical insurance.
It is necessary to understand these situations in advance to avoid unnecessary troubles and losses when seeking medical treatment and reimbursement.
It is necessary to use medical insurance reasonably, do not waste, abuse, or defraud medical insurance, and do not violate the rules and requirements of medical insurance.
In this way, we can truly enjoy the benefits of medical insurance and make medical insurance our protective umbrella.
Do you know that there are "six non-reports" in medical insurance? Welcome to leave a message in the comment area.