Many times you also wonder: why do you need to pay different expenses when you are discharged from the hospital with the same medical expenses? Could it be that the hospital miscalculated?
In fact, this situation really exists! Today, we have summarized all these problems! Let's go down and see what's going on~
There are different types of medical insurance
Mr. Zheng, an employee of a company in Guangzhou, has been participating in insurance normally, but last month he accidentally stepped on an empty staircase at home, resulting in a fracture and hospitalization. Xiaowei, who is also in the same ward, is a freelance photographer who has been participating in the medical insurance for urban and rural residents in Guangzhou. Both were injured on the same day and were hospitalized in a tertiary hospital, and they were also discharged at the same time. However, when settling the expenses, Xiaowei needs to pay more than Mr. Zheng, is the hospital miscalculated?
A: That's right! Mr. Zheng participated in the Guangzhou Employee Medical Insurance, with a reimbursement rate of 80%, and Xiaowei participated in the Guangzhou Urban and Rural Residents' Medical Insurance, with a reimbursement rate of 70%.
Therefore, even if you are treated in the same designated hospital, the reimbursement ratio will naturally be different if the type of insurance is different.
The specific hospitalization reimbursement rates are as follows:
1. Reimbursement ratio of employee medical insurance hospitalization
2. Reimbursement ratio of medical insurance for urban and rural residents
The causes of injury are different
Then even if the medical expenses are the same, if the cause of the injury is different, the cost of paying will be different.
(1) It is within the scope of work-related injury insurance
For example, Mr. Du is a safety officer of a construction engineering company, mainly responsible for the engineering inspection and acceptance of the construction site. A few days ago, when the project was accepted at the construction site, he was accidentally injured in the head and hospitalized. As determined by the relevant departments, the medical expenses incurred shall be paid by the work-related injury insurance in accordance with the regulations.
(2) It is within the scope of third-party liability compensation
Example: Xiao Yang, a food delivery driver, was on his way home last weekend when he was accidentally hit by a car that ran a red light and rolled over, and was hospitalized with a head injury. According to the traffic police department, the driver who ran the red light is mainly responsible. Then, all the medical expenses incurred by Xiao Yang will be fully compensated and paid by the third-party responsible person, and there is no need to use his own medical insurance.
(C) within the scope of medical insurance payment
For example, Xiao Li changed the light bulb at home last night, and he was in a hurry and panicked, and fell off the ladder with an unstable center of gravity, resulting in a head injury and hospitalization, and the medical expenses incurred were paid by the medical insurance in accordance with the regulations.
Failure to meet medical insurance reimbursement requirements
Generally speaking, if you want to use Medicare reimbursement, you need to do it first.
Among them, the employee medical insurance must be paid in full every month in order to enjoy the medical insurance reimbursement treatment; if the payment is interrupted, the medical insurance reimbursement will not be able to continue to be enjoyed from the next month; if the payment period is reached (30 years for male employees in Guangzhou, 25 years for female employees), you can enjoy lifelong medical insurance treatment.
The medical insurance for urban and rural residents needs to be paid on time every year in order to enjoy medical insurance benefits.
In addition, if the situation is not reimbursable!
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