Does private discharge during hospitalization affect reimbursement?

One. Medical insurance policy

Medical insurance policies usually stipulate the scope, conditions and procedures of reimbursement. During hospitalization, patients should abide by the rules and regulations of the hospital and treat according to the doctor's treatment plan. If the patient leaves the hospital privately, it may be regarded as a violation of the medical insurance policy, thus affecting reimbursement.

Specifically, the medical insurance policy may require patients to be treated and managed by the hospital during hospitalization. If they leave the hospital privately, they may be regarded as "interrupting treatment by themselves", which may lead to some or all medical expenses not being reimbursed. In addition, the medical insurance policy may also specify the time and frequency of discharge during hospitalization, and the discharge beyond the prescribed scope may also affect reimbursement.

Second, the hospital rules and regulations

The hospital formulates rules and regulations to ensure the safety of patients and medical order. Patients should abide by hospital regulations during hospitalization, including not leaving the hospital without authorization. If patients violate hospital rules and regulations, they may be punished by the hospital, such as warnings and fines, and may affect reimbursement.

Hospitals usually ask patients to ask for leave from doctors or nurses before discharge, and explain the reason and time of discharge. If the patient leaves the hospital without authorization, the hospital may think that the patient has given up treatment on his own, which may also lead to the inability to reimburse medical expenses.

Three. Personal responsibilities and obligations

As patients, we have the responsibility and obligation to abide by the medical insurance policy and hospital rules and regulations. During hospitalization, we should actively cooperate with the doctor's treatment plan and carry out treatment and management according to the requirements of the hospital. If you really need to leave the hospital, you should ask the doctor or nurse for leave in advance and explain the reason and time of leaving the hospital.

At the same time, we should also know our own medical insurance policies and reimbursement procedures to ensure that we can provide complete reimbursement materials when reimbursement is required. If we leave the hospital privately and the medical expenses cannot be reimbursed, then this part of the loss will be borne by ourselves.

To sum up:

Leaving the hospital privately during hospitalization may affect reimbursement, depending on the medical insurance policy and hospital rules and regulations. As patients, we should abide by the relevant regulations and actively cooperate with the doctor's treatment plan to ensure our own safety and medical order. If you need to leave the hospital, you should ask for leave from the doctor or nurse in advance and understand the possible impact of leaving the hospital on reimbursement.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 30 provides that:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

Should be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

4 go abroad for medical treatment.

Medical expenses shall be borne by a third party according to law. If the third party fails to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

People's Republic of China (PRC) social insurance law

Article 3 1 stipulates that:

According to the needs of management services, social insurance agencies can sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.