How does Zhong Yi Life Insurance Clinic settle claims?

The claim settlement steps are as follows:

1. Determine your reimbursement eligibility.

Patients seeking medical treatment in outpatient department should first determine whether they meet the conditions for reimbursement of outpatient medical insurance, whether they seek medical treatment in medical institutions stipulated by outpatient medical insurance, and secondly whether their medical treatment items are within the scope of reimbursement of outpatient medical insurance; Finally, it is necessary to determine that the amount of medical expenses exceeds the deductible line of outpatient medical insurance reimbursement.

2. Relevant documents issued by the attending doctor.

After confirming that it meets the conditions for reimbursement of outpatient medical insurance, it is necessary to ask the attending doctor to issue the patient's medical record summary and the doctor's diagnosis certificate, including the patient's visit time, illness description and medical expenses.

The use of some self-funded drugs and treatment facilities must be signed by patients or their families, and the attending doctor should also indicate it on the certification materials. The hospitalization time is calculated from the same day to the discharge time. If the patient fails to postpone discharge according to the regulations of the hospital, the expenses incurred in accordance with the doctor's advice shall be paid by the patient personally from the second day of discharge.

3, deputy chief physician or above signature

After the patient or family members get the relevant materials issued by the attending doctor, they need to find the person in charge of the medical institution above the deputy chief physician to sign and confirm, so as to ensure the authenticity of the certification materials.

4, medical institutions audit and seal

After the signature of the patient or his/her family or the person in charge above the deputy director, he/she still needs to hold the relevant certification materials issued by the attending doctor and affix his/her seal to the medical department of the medical institution to ensure the authority of the certification materials.

5, the municipal medical insurance agency audit

After the insured person issues all the required certification materials, the insured person or the relevant personnel of his unit can go to the municipal medical insurance agency to handle the reimbursement procedures for outpatient medical insurance.

After the examination and approval, you can receive the corresponding proportion of reimbursement in the outpatient medical insurance agency. Although the reimbursement rate of outpatient medical insurance varies from place to place, it is generally around 80%-90%.