Can medical insurance for gastrointestinal endoscopy be reimbursed?

Whether gastrointestinal endoscopy can be reimbursed by medical insurance depends on the specific situation. Ordinary people can't be reimbursed for gastrointestinal endoscopy in outpatient department, but they can be reimbursed for medical insurance if they have indications for gastrointestinal endoscopy during hospitalization.

For patients with gastric cancer and gastric malignant lymphoma, if they are chronic diseases or serious diseases covered by local medical insurance, they can enjoy medical insurance reimbursement even if they have gastroscopy in outpatient department, and the reimbursement ratio is similar to that of hospitalization. Of course, this needs to be decided according to the local medical insurance policy.

Generally, gastroscopy during hospitalization can be reimbursed through medical insurance, and outpatient examination cannot be reimbursed. Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. With the characteristics of "low level and wide coverage", the payment is based on the cost that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees of different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "the burden of both parties and the combination of unified accounts"; Based on the principle of "balance of payments".

legal ground

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.