Which department should I complain to if medical insurance does not reimburse me?

If the hospital does not provide reimbursement, you can complain to the following departments:

1. The hospital generally has a complaint reporting hotline, and you can complain to the hospital;

2. If it is a disorder If you are charged, you can also complain to the National Health Commission and the Market Supervision and Administration Bureau;

3. Dial the 12333 national labor and social security telephone consultation service number or the 12345 government service hotline to make a complaint.

4. Complain on public accounts such as the “National Medical Insurance Administration”.

Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. in the hospital. Medical expenses can be reimbursed through the medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, and the project scale and The coverage is large, but the compensation for major diseases or accidents is limited. At this time, the author recommends that the insured can purchase a combination of commercial critical illness medical supplementary insurance and social security to reduce their economic losses.

1. Medical insurance reimbursement process for insured persons:

1. The handler submits reimbursement documents and other materials to the social security agency to apply;

2. Acceptance department After receiving the application materials, review and other work will be carried out;

3. If the social security institution approves the application, the applicant will be reimbursed after receiving the social medical insurance medical expense reimbursement form.

2. Rural Medical Insurance Reimbursement

1. Outpatient compensation:

(1) Village clinics and village central clinics are reimbursed 60 RMB for prescription drugs for each visit The fee limit is 10 yuan, and the doctor's temporary rehydration prescription drug fee limit at the health center is 50 yuan.

(2) The town health center will reimburse RMB 40 for a visit, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 100 for prescription drugs.

(3) A visit to a secondary hospital will be reimbursed at RMB 30, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 200 for prescription drugs.

(4) RMB 20 is reimbursed for visits to tertiary hospitals, the examination fee and surgical fee limit for each visit is RMB 50, and the prescription drug fee is limited to RMB 200.

(5) There is a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice.

(6) The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.

2. Hospitalization compensation

(1) Scope of reimbursement:

A. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, The fee limit for various examinations such as laboratory tests, physical therapy, acupuncture, CT, MRI, etc. is 200 yuan; the operation fee (referring to national standards, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

B. If an elderly person over 60 years old is hospitalized in a health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

(2) Reimbursement ratio:

The town health center will reimburse 60; the second-level hospital will reimburse 40; the third-level hospital will reimburse 30.

Legal basis:

Article 26 of the "Social Insurance Law of the People's Republic of China" Benefits of Basic Medical Insurance for Employees, New Rural Cooperative Medical Care and Basic Medical Insurance for Urban Residents Standards are implemented in accordance with national regulations.

Article 28 of the "Social Insurance Law of the People's Republic of China" complies with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses. Paid from the medical insurance fund.