Special outpatient service refers to eligible serious diseases and chronic diseases, which can also be reimbursed as hospitalization in outpatient service, because medical insurance only reimburses hospitalization expenses, but some serious diseases and chronic diseases do not necessarily need hospitalization, and can also be treated in outpatient service, so there are special outpatient services.
1, preliminary declaration.
The insured units or individuals who apply for the first time shall, before the last month of each quarter 15, hold the form of the medical insurance department of the first-instance hospital and fill in the application form for special disease outpatient service, prepare the relevant medical records (or copies) of the declared diseases and a recent 1 inch bareheaded photo, and choose designated hospitals and special disease outpatient pharmacies for medical treatment.
The special declaration of resettlement personnel in different places shall be handled by the medical insurance administrator of the unit or myself in the medical insurance department of the special trial appraisal hospital at the corresponding level in this city.
2. Preliminary examination of the hospital. After the first-instance hospital collects all the relevant information of the applicant, it will organize medical experts in our hospital to make diagnosis and preliminary identification.
3. Expert review. At the end of each quarter, the municipal medical insurance department organizes the expert committee of the basic medical insurance for urban workers in this Municipality to conduct centralized review, and the expert committee will review them one by one according to the special confirmation standards.
4, the issuance of "special outpatient medical records of special diseases". After passing the review by the Municipal Expert Committee, special applicants will bring the medical insurance manual to the Municipal Medical Insurance Office to receive special medical records for special disease clinics within 5 working days in the first month of the next quarter. Those who pass the review will begin to enjoy the basic medical insurance special disease outpatient treatment that month. If the evaluation by the Municipal Expert Committee is unqualified, it shall indicate the reasons for the unqualified and inform it in writing, and return the medical records to the applicant.
5, special disease renewal procedures. The period of validity of special disease A and B clinics is two years, and that of class C is one year. If the illness is not healed and needs treatment, it is necessary to go through the renewal procedures.
Extended data:
Special diseases: outpatient special diseases refer to chronic diseases that can be treated without hospitalization and still rely on drugs to maintain long-term stability. It usually refers to malignant tumors that need radiotherapy and chemotherapy, renal insufficiency that needs long-term renal dialysis treatment, and diseases that need long-term anti-rejection drugs after kidney transplantation.
Because many special diseases need outpatient treatment or long-term medication, after the examination and approval of special diseases, one can be selected as a designated hospital for special diseases, and the expenses of outpatient special diseases can be reimbursed according to the proportion of hospitalization as a whole, and medical treatment can be carried out by bookkeeping to reduce the personal burden of patients. With the improvement of medical insurance level in various places, many areas gradually include more diseases into the scope of special diseases.
"Three special diseases"
The so-called "special diseases", also known as "three special diseases", means that the general scope of special diseases includes the following three diseases:
1, renal insufficiency needs long-term dialysis treatment; ?
2. Suffering from malignant tumor requires radiotherapy and chemotherapy;
3. Anti-rejection drugs should be taken for a long time after renal transplantation.
References:
Characteristic outpatient service-Baidu encyclopedia characteristic disease-Baidu encyclopedia