How to apply for chronic diseases

The core application process for outpatient chronic diseases (often referred to as "chronic diseases" and "chronic special diseases") in various parts of the country is actually very clear. First, confirm that the disease is in the chronic disease catalog of the insured place, prepare the corresponding diagnostic materials and submit them to the chronic disease window of the designated hospital or the medical insurance agency. After expert review, the application will take effect if it meets the certification standards. The entire cycle usually does not exceed 20 working days. After the effective date, outpatient prescriptions and related examinations can enjoy medical insurance reimbursement benefits.

Two months ago, I just went through this procedure for Uncle Wang downstairs, who suffers from hypertension and lacunar cerebral infarction. He used to pay more than 300 out-of-pocket for antihypertensive drugs and neurotrophic drugs every month. After the application was approved, the monthly out-of-pocket for the same amount of medicine was less than 80, which really saved a lot of money.

You don’t need to save a bunch of useless materials when applying. First, call the hotline of the local medical insurance bureau or go to the official medical insurance applet to check two key points. First, whether the disease you have is in the local chronic disease reimbursement catalog. After all, the affordability of medical insurance funds in different places is different, and the chronic disease catalogs are also different. For example, some places Migraines and moderate gout are included in the scope of reimbursement. In some places, it currently only covers high-risk serious and chronic diseases such as hypertension, diabetes, and radiotherapy and chemotherapy for malignant tumors. Diseases that are not in the catalog cannot be applied for. However, the catalogs in various places will be dynamically adjusted every year. If there is demand, you can also provide suggestions to the medical insurance department.

The second is to find out the identification criteria for the corresponding disease in advance, and don’t rush to submit the application as soon as you are diagnosed with the disease. For example, you don’t have to have excessive fasting blood sugar to apply for a chronic disease of diabetes. Most places require a history of continuous medication for more than six months, or complications such as diabetic foot and retinopathy. If you do not meet the standards, you will not be able to pass even if you submit the materials.

Preparing the materials is not that complicated. You need to find a doctor in charge of a designated hospital of level 2 or above to issue a clear diagnosis certificate, and bring along the medical records and examination reports for the past six months. If you have been hospitalized, bring the discharge summary as well. Just bring your ID card and social security card. If you forget to bring your physical card, you can also use your electronic medical insurance voucher. Nowadays, many places have opened online application ports. You can upload materials in the medical insurance APP or the medical insurance area of ​​Alipay and WeChat. For example, Uncle Wang has difficulty moving, so I submitted his application on our province’s medical insurance applet and received the approval text message in 11 days. I did not go through the offline window in the whole process.

Many friends also said that they had all the materials but were called back. I have asked the staff at the medical insurance window for relatives before. In most cases, the materials did not meet the requirements. For example, the diagnosis certificate was issued by a community hospital and did not meet the requirements of a second-level hospital or above, or the examination report was from a year ago and could not prove the current condition. Don’t panic when encountering this situation. The window will give specific reasons for disapproval. Just submit whatever is missing and submit it. If you have any objections to the review results, you can also apply for expert review.

As for the often-asked question of whether annual review is required, the qualifications for most chronic diseases are valid for a long time. Only diseases with a clear course, such as tuberculosis and acute hepatitis, will have a validity period of 1-2 years. Before expiration, just go through the review process with the latest review materials, and there is no need to bother reapplying every year.