How to handle chronic disease outpatient services

Nowadays, the core of handling chronic disease outpatient clinics (often called chronic disease outpatient clinics) in most medical insurance coordinating areas in China is to bring together the confirmed medical records of the corresponding diseases and submit a qualification application to the medical insurance department in the insured place. After passing the application, you can directly enjoy reimbursement benefits when you go to the outpatient clinic of a designated medical institution. Many cities have already implemented instant application and results can be obtained on the spot.

Last month, when I helped my aunt with type 2 diabetes apply, I was afraid that I would have to make two or three trips, so I called the 12393 medical insurance hotline in advance to ask for the request. I brought along her blood sugar monitoring records for the past six months, the medical records of three outpatient visits to the endocrinology department, and the most recent glycosylated hemoglobin test report. She also submitted her ID card and electronic medical insurance certificate directly to the medical insurance window of the community health service center near her home. The staff checked the materials and handed them over on the spot. In the afternoon, she went to get a prescription for metformin, and she only paid more than 80 for the originally more than 300 yuan, saving a lot of money.

Of course, the details of policies do vary from place to place, and not everyone can be so smooth. I have seen many netizens complain, saying that in order to deal with chronic diseases there, hospitalization diagnosis records are required, but many patients with mild chronic diseases have never been hospitalized at all, and they cannot be dealt with under this condition. This kind of controversy In fact, it has been gradually solved in the past two years. Many provinces have adjusted the identification standards. As long as 6 consecutive months of outpatient follow-up records of designated hospitals, corresponding inspection and test reports, and even the contract management files of family doctors can be used as the basis for identification, there is no need to obtain hospitalization materials.

Nowadays, many places have opened online processing channels. You don’t need to go to offline windows. You can just upload the materials directly to the local medical insurance public account, Alipay medical insurance area, and government service APP. My brother works in Shenzhen, and his parents are from Hunan. Last year, he treated his father with chronic obstructive pulmonary disease for chronic diseases. He submitted the materials directly on the "Hunan Medical Insurance" applet and received a text message confirming the approval within three days. There was no need to go back to his hometown.

By the way, it’s best to check the local chronic disease directory before applying. Not all chronic diseases can be included in the reimbursement scope. For example, some places also include common diseases such as allergic rhinitis, and some places only cover high-incidence severe chronic diseases such as malignant tumors, hypertension, and diabetes. Call 12393 in advance to ask clearly about the requirements, so as to save yourself a lot of trouble. Also, once the certification is approved, it is not valid for life. In most areas, qualifications are reviewed every 2-3 years. Just remember to prepare the latest medical records in advance, so as not to accidentally cut off your benefits.