Guangdong Provincial Medical Insurance Bureau: In case of mandatory discharge or breakdown of hospitalization, you can call 12345 to file a complaint


On the morning of September 12th, the Guangdong Provincial Medical Security Bureau launched a live broadcast program on the "Guangdong Voice Hotline" in conjunction with themed education, focusing on the special treatment of dental implants, centralized procurement of drug consumables, and direct settlement of medical treatment in other places in Guangdong. The program also responded and answered hot issues related to medical insurance. If a patient is required to be discharged or discharged, they can call 12345 to file a complaint. Some patients have had such experiences during hospitalization, where they were informed that "according to medical insurance requirements, they must be discharged" after staying for about 15 days. Some patients who have not yet recovered have had to transfer to other hospitals to continue hospitalization, and some patients have even transferred to more than ten hospitals for this reason. The medical insurance department once again clarified in the program that the National Medical Insurance Bureau and various levels of medical insurance departments do not have an unlimited policy on the length of hospitalization for insured patients, and the enjoyment of medical insurance benefits is not related to the length of hospitalization for patients. We will investigate and punish together if we discover it! "Said Dong Bingguang, a member of the party group and deputy director of the Guangdong Medical Insurance Bureau. It is understood that the medical insurance department supervises and manages medical insurance designated medical institutions in accordance with the provisions of the medical insurance designated management agreement and the "Regulations on the Supervision and Management of the Use of Medical Security Funds". If any violations of the agreement or regulations are found, they will be investigated and dealt with in accordance with the law and regulations. If the public encounters situations where the hospital does not meet the mandatory discharge requirements or induces decomposition of hospitalization, they can complain to the health department or medical security department by calling the government hotline "12345" or other means. It is understood that the so-called decomposed hospitalization refers to the process of artificially decomposing a continuous hospitalization into two or even multiple hospitalization treatments without following the clinical discharge standards, or the frequent transfer of insured personnel between hospitals or internal departments. Can the reimbursement ratio not be reduced due to the exemption from filing for medical treatment in other places? At least 18 cities in Guangdong have implemented the "exemption from filing" policy for temporary medical personnel seeking medical treatment, and direct settlement for medical treatment in other places. However, during a visit by the reporter, it was found that although some cities have exempted the filing procedures, the proportion of medical insurance reimbursement is still linked to whether it is filed or not. Some insured people roast that although the "record free" procedure is convenient, it may cost more money. Mr. Huang's wife from Dongguan went to a hospital in Guangzhou this year due to heart discomfort. Due to the course of the illness, the hospital immediately arranged for hospitalization and surgery. During this time, Mr. Huang inquired with the hospital about the registration procedures for medical treatment in a different location and was informed that Dongguan residents do not need to register for medical treatment in a different location, but can settle directly. But when he was discharged and settled, Mr. Huang found that due to the lack of filing, the reimbursement ratio had decreased by 15%, which means they had to pay an additional 10000 yuan for their medical expenses. Fortunately, the filing can still be made up. Another Ms. Chen from Heyuan was informed that there was no need to file for medical treatment, but she only learned before settlement that due to the lack of filing, the reimbursement ratio decreased by 10%. Why is Guangdong still unable to achieve the exemption from medical records in other places, and the reimbursement ratio does not decrease? Zhang Yanchun, Director of the Guangdong Medical Insurance Center, responded that seeking medical treatment in other places is very complex. On the one hand, it is necessary to consider the medical needs of insured individuals, and on the other hand, it is necessary to consider the supply capacity of local medical services. In other words, if medical resources are sufficient, can everyone come here to seek medical treatment and be able to bear it.

Edit:GuoGuo Responsible editor:FangZhiYou

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