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异地就医 报销如何更便利(走转改·一线调查)

2017-08-07 06:31:20   中国青年网

核心阅读

截至今年6月19日,30个省份和新疆生产建设兵团均整体或部分接入国家基本医疗保险异地就医结算系统。今年2月,云南省作为全国首批省份正式接入国家平台。老百姓异地就医享受到哪些便利?又有哪些待突破的瓶颈?异地就医如何更好地造福百姓?记者进行了实地调查。

“在养老的地方解决异地就医住院报销,这一天终于来了。”户籍吉林、在云南养老的徐长生老先生说。6月份,他因心律失常住进云南省第二人民医院,出院时发现,通过国家跨省异地就医直接结算平台结算医疗费用9115.12元,医保支付7892.52元,个人自付仅1222.6元。“早在2月,我就收到了吉林省医保局的第二代社会保障卡,通知说可以在昆明就医、直接刷卡结算。”徐长生说。

云南跨省异地就医直接结算施行已5个多月。3月1日,退休后随子女在昆明居住的贵州省参保人王先生,其医疗费用在云南省中医医院通过云南省跨省异地就医联网直接结算平台与国家跨省异地就医联网直接结算平台,首次实现异地就医直接结算。这件事标志着云南省的跨省异地就医联网直接结算,实现了从原来的点对点的省级(地方系统)之间结算,到通过国家跨省异地就医联网结算平台(国家系统)的突破。

参保人员异地就医结算需申请备案,采取“参保地待遇,就医地管理”模式

从1999年城镇职工基本医疗保险制度改革启动至今,云南城镇职工、城乡居民医疗保险参保人数已达4096万人,全民医保基本实现,医疗保险日益融入人民群众的日常生活中。

2009年起,云南启动了省内异地就医联网即时结算试点,2011年实现全省范围的异地就医联网直接结算;2016年跨省联网直接结算实现了与17个省市的互联互通。2016年底,全国跨省异地就医直接结算系统平台(简称国家平台)搭建完成,进入全国联网测试阶段,云南省作为全国首批接入省份,今年2月,顺利完成了各项准备及测试工作,正式接入国家平台。今年6月16日,全省所有统筹区全部接入国家跨省异地就医直接结算平台,开展跨省异地就医直接结算业务。该平台的建成,在国家层面上,从制度设计、业务经办管理、信息网络构建等多个方面实现规范管理、标准统一。

据介绍,目前参保人员如果需要跨省异地直接结算,首先需要在参保地医保经办机构办理异地就医申请备案,选择就医地以及将要就医的医院,所选定点医院需是就医地开通跨省异地就医的定点医院,然后携带备案表、社保卡、身份证,即可到所选地区的定点医院进行看病就医结算。

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