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新农合跨省就医可微信直接结算 每人平均少垫付七千余元

2017-09-07 15:21:50   央广网

1518家跨省就医定点医疗机构可直接结算,覆盖31个省

8月底的一天,身在广东打工的吴磊(化名)突发急性胰腺炎,因为觉得广东的医院费用贵,他转而回到老家贵州习水入院治疗,一天后,当地医院因无法医治,主动提出将其转诊到四川省西南医科大学附属中医医院。

8月30日,吴磊正式入院。9月5日,基本康复的吴磊在该院办理出院手续,令他没想到的是,虽然不在户籍地就诊,但在结算时,他收到了新农合直接报销费用4258元,大病保险直接报销4401.83元,报销补偿比例达到了91.8%。

而吴磊也成为了全国“新农合+大病医保”跨省就医“一站式”结算的首个受益者。

“真是没想到,这下既解决了我到贵州习水报销的费用,又减轻了住院个人垫付的负担,很高兴。”吴磊说。

同样在8月,患有严重心脏病的西藏姑娘降央卓玛(化名),根据西藏自治区第二人民医院的转诊建议,来到北京协和医院就诊,就医总费用8.4万元,而按照新农合跨省就医联网结算政策,降央卓玛个人仅支付了3万,报销比例接近65%。

实际上,无论吴磊还是降央卓玛,都只是新农合异地就医直接结算政策的缩影。

 哪些人可以进行跨省就医直接结算?

新农合跨省就医联网结报,意味着参合患者到省外的“跨省定点医疗机构”住院时,在出院时可在医院结算窗口直接结算,患者只需支付自付费用,其余费用则由跨省定点医疗机构先行垫付。

“这改变了以前参合患者需缴纳全部医疗费用,然后再回参合第报销的结算方式,不仅少垫钱,还能少跑腿。”在国家卫计委基层司监察专员聂春雷看来,经规范转诊后的新农合跨省就医患者除了享受以上好处之外,还可适量减少部分住院押金,减轻就医负担。

目前,有两类参合患者可按参合地分级诊疗相关规定来申请办理新农合跨省就医转诊手续。一类为在省内医疗机构无法确诊,或确诊后无治疗条件的疑难病症患者;另一类,则为在外务工、探亲(异地长期居住)或急症的参合患者。

其中,后者如需在居住地住院,本人或家属需联系参合地经办机构申请办理转诊手续,如果没有在入院前办理转诊的以及异地急诊的参合患者,也可在入院后5个工作日内补办。

但并不是所有就医费用都能报销。据聂春雷介绍,门诊就诊费用、因第三方责任导致意外伤害的住院医疗费用以及就医地基本医保(或新农合)不予报销的费用,则不在异地就诊报销之列。

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