Chronic disease application

First confirm that the disease you suffer from is within the scope of the medical insurance chronic disease catalog in the insured area, prepare medical records, examination reports and physician diagnosis certificates that meet the identification standards, and submit them through online or offline medical insurance handling channels. In most areas, the review cycle ranges from 3 to 30 working days. After the benefits take effect, the reimbursement ratio for outpatient drug purchases and examinations is generally between 50% and 90%.

Last week, I accompanied Aunt Zhang downstairs to apply for a chronic disease application for high blood pressure. It took her three trips to get it done. The first time I went there, she only brought the blood pressure record book she measured at home. They confiscated it and said she needed an inspection report from a second-level hospital or above.； The second time I went there, I brought a brain CT scan from six months ago, but the required diagnostic certificate was not issued, so I went back to the hospital to see the doctor. ； The third time she submitted the materials smoothly, the approval was approved in less than a week. Now she goes to the outpatient clinic to get antihypertensive drugs, which used to cost more than 300 per month, but now the out-of-pocket cost is less than 80.

Many people on the Internet say, "You can easily apply for a chronic disease," while others say, "I have had high blood pressure for many years, but my application has not been approved." In fact, both situations are very common. The fundamental reason is that the identification standards for chronic diseases are not uniform in various places. For example, for the same high blood pressure, some places require it to be high-risk level 3 or above, combined with heart, brain, and kidney. One of the target organ injuries can only be applied for. In some places, you only need to take the medicine continuously for one year and have clear medical records. There is no so-called unified national standard. The most reliable way is to call the 12393 medical insurance hotline, report your insured place and disease, and ask what specific materials are required. It is more useful than reading ten general guides.

In the past two years, I have helped relatives and friends apply for chronic diseases no less than ten times, and I found that the most common issue is material issues. Many people think that it’s enough if I have a medical certificate? Really not. For example, when applying for diabetes, you will most likely not be able to pass with just a diagnosis certificate of "Type 2 diabetes". You must attach the glycosylated hemoglobin test report for the past three months. If there are complications, there must also be a test sheet corresponding to the complications, such as an electromyography report for peripheral neuropathy and a urine routine report for diabetic nephropathy. These are the core basis for identification, and the diagnosis certificate is just a supplement. If you have been hospitalized before, it will save you a lot of trouble. You can go directly to the medical record room to copy the complete set of hospitalization records and stamp them with an official seal. This can be used in 90% of cases. It is much more convenient than saving a lot of outpatient records.

As for the submission channel, it’s entirely up to you. If young people don’t want to run away, they can directly open the National Medical Insurance Service Platform APP, search for “chronic special disease application”, and follow the prompts to upload the materials. The last time I helped my brother apply for rheumatoid arthritis, I sent it on Friday night, and I received the approved text message on Tuesday, which saved a lot of trouble. For the elderly who are not good at using smartphones, they can go directly to the medical insurance handling hall, or many tertiary hospitals now have a dedicated window for accepting chronic and special diseases. After seeing the patient, you can go directly to the window to submit the documents. The staff will check it for you on the spot. If you are missing something, you can make up for it on the spot, so you won’t have to go back and forth. By the way, there are still many places that support community agencies. Just hand the materials to the medical insurance handlers in the community. However, the review speed will be a little slower. If you are in a hurry, it is faster to hand it in yourself.

Oh, by the way, many people have asked me, does having commercial medical insurance eliminate the need for chronic diseases? My suggestion is to do it if you can. Reimbursement for chronic and special diseases is a basic benefit of medical insurance. It does not affect the claims of commercial insurance. It is equivalent to an extra layer of reimbursement. You can save a little bit. After all, you have to pay for the deductible of commercial insurance yourself.

Many people ask before applying, how much can they get after applying? There is no unified answer to this. The general reimbursement ratio of employee medical insurance is 70%-90%, and that of resident medical insurance is 50%-70%. In most areas, reimbursement for chronic diseases does not account for the general outpatient quota, and the annual quota is tens of thousands to hundreds of thousands. For large-scale outpatient treatments such as dialysis and tumor radiotherapy and chemotherapy, many places can reimburse more than 90%, and some can save hundreds of thousands a year. Some people also say that "it can only be used in one hospital". This has long been an old history. Now most areas can choose 3-5 designated hospitals. If you need to see a doctor in another place, make a record of the medical treatment in another place in advance. You can also directly reimburse the designated hospital in other places, which is very convenient.

To be honest, I have seen too many people who find it too troublesome and are unwilling to do it. They spend thousands more on medicine every year. It is really unnecessary. The only thing to note is that the chronic disease qualifications in many places are not valid for life. They need to be reviewed every 1-3 years. At that time, just submit the latest inspection report as required. If you forget to review, the benefits will be automatically suspended. If the reimbursement is not available then it will be delayed. If you really don’t have time to do it yourself, it’s very simple for family members to do it for you. Just bring the ID cards of both parties. In most areas, you don’t even need an additional power of attorney and you can do it directly.