Go homepage(回首页) Upload pictures (上传图片) Write articles (发文字帖)
The author:(作者)aaapublished in(发表于) 2013/12/22 18:54:21 Master hit Medicare reimbursed or denied， Department of labor
Authorities wide nets of Shenyang, December 22 (reporter Ji Suping) according to the voice of the news aspect of the report, last year, hit the news not found media, Shaanxi old man claiming to be knocked down anti-corruption people were children, hit by a foreigner who was hit, hit the road with mostly negative news. But these days there is a positive energy news and attracted the attention of many people, one recent Shenyang Uncle after being hit, but to hit people who said: "I have health insurance, you go to work. "Grandpa's response make people feel warm this winter, and Shenyang are all over the city looking for hit man in the hope that positive energy can be passed.
There is however to reflect the voice of China by the audience, had encountered a similar situation myself, but the hospital refused to reimburse. This is true right? Whether Medicare will pay for traffic accidents? The practice is in line with the provisions of the hospital? Journalists make a clarification.
On December 19, the Shenyang friends in micro-Bo, basking in the warm scene, after an old man knocked down by electric cars, to hit people who said: "my child, I am fine, I have health insurance, you need to go to work. "In our last report, reporters wrote that: looking hit man limp away from the shadow of feeling arises spontaneously ...... ... This warm picture should probably on hold, but should be more than that. Because if the man really to the hospital to visit injured, probably can not use healthcare. A Chinese voice of enthusiastic listeners phoned about his own similar experiences: the man had been hit, also thought to have health insurance is no problem, but to the hospital only to be told that this health care regardless. Wang Shaoli, Deputy Director of Beijing huilongguan hospital confirmed.
Wang Shaoli: is in accordance with the provisions, it should be with traffic accidents and some accident in the first place are the legal responsibility, and walked out of the health insurance, this is the internal regulations.
Such a requirement is the local policies of individual hospitals in Beijing are also expressly provided in black and white. Second subsidiary Hospital of Zhengzhou University is a leading three-level hospital, healthcare Office Director Zhu Guoqin dealing with Medicare every day, she said someone knocked needs at their own expense, if it is itself falls to the community or public security departments to produce evidence.
Zhu Guoqin: because if we own fell, and community or public security traffic police to issue a certificate is own fell, and Medicare reimbursement. Be borne by the perpetrator. Being crashed not into the system at their own expense reimbursement, all at their own expense, provided, verification in this health insurance Center.
Further proof of labor and Social Security Department. Shandong Zibo hotline service picks up a file and labour and social security, accident medical insurance no matter what.
Service: this is not possible, because we have rules, there are 10 cases are not on Medicare reimbursement, which contains because traffic was not on Medicare reimbursement of medical expenses. Because traffic accidents, intentional injury is the responsibility of people, should be borne by the responsible duty.
Such a requirement sounds a little heartless, but Wang Shaoli, clarifying responsibility is also responsible for Medicare, hospitals must not be belly-worship.
Wang Shaoli: which means that after a disputed injury, first of all to clear responsibility. You say you might have broken it, and by others, you have to figure out who has responsibility, and hospitals who do not give you the normal health insurance programs, Medicare should not claim.
Neither the hospital nor the labor and social security departments have given a clear answer. People's Republic of China social security law provided in express terms, should be borne by the third party paid for medical expenses not covered by basic medical insurance fund range. But then later added: third person did not pay or cannot be determined third party, paid by the basic medical insurance fund. After the Medicare Interim Payment, right of recourse against third parties.
So Medicare actually is fallback feature. Despite the articulate said hospital and medical insurance, but not all of them agree with their point of view.
Deng Liqiang, Director of Legal Affairs of the Chinese Medical Association said that while Medicare does not include traffic accidents, to Shenyang, the man's case, even if not a traffic accident, up to a civil dispute.
Deng Liqiang: this should not be a strong risk of traffic accidents this area, this should be regarded as an ordinary civil disputes before or should I say is really not clear, even disputes are not likely, paid from health insurance, is the intent of Medicare. First hospital have no right to refuse it, if I can deny patients healthcare centre, healthcare Centre still refuse to pay, the patient can go to court to assert their rights.
View seems to be that there is some truth on both sides of the debate, officials also seem to be distinct. In practical operation, however, many patients in order to reduce troubles tend to take other alternative methods.
Wang Shaoli: is that you make sure that you have nothing injuries he went to the hospital can be. After only comes to the hospital should not tell people my own accident, if you said you were an accident, people certainly do not claim.
(Original title: master hit Medicare reimbursed or denied Insurance Department: traffic accidents needs at their own expense)
央广网沈阳12月22日消息（记者季苏平）据中国之声《新闻纵横》报道，最近这一年，撞人的新闻不住的见诸媒体，有陕西老人自称遭小孩撞倒反讹人的，有老外撞人辱骂被撞者的，马路撞人以负面新闻居多。但这几天有一个正能量的新闻也吸引了不少人的关注，近日一位沈阳大爷被撞后，却对撞人者说："我有医保，你上班去吧。"大爷的回应在这个冬天让人倍感温暖，而沈阳也正在全城寻找被撞的老大爷，希望正能量能够传递。
然而有听众却向中国之声反映，自己也曾经遭遇过类似的情况，但是医院却拒绝报销。这是真的吗？医保是否会为交通事故买单？医院的做法是否符合规定？记者做出一番求证。
12月19日，沈阳网友在微博中晒出了温暖一幕，一位老人在被电动车撞倒后，对撞人者说："孩子，我没事，我有医保，你赶紧上班去吧。"在报道的最后，记者写道说：望着被撞的老大爷一瘸一拐远去的身影，感动之情油然而生……这幅温情的画面也许应该就此定格，但是现实应该不止于此。因为如果老大爷果真到医院看伤，也许根本无法使用医保。一位中国之声的热心听众打来电话讲述了自己类似的经历：老人也曾经被人撞了，也以为有医保就没问题，可是到了医院却被告知这种情况医保不管。北京回龙观医院副院长王绍礼证实。
王绍礼：就是按照规定的话，应该是有交通事故或者是有些什么意外的首先走那个法律责任，后走医保，这个是有内部规定的。
这样的规定究竟是北京个别医院的土政策还是白纸黑字的明文规定。郑州大学第二附属医院是当地的一家知名三级甲等医院，医保办主任朱国琴天天和医保打交道，她表示被别人撞倒受伤的情况需要自费，如果是自己摔倒的要由社区或者公安部门出示证明。
朱国琴：因为我们如果是自己摔倒的，社区或者公安交警要出个证明是自己摔倒的，医保也报销。被别人撞到的由肇事者承担。被人撞了就自费就不进系统报销了，全部自费，有规定的，这个医保中心还要核查的。
记者进一步求证劳动保障部门。山东淄博劳动和社会保障热线服务人员拿出文件，交通事故医保肯定不管。
服务人员：这个是不可以的，因为咱们有规定，有10种情况是不能享受医保报销，其中就包含因为交通肇事产生的医疗费用是不能享受医保报销的。因为像交通事故、还有故意伤害等都有责任人，应该是由责任人承担相关的义务。
这样的规定听起来似乎有些不近人情，但是在王绍礼看来，厘清责任也是对医保负责任，医院绝对不能大包大揽。
王绍礼：就是说发生有争议的损伤以后，首先要明确责任。比如你说你骨折了，被别人打的，那就得弄清楚责任在谁身上，医院谁也不会给你走正常医保程序的，医保应该不会理赔的。
刚才不管是医院还是劳动保障部门都给出了一个明确的答复。《中华人民共和国社会保险法》明确规定，应当由第三人负担的医疗费用不纳入基本医疗保险基金支付的范围。但是后面又有补充：第三人不支付或者无法确定第三人的，由基本医疗保险基金先行支付。医保先行支付后，有权向第三人追偿。
所以医保实际上起的是兜底的功能。尽管医院和医保方面把道理说得头头是道，可是并不是所有人都认同他们的观点。
中国医师协会法律事务部主任邓利强表示，虽然医保不包括交通事故，但是向沈阳这位老大爷的情形根本就算不上是交通事故，最多算民事纠纷。
邓利强：这不应该算交通事故交强险这种范畴，这应该算是一般的民事纠纷或者说是在责任没有分清楚之前，甚至有可能连纠纷都算不上，从医疗保险中支付，是医保的本意。首先医院它没有权利拒绝，如果真的拒绝患者可以到医保中心，医保中心仍然拒绝支付，患者可以到法院去主张自己的权利。
辩论双方的观点似乎都有道理，官方的规定也似乎是泾渭分明。但是在现实操作中，很多患者为了减少麻烦往往会采取其它变通的方法。
王绍礼：就是你确认自己没什么损伤，自己去医院是可以的。但是前提是到了医院以后，不应该跟别人说我自己发生交通事故了，如果你说你发生交通事故了，人家当然不给理赔。
（原标题：被撞大爷医保或被拒报销 劳保部：交通事故需自费）
赞