Q: What are the insurance reimbursement requests?
A: Public hospital visits, consistent with diagnosis, treatment details and the total invoice amount, and complete medical records are required for dental reimbursement. In addition, the cost of dental care can be reimbursed depending on the treatment program and the materials used.
Q: What are the items that cannot be reimbursed?
A: 1. Denture. Ordinary denture, such as with tooth 1, 2 and 3, the second tooth needs to be extracted for some reason. Dental caps (3 porcelain crowns) for the three teeth are made, and put on Tooth 1 and 3, and then Tooth 2 is also fixed. But the premise is that tooth No. 1 and 3 must be worn off to make a thick layer for the crown. The advantage of this method is that it is cheaper than a dental implant, but the disadvantage is that the two good teeth, No.1 and 3 are damaged.
2. Dental implant. As mentioned above, such as with tooth 1, 2 and 3, the second tooth is extracted for some reason. The dental implant consists of implanting a nail into the alveolar bone on the location of tooth No.2, and then an independent porcelain crown is implanted on the head of the distressed area. The advantage of this method is that it has nothing to do with the adjacent teeth, but it is relatively expensive.
3. Denture restoration. Including the post crown, dental crown, complete denture, partial denture etc.
4. Orthodontics. Orthodontic treatment is needed due to teeth being in an irregular position.
5. Repair. The use of imported high-end materials cannot be reimbursed generally, but the use of ordinary materials can be reimbursed.
6. Stained tooth treatment and other esthetic dentistry items.
7. Simple teeth wash, or when the teeth wash is required for the treatment, the costs involved in esthetic dentistry.
Q: What are the items that can be reimbursed?
A: 1. Tooth extraction
2. Tooth filling (Including ordinary materials and treatment fees.)
3. Oral hemostasis, periodontal disease, pulpitis, periapical periodontitis, root canal therapy, toothache and other disease treatment costs.
Q: What are the general reimbursement rate and type (in general departments of public hospitals)?
A: Outpatient. There is a daily maximum reimbursement rate of 600 yuan (if the cost exceeds 600, for example if the cost is 700, then only 600 can be reimbursed and 100 must be paid by oneself). Then, the excess amount (for example 650) is deducted from the treatment amount. The payout rate is 85% of this total.
You make three trips to the dentist for a procedure. The costs incurred are:
Day 1: 500
Day 2: 750
Day 3: 800
Afterwards, when making the reimbursement, according to the daily maximum reimbursement rate, they will be tallied as:
(500 + 600 + 600) =1700. Then minus the excess rate, e.g. 650 (1700-650 = 1050). Then get 85% of 1050 = 892.5
892.5 is the amount that you will be reimbursed.
*Please note: the excess rate will depend on the type of insurance purchased.