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来源:本站 最后更新:2019-10-24 10:30:58 作者:佚名 浏览:2970次
 
牙科费用报销与不报销的项目—保险篇
 
保险报销要求:
公立医院就诊、诊疗明细与发票总金额一致、看病病历资料齐全是享受牙科费用报销的首要条件。另外,牙齿治疗的费用能不能报销,要根据治疗项目和使用材料而定。
 
一般不报销的项目:
1.镶牙:普通的镶牙,譬如1、2、3这3个牙齿,其中2因故而拔掉了。 于是做一个3个牙齿的帽子(就是3个烤瓷冠)的牙,分别套在1和3的上面,这样2也就镶好了。但前提1和3这两颗牙也要磨掉一大层用来套冠。这种方式比种牙的优势在于便宜,劣势在于损伤了1和3这两颗好牙;
                                                                                         
 
2.种牙:如同上面所说的,1、2、3这3个牙齿,其中2因故而拔掉了。 种牙是就在2的位置种一个钉子到牙槽骨里,然后在钉子的头上镶一个独立的烤瓷牙冠。这种方式的优点就是与邻牙无关,但是比较贵;
                                                                                         
 
3.义齿修复:包括桩冠、套冠、全口义齿、局部义齿等;
4.正畸:牙齿不整齐而进行矫正治疗;
                                                                                                                                      
 
5.修补:使用进口等高端材料费用一般不能报销,使用普通材料可以报销;
6.色斑牙治疗等美容美牙项目;
7.单纯洗牙,或因治疗需要洗牙时而涉及牙齿美容的费用。
 
 可以报销的费用:
1.拔牙;
2.补牙:包括普通材料费和治疗费;
3.口腔止血、牙周病、牙髓炎、根尖周炎、根管治疗、牙疼等疾病的治 疗费用。
                                                                                                                                       
 
 
一般报销比例及形式(公立医院普通科室):
1. 疾病门诊:有日限额600元限制(减去自费费用之后在日限额内的费用),有起付线,赔付比例85%。即(日限额以内金额合计 - 起付线)*85%=报销金额;
 
Reimbursement andNon-reimbursement Items in Dental Expense-Insurance
Chapter
About the insurance reimbursement request: 
  Public hospital visits, consistency between diagnosisand treatment details and the total amount of invoice, and complete medicalrecords are the first condition to enjoy dental expenses reimbursement. Inaddition, the cost of dental care can be reimbursed depending on the treatmentprogram and the materials used.
 
General non-reimbursement items:
1. Denture: ordinarydenture, such as there are tooth No.1, 2and 3, among which the second tooth is pulled out for some reason. So makedental caps (3 porcelain crowns) for the three teeth, put them on 1st and 3rdrespectively, and then the second tooth is fixed too.But the premiseis that tooth No. 1 and 3 must be worn off a thick layer for the crown. Theadvantage of this method is that it is cheaper than dental implant, and thedisadvantage is that the two good teeth No.1 and 3 are damaged.
 
2. Dental implant: As mentioned above, amongthe tooth No.1, 2 and 3, the second tooth is pulled out for some reason. Dentalimplant is to implant a nail into the alveolar bone on the location of toothNo.2, and then an independent porcelain crown is implanted on the head of thenail. The advantage of this method is that it has nothing to do with the adjacentteeth, but it is relatively expensive.
3. Denture restoration: including the post crown, dentalcrown, complete denture, partial denture etc.
4. Orthodontics:orthodontic treatment is needed due to irregular teeth.
5. Repair: The use of imported high-endmaterials cannot be reimbursed
generally, but the use of ordinary materials canbe reimbursed.
6. Stained tooth treatment and other estheticdentistry items
7. Simple teethwash, or when the teeth wash is required for the
treatment, the costsinvolved in esthetic dentistry.
 
Reimbursement items:
1. Tooth extraction
2. Tooth filling: includingordinary materials and treatment fees.
3. Oral hemostasis,periodontal disease, pulpitis, periapical periodontitis, root canal therapy,toothache and other disease treatment costs.
 
General reimbursement ratioand form (general departments of public hospitals): 
1. Outpatient fordisease: There is a daily limit of 600 yuan ( the cost within the daily limit afterdeduction of the expenses paid by oneself); there is a minimum charge, and the payout ratio is 85%. That is (the totalamount within daily limit-minimum charge)*85%= Reimbursement amount.
2. Outpatient foraccident:Subtract the non-reimbursement expense, 100% of therest expense
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