Outpatient Guide

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Medical Treatment Guide

Outpatient Special Disease Application Process

1. Outpatient Application for Special Diseases by Chengdu Municipal-Level Insured Patients (Medical Insurance Office, Windows 5-7)

(1) Documents Required for Disease Identification

1. Huaxi Hospital Real-Name Registration Card, Chengdu Social Security Card (with PIN)

2. A discharge summary or outpatient medical certificate from West China Hospital issued within the past six months

3. Relevant examination reports from medical institutions qualified to diagnose specific diseases (see the Medicare Information Board next to Window No. 9 at the Medical Insurance Office for details).

4. Photocopy of ID card

Note: During the assessment process for chronic kidney disease (outpatient hemodialysis), organ transplantation, and tyrosine kinase inhibitor eligibility (for chronic myeloid leukemia and gastrointestinal stromal tumors), a patient’s facial image will be collected (an electronic photo with clear features of the face is acceptable).

(II) Documents Required for Treatment Approval (for Patients Who Have Already Been Approved for the Disease Category)

1. Huaxi Hospital Real-Name Registration Card, Chengdu Social Security Card (with PIN)

2. "Outpatient Special Disease Application Referral Form" issued by the doctor

(III) Relevant Health Insurance Regulations

1. The "Mentor" review cycle lasts three months, during which no new or modified disease categories can be added. If there are any changes to the treatment plan for an applied disease category, the attending physician must issue a change request form, which will only take effect after being reviewed at Window 5-7 of the Medical Insurance Office.

2. Patients pay a prepaid deposit at the outpatient billing window based on their assessment, and billing is recorded throughout the cycle. At the end of the cycle, reimbursement is processed according to Medicare policies.

3. After the treatment cycle ends, reimbursement should be claimed promptly. If treatment needs to continue, apply for a new cycle of the treatment plan (at this point, additional conditions can be added).

4. If a patient is hospitalized during the "Ment" cycle, they must fully advance the costs incurred during that period. Afterward, they should submit the "Outpatient Special Disease Treatment Plan Application Form" along with the detailed hospitalization bill to their respective insurance provider for reimbursement. Whether or not reimbursement is approved will not affect the patient’s eligibility to apply for the next cycle.

II. Application Process for Outpatient Special Diseases by Insured Patients at the Provincial Level in Sichuan Province (Medical Insurance Office, Window No. 9)

(1) Documents Required for Disease Identification

1. Huaxi Hospital Real-Name Registration Card, Provincial-Level Medical Insurance Card (with PIN)

2. A discharge summary or outpatient medical certificate from Huaxi Hospital issued within the past three months

3. Submit the relevant examination reports for the identified medical conditions (see the Medicare Information Board next to Window No. 9 at the Medical Insurance Office).

4. Photocopy of ID card and contact information

(II) Designated Disease Type (Select Treatment Hospital)

Patients with insurance should visit windows 5, 6, 7, and 9 at the Huaxi Hospital Medical Insurance Office, presenting their real-name registration cards and medical insurance cards for designated-point registration.

(III) Relevant Health Insurance Regulations

After approval, patients enrolled in the program must pay for prescribed medications and examination fees at the designated "Provincial Special Services" window within the Settlement Office of West China Hospital. Each medication purchase should not exceed a one-month supply, and there must be an interval of 22 days between consecutive purchases. (Note: For diabetes and hypertension, only up to three medications can be prescribed per prescription.) Reimbursement details will be determined based on the information returned by the Provincial Special Services system.

3. Out-of-Province Outpatient Special Disease Networked Services within Sichuan Province (Medical Insurance Office, Window No. 9)

(1) Basic Requirements for Business Processing

1. Second-generation chip-based health insurance card (with PIN)

2. Have already completed the outpatient special disease identification and inter-provincial registration/filing in the insurance enrollment location.

(II) Processing Procedure

1. Our hospital’s real-name registration card and second-generation chip-based medical insurance card must be swiped at Window 9 of the Medical Insurance Office for online connectivity. (Note: If a new outpatient disease category is added or your medical card is replaced, you’ll need to reapply for online connectivity.)

2. Inform the doctor at the time of consultation that the patient is a provincial out-of-province special-need outpatient.

3. Bring the referral slip issued by your doctor to Window 7 in the Financial Billing Office on the first floor of the outpatient hall for payment and settlement.

(III) Relevant Health Insurance Regulations

For reimbursement policies, please consult the medical insurance bureau in your place of enrollment (for consultation phone numbers, refer to the medical insurance information board next to Window No. 9 at the Medical Insurance Office).

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