{"id":13576,"date":"2025-06-13T09:58:24","date_gmt":"2025-06-13T02:58:24","guid":{"rendered":"https:\/\/quanhelaodong.molisa.gov.vn\/?p=13576"},"modified":"2025-06-13T10:01:52","modified_gmt":"2025-06-13T03:01:52","slug":"12-truong-hop-khong-duoc-bao-hiem-y-te-chi-tra-du-di-kham-dung-tuyen-tu-1-7","status":"publish","type":"post","link":"https:\/\/quanhelaodong.moha.gov.vn\/?p=13576","title":{"rendered":"12 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o hi\u1ec3m y t\u1ebf chi tr\u1ea3 d\u00f9 \u0111i kh\u00e1m ‘\u0111\u00fang tuy\u1ebfn’ t\u1eeb 1-7"},"content":{"rendered":"\n\n\n

T\u1eeb ng\u00e0y 1-7, Lu\u1eadt B\u1ea3o hi\u1ec3m y t\u1ebf s\u1eeda \u0111\u1ed5i, b\u1ed5 sung m\u1ed9t s\u1ed1 \u0111i\u1ec1u b\u1eaft \u0111\u1ea7u c\u00f3 hi\u1ec7u l\u1ef1c, quy \u0111\u1ecbnh r\u00f5 12 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng thu\u1ed9c ph\u1ea1m vi chi tr\u1ea3 c\u1ee7a qu\u1ef9 b\u1ea3o hi\u1ec3m y t\u1ebf k\u1ec3 c\u1ea3 khi ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 \u0111\u00fang quy tr\u00ecnh kh\u00e1m ch\u1eefa b\u1ec7nh.<\/p>\n

Theo \u0111\u00f3, danh s\u00e1ch 12 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u01b0\u1ee3c h\u01b0\u1edfng\u00a0b\u1ea3o hi\u1ec3m y t\u1ebf\u00a0(BHYT) v\u1eabn gi\u1eef nguy\u00ean so v\u1edbi quy \u0111\u1ecbnh t\u1ea1i Lu\u1eadt BHYT n\u0103m 2014. Tuy nhi\u00ean, hai tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh cho ph\u00f9 h\u1ee3p v\u1edbi th\u1ef1c ti\u1ec5n v\u00e0 h\u01b0\u1edbng t\u1edbi s\u1eed d\u1ee5ng hi\u1ec7u qu\u1ea3 qu\u1ef9 b\u1ea3o hi\u1ec3m.<\/p>\n

Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p “\u0111\u00fang tuy\u1ebfn” nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c chi tr\u1ea3<\/strong><\/p>\n

Theo V\u1ee5 B\u1ea3o hi\u1ec3m y t\u1ebf (B\u1ed9 Y t\u1ebf), vi\u1ec7c gi\u1edbi h\u1ea1n ph\u1ea1m vi chi tr\u1ea3 l\u00e0 nh\u1eb1m b\u1ea3o \u0111\u1ea3m s\u1eed d\u1ee5ng qu\u1ef9 BHYT m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3, c\u00f4ng b\u1eb1ng v\u00e0 h\u01b0\u1edbng v\u00e0o m\u1ee5c ti\u00eau ch\u00ednh l\u00e0\u00a0kh\u00e1m ch\u1eefa b\u1ec7nh. Nh\u1eefng d\u1ecbch v\u1ee5 kh\u00f4ng nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd, nh\u01b0 l\u00e0m \u0111\u1eb9p hay kh\u00e1m s\u1ee9c kh\u1ecfe t\u1ed5ng qu\u00e1t, s\u1ebd kh\u00f4ng d\u00f9ng ngu\u1ed3n l\u1ef1c t\u1eeb qu\u1ef9.<\/p>\n

Th\u1ef1c t\u1ebf cho th\u1ea5y nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p hi\u1ec3u nh\u1ea7m r\u1eb1ng ch\u1ec9 c\u1ea7n c\u00f3 th\u1ebb BHYT v\u00e0 \u0111i kh\u00e1m \u0111\u00fang n\u01a1i \u0111\u0103ng k\u00fd l\u00e0 \u0111\u01b0\u1ee3c thanh to\u00e1n to\u00e0n b\u1ed9 chi ph\u00ed. Tuy nhi\u00ean, BHYT ch\u1ec9 chi tr\u1ea3 cho nh\u1eefng d\u1ecbch v\u1ee5 kh\u00e1m ch\u1eefa b\u1ec7nh thu\u1ed9c danh m\u1ee5c, c\u00f3 ch\u1ec9 \u0111\u1ecbnh y t\u1ebf r\u00f5 r\u00e0ng.<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u01b0\u1ee3c BHYT thanh to\u00e1n bao g\u1ed3m:<\/p>\n

1. Chi ph\u00ed \u0111\u00e3 \u0111\u01b0\u1ee3c ng\u00e2n s\u00e1ch nh\u00e0 n\u01b0\u1edbc thanh to\u00e1n<\/b>:<\/em> \u0110\u00e2y l\u00e0 c\u00e1c kho\u1ea3n chi cho kh\u00e1m ch\u1eefa b\u1ec7nh, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, kh\u00e1m thai \u0111\u1ecbnh k\u1ef3, sinh con, kh\u00e1m s\u00e0ng l\u1ecdc, ch\u1ea9n \u0111o\u00e1n s\u1edbm m\u1ed9t s\u1ed1 b\u1ec7nh, v\u00e0 chi ph\u00ed v\u1eadn chuy\u1ec3n\u00a0c\u1ea5p c\u1ee9u\u00a0t\u1eeb tuy\u1ebfn d\u01b0\u1edbi l\u00ean tuy\u1ebfn tr\u00ean \u0111\u1ed1i v\u1edbi c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng ch\u00ednh s\u00e1ch nh\u01b0 ng\u01b0\u1eddi c\u00f3 c\u00f4ng, h\u1ed9 ngh\u00e8o, c\u1eadn ngh\u00e8o, ng\u01b0\u1eddi d\u00e2n t\u1ed9c thi\u1ec3u s\u1ed1, tr\u1ebb d\u01b0\u1edbi 6 tu\u1ed5i\u2026<\/p>\n

2. D\u1ecbch v\u1ee5 \u0111i\u1ec1u d\u01b0\u1ee1ng, an d\u01b0\u1ee1ng t\u1ea1i c\u01a1 s\u1edf chuy\u00ean bi\u1ec7t.<\/b><\/em><\/p>\n

3. Kh\u00e1m s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3<\/b>:<\/em> Bao g\u1ed3m kh\u00e1m t\u1ed5ng qu\u00e1t kh\u00f4ng nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb.<\/p>\n

4. X\u00e9t nghi\u1ec7m, ch\u1ea9n \u0111o\u00e1n thai kh\u00f4ng nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb<\/b>:<\/em> V\u00ed d\u1ee5 nh\u01b0 si\u00eau \u00e2m, theo d\u00f5i thai k\u1ef3 \u0111\u01a1n thu\u1ea7n.<\/p>\n

5. D\u1ecbch v\u1ee5 h\u1ed7 tr\u1ee3 sinh s\u1ea3n v\u00e0 k\u1ebf ho\u1ea1ch h\u00f3a gia \u0111\u00ecnh,<\/b>\u00a0<\/em>bao g\u1ed3m n\u1ea1o, h\u00fat thai, ph\u00e1 thai t\u1ef1 nguy\u1ec7n, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p \u0111\u00ecnh ch\u1ec9 thai ngh\u00e9n v\u00ec l\u00fd do b\u1ec7nh l\u00fd.<\/p>\n

6. C\u00e1c d\u1ecbch v\u1ee5 th\u1ea9m m\u1ef9:<\/b>\u00a0<\/em>Ch\u1ec9nh h\u00ecnh, l\u00e0m \u0111\u1eb9p kh\u00f4ng ph\u1ee5c v\u1ee5 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh.<\/p>\n

7. \u0110i\u1ec1u tr\u1ecb l\u00e1c v\u00e0 t\u1eadt kh\u00fac x\u1ea1 m\u1eaft \u1edf ng\u01b0\u1eddi t\u1eeb 18 tu\u1ed5i tr\u1edf l\u00ean<\/b>:<\/em> \u0110\u00e2y l\u00e0 \u0111i\u1ec3m m\u1edbi \u0111\u00e1ng ch\u00fa \u00fd v\u00ec tr\u01b0\u1edbc \u0111\u00e2y gi\u1edbi h\u1ea1n t\u1eeb 6 tu\u1ed5i tr\u1edf l\u00ean. Thay \u0111\u1ed5i n\u00e0y m\u1edf r\u1ed9ng ph\u1ea1m vi \u0111\u01b0\u1ee3c h\u01b0\u1edfng BHYT cho tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean d\u01b0\u1edbi 18 tu\u1ed5i m\u1eafc c\u00e1c t\u1eadt kh\u00fac x\u1ea1 nh\u01b0 c\u1eadn, lo\u1ea1n, vi\u1ec5n th\u1ecb.<\/p>\n

8. Thi\u1ebft b\u1ecb y t\u1ebf thay th\u1ebf nh\u01b0 ch\u00e2n tay gi\u1ea3, r\u0103ng gi\u1ea3, k\u00ednh m\u1eaft, m\u00e1y tr\u1ee3 th\u00ednh<\/b>…<\/em> (tr\u01b0\u1edbc \u0111\u00e2y quy \u0111\u1ecbnh l\u00e0\u00a0v\u1eadt t\u01b0 y t\u1ebf). Vi\u1ec7c thay \u0111\u1ed5i c\u00e1ch di\u1ec5n \u0111\u1ea1t gi\u00fap l\u00e0m r\u00f5 nh\u1eefng thi\u1ebft b\u1ecb n\u00e0o kh\u00f4ng thu\u1ed9c chi tr\u1ea3 t\u1eeb qu\u1ef9 BHYT.<\/p>\n

9. Kh\u00e1m ch\u1eefa b\u1ec7nh, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng trong t\u00ecnh hu\u1ed1ng th\u1ea3m h\u1ecda.<\/b><\/em><\/p>\n

10. \u0110i\u1ec1u tr\u1ecb nghi\u1ec7n r\u01b0\u1ee3u, ma t\u00fay ho\u1eb7c c\u00e1c ch\u1ea5t g\u00e2y nghi\u1ec7n kh\u00e1c.<\/b><\/em><\/p>\n

11. Gi\u00e1m \u0111\u1ecbnh y khoa, ph\u00e1p y, ph\u00e1p y t\u00e2m th\u1ea7n<\/b>:<\/em> C\u00e1c d\u1ecbch v\u1ee5 nh\u1eb1m ph\u1ee5c v\u1ee5 h\u00e0nh ch\u00ednh, ph\u00e1p lu\u1eadt, kh\u00f4ng ph\u1ee5c v\u1ee5 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

12. Tham gia th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, nghi\u00ean c\u1ee9u khoa h\u1ecdc.<\/b><\/em><\/p>\n

Vi\u1ec7c hi\u1ec3u r\u00f5 c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u01b0\u1ee3c chi tr\u1ea3 s\u1ebd gi\u00fap ng\u01b0\u1eddi tham gia BHYT ch\u1ee7 \u0111\u1ed9ng h\u01a1n trong vi\u1ec7c l\u1ef1a ch\u1ecdn d\u1ecbch v\u1ee5 y t\u1ebf, tr\u00e1nh c\u00e1c chi ph\u00ed ph\u00e1t sinh kh\u00f4ng mong mu\u1ed1n.\u00a0<\/p>\n

Khi c\u00f3 nhu c\u1ea7u th\u1ef1c hi\u1ec7n c\u00e1c k\u1ef9 thu\u1eadt li\u00ean quan \u0111\u1ebfn sinh s\u1ea3n, kh\u00e1m s\u1ee9c kh\u1ecfe, hay s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3, ng\u01b0\u1eddi b\u1ec7nh n\u00ean h\u1ecfi r\u00f5 c\u01a1 s\u1edf y t\u1ebf v\u1ec1 kh\u1ea3 n\u0103ng \u0111\u01b0\u1ee3c BHYT thanh to\u00e1n hay kh\u00f4ng, tr\u00e1nh nh\u1eefng tranh c\u00e3i kh\u00f4ng \u0111\u00e1ng c\u00f3.<\/p>\n

Kh\u00e1m ch\u1eefa b\u1ec7nh theo y\u00eau c\u1ea7u c\u0169ng \u0111\u01b0\u1ee3c h\u01b0\u1edfng b\u1ea3o hi\u1ec3m y t\u1ebf<\/strong><\/p>\n

Theo quy \u0111\u1ecbnh t\u1ea1i Lu\u1eadt BHYT m\u1edbi \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi tham gia BHYT \u0111i kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh theo y\u00eau c\u1ea7u \u0111\u01b0\u1ee3c qu\u1ef9 BHYT thanh to\u00e1n ph\u1ea7n chi ph\u00ed kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh theo ph\u1ea1m vi \u0111\u01b0\u1ee3c h\u01b0\u1edfng (n\u1ebfu c\u00f3) theo quy \u0111\u1ecbnh.<\/p>\n

Ph\u1ea7n chi ph\u00ed ch\u00eanh l\u1ec7ch gi\u1eefa gi\u00e1 d\u1ecbch v\u1ee5 kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh theo y\u00eau c\u1ea7u v\u1edbi m\u1ee9c thanh to\u00e1n c\u1ee7a qu\u1ef9 BHYT do ng\u01b0\u1eddi b\u1ec7nh thanh to\u00e1n cho c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh.<\/p>\n

C\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh c\u00f3 tr\u00e1ch nhi\u1ec7m b\u1ea3o \u0111\u1ea3m v\u1ec1 nh\u00e2n l\u1ef1c, \u0111i\u1ec1u ki\u1ec7n chuy\u00ean m\u00f4n, thi\u1ebft b\u1ecb y t\u1ebf, kh\u1ea3 n\u0103ng cung \u1ee9ng d\u1ecbch v\u1ee5 kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh theo \u0111\u00fang h\u1ee3p \u0111\u1ed3ng kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh BHYT \u0111\u00e3 k\u00fd v\u1edbi c\u01a1 quan\u00a0b\u1ea3o hi\u1ec3m x\u00e3 h\u1ed9i.<\/p>\n

\u0110\u1ed3ng th\u1eddi, c\u00f4ng khai nh\u1eefng kho\u1ea3n chi ph\u00ed ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i chi tr\u1ea3 ngo\u00e0i ph\u1ea1m vi \u0111\u01b0\u1ee3c h\u01b0\u1edfng v\u00e0 m\u1ee9c h\u01b0\u1edfng BHYT, ph\u1ea7n chi ph\u00ed ch\u00eanh l\u1ec7ch v\u00e0 ph\u1ea3i th\u00f4ng b\u00e1o tr\u01b0\u1edbc cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

\u0110\u00e2y c\u0169ng l\u00e0 quy \u0111\u1ecbnh m\u1edbi nh\u1eb1m \u0111\u1ea3m b\u1ea3o quy\u1ec1n l\u1ee3i c\u1ee7a ng\u01b0\u1eddi tham gia BHYT khi kh\u00e1m ch\u1eefa b\u1ec7nh t\u1ea1i khu v\u1ef1c theo y\u00eau c\u1ea7u c\u1ee7a c\u00e1c b\u1ec7nh vi\u1ec7n.<\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1eeb ng\u00e0y 1-7, Lu\u1eadt B\u1ea3o hi\u1ec3m y t\u1ebf s\u1eeda \u0111\u1ed5i, b\u1ed5 sung m\u1ed9t s\u1ed1 \u0111i\u1ec1u b\u1eaft \u0111\u1ea7u c\u00f3 hi\u1ec7u l\u1ef1c, quy \u0111\u1ecbnh r\u00f5 12 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng thu\u1ed9c ph\u1ea1m vi chi tr\u1ea3 c\u1ee7a qu\u1ef9 b\u1ea3o hi\u1ec3m y t\u1ebf k\u1ec3 c\u1ea3 khi ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 \u0111\u00fang quy tr\u00ecnh kh\u00e1m ch\u1eefa b\u1ec7nh. Theo \u0111\u00f3, danh s\u00e1ch…<\/p>\n","protected":false},"author":96,"featured_media":11007,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-13576","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tin-tuc-su-kien"],"_links":{"self":[{"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/posts\/13576","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/users\/96"}],"replies":[{"embeddable":true,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13576"}],"version-history":[{"count":2,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/posts\/13576\/revisions"}],"predecessor-version":[{"id":13579,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/posts\/13576\/revisions\/13579"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=\/wp\/v2\/media\/11007"}],"wp:attachment":[{"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13576"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13576"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/quanhelaodong.moha.gov.vn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13576"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}