100% cover - nice in theory

Since I have a long term illness, I am informed by my specialist and my medecin traitant that I’m entitled to 100% reimbursement of all healthcare costs relating to that condition.


Except… I cannot seem to get that status recognised.

I’m autoentrepreneur under RSI, or whatever it is now. I don’t have a complementary mutuelle, therefore apparently the mutuelle that acts as ‘organisme’ under RSI and should issue my CEAM (another problem to deal with) doesn’t issue me a card, and the hospital think that may be the issue - but why should I pay to take out cover for something that should be reimbursed 100%?

My medicin traitant has sent the form attesting my 100% status to (I think) CPAM: again, I’m not sure whether he’s sent it to the wrong place.

At this point the system isn’t making any sense at all. My partner is French and simply doesn’t understand what’s going on. French health system - 100% brilliant: French health insurance system - totally not fit for purpose.

Does anyone know their way round this? It isn’t going to bankrupt me if I have to pay a percentage, but it is making me pretty fed up with paying cotisations to get sod all. This, after it took 18 months to get a carte vitale … and then another couple of months to find out why it wasn’t recognised.

The document from your Doctor should come back to him, officially stamped… if the Social Sante folk are in agreement with his request.

Then he can give you a copy of the document… and you can wave that at anyone when going for treatment…

OH always has his copy in the medical folder… it lasts for 7 years (I think)…

If your entitled to 100% & the paper work has gone though to the CPAM try up dating your carte vitale which after will show to all that you’re entitled to it.

I have the reverse scenario… Probably a glitch in the system & even after calling CPAM telling them I do not need 100% they will not take it off my carte vitale as I’m not qualified to say to my needs & they will not tell me why I have 100% ?
My Carte Vitale shows I’m entitled to 100% which doctors dentists etc ask why . As I don’t know myself, I always insist on pay the dues, but one or two times the doctors have just put my appointment on the 100% & no complaints for the CPAM. Bizarre!

Sincerely, hope you get everything sorted very very soon.

Hi Warren… sounds very odd… and good for you, insisting on paying when some other folk might simply take advantage of the hiccup.

Someone, somewhere has made an error. Your “chosen/declared” Médecin Traitant should be able to sort it out… since it is his/her initiative that gets the ALD 100% rolling… Your Médecin Traitant needs to write to CPAM confirming/advising that you do NOT suffer any ALD…

other than that … you will need to wait for it to automatically expire… :wink:

I was told by letter that they had removed my 100% status for cancer because I had not had any treatment for it for two years.
I do not get it for my prosthesis, which was totally free on NHS.
I have to have an ultrasound as well as a mammogram every two years because I had lobular cancer which is not detected by mammogram and the extra for thst is picked up by my Mutuelle.
You are not alone.

Jane… your Médecin Traitant will have put in a request for a “suivi Post ALD”… extension of your 100% for the regular check-ups you have to have.

The following Ameli link clearly states that this is possible, where a medical situation has stabilized but still needs the checks…

"Un exemple courant est le cancer du sein : détecté à un stade précoce, ce cancer de bon pronostic (taux de survie à 5 ans : 87 %) peut être guéri dans 9 cas sur 10. Cependant, un suivi par des consultations et par des examens biologiques et d’imagerie est nécessaire à des intervalles réguliers.

Dans ce cas, les actes et prestations nécessaires à ce suivi clinique et paraclinique sont exonérés du ticket modérateur (pris en charge à « 100 % ») en « suivi post-ALD ». Les produits de santé à usage thérapeutique et les frais de transport sont exclus du champ de ce dispositif et ne sont plus exonérés du ticket modérateur."


Mum’s is renewable every 5 years so have a look at the date on your OH’s document Stella. Wouldn’t want you to get a shock ! :wink:

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Cheers Ann… I haven’t looked lately as it was renewed last year…

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I’m not quite understanding what a mutuelle has to do with your ALD cover, nor getting a CEAM card… but then I don’t deal with RSI so that could be the complication. It took about 6 weeks to get my ALD sorted in first place, and my MT sent the form to CPAM who registered it. She later gave me a copy of the authorised form, and I updated my carte vitale. If you are with RSI does that mean you don’t have an account on Ameli? As I use that to send messages and ask questions, plus the ALD shows up.

What a shame I saw him yesterday!

Why do you want a CEAM card? CEAM= EHIC. You would only use a CEAM when you are visiting an EU country other than France.

RSI no longer exists and I’m not sure what the new arrangements are, but it did used to be that when you affiliated to RSI, you nominated which insurance caisse you wanted to use (eg Harmonie, LA RAM etc - don’t confuse your primary caisse with a mutuelle) and as you say, that is the caisse that issues your CV, deals with reimbursements, also issues your CEAM etc. You can create an account on their website.

Well, you don’t have to, it’s your decision. But it’s possible that you might also need treatment for different conditions that are not ALD.

Frankly Jane… it will be worth asking him to ensure that he has followed-through with all that you might be entitled to… perhaps your case “slipped through the net”.

Thanks Stella.
The CPAM in Chalon is not that bright.

RSI does still exist but it has changed it’s name to Sécurité Sociale Indépendents during the 2 year transition to transferring everyone to CPAM.

All the offices and infrastructure remain in place for now and very little has changed, just the name really.

If the MT has sent the ALD request to CPAM then it has obviously gone to the wrong place. It needs to be sent to SSI at the usual address for the area.

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Being with RSI I’m not allowed an account on Ameli, and everything has to be done by phone or paper, there’s no web service. It’s a complete bloody mess. And RSI (or its successor) does absolutely nothing, all the paperwork has to go to a mutuelle, although it’s acting for RSI and is not in this case actually a mutuelle as I don’t pay for extra insurance. Is that clear? No, it isn’t, is it!

I’ll put a call in to my medecin traitant and see what is happening (or not); if he doesn’t have the form back, then there is clearly a log jam. If he does, then I need a copy.

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Aha! That is probably the answer.

I can’t wait for sodding RSI / SSI whatever it is to be suppressed. But by then I’ll probably have given up and closed the business.

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Website here Andrea

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I know. It’s a proper mess. They have always been hard work to deal with. I suggest you get the MT to redo the form and then you send it by recommandé avec accusé de réception. I have discovered they are far more likely to reply if you do that.

Don’t bother with emails. They never reply.

I want a CEAM card so I can travel! I’m a travel writer, among other things, so that comes with the job, even if I didn’t have terminal wanderlust (chronic disease that doesn’t, alas, come with 100% reimbursement of all required treatment!) And that is proving to be difficult.

The situation with the caisse is as you say, but it’s always been described to me as a ‘mutuelle’ and of course when the hospital see it, they expect it to be a mutuelle because that’s what it has in the name. The hospital doesn’t understand any of this, the pharmacy doesn’t understand any of this, and my medecin traitant doesn’t understand any of this. Nightmare.

Still, now I understand a bit more thanks to everyone’s help, so I do at least have a few ideas on what I can do next.

Fair enough, I thought the CEAM issue was somehow connected with the ALD issue, didn’t realise it was a separate problem.

I think you just need to make it clear to the hospital, doctor, pharmacy etc which caisse you are covered by, and that you do not have mutuelle cover (if that’s the case) and I think you will find they will understand, because they deal with the system all day every day and they must see thousands of people in your exact situation.

In fact I think all your issues would become transparent via your espace client on your caisse’s website. It’s important to be dealing with the right interlocuteur and if you’re profession libérale, which it sounds like you are, it is your caisse that you need to be dealing with for all this. Which is your caisse? Mine is RAM, and requesting a CEAM from them is a couple of clicks on their website and it arrives in the post within the week. I believe you can also see online what ALDs are registered (your MT can probably also do this - certainly doctors can access and update patients’ details, for instance they can register themselves as your MT online with no need to send in any paperwork, because mine did, and I would be quite surprised if they can’t also register your ALDs online). Also you can follow your reimbursements and generally manage your health cover situation all from your espace client. Hopefully once you set up an espace client, if you haven’t already, the situation will be clearer and you’ll see what needs doing to resolve it.

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