Over the last few weeks I have had several visits to doctors / dentists / opticians etc and the sums I’ve been paying out of my bank account have been steadily rising.
When we set everything up with CPAM it was OH’s bank account that was registered with them. So he gets any reimbursements. Normally, I haven’t bothered, but this time I could do with some of that money back in my account.
So I thought I’d set up a spreadsheet for him. Date of my visit / amount I paid out / amount Ameli reimbursed / amount mutuelle reimbursed.
I’ve fallen at the first hurdle!
For example, on December 10th I had a cardiologist’s check-up and paid them 75€.
When I look at the Ameli website and check under “nature/date” for 10/12 I find for montant payé a total of 85€:
when I look at the details it’s only 75€
C.specifique: 60.74 €
Acte tech medical: 14.26€
On December 13th I paid out 160€
Yet, for that date the Ameli site is showing only the same amounts for montant payé ie 75€:
C.specifique: 60.74 €
Acte tech medical 14.26
So my thoughts are:
The cardiologists sent the wrong information to Ameli
Someone at Ameli put in the wrong information
The dates bear no relation to when the appointment happened but are when they inputted the information.
NB; please note I know that Ameli “adjusts” all of this downwards to the base for reimbursement. I’m not talking about that. I am assuming that the first column in their table should show the total amount I paid.
Has anyone else made sense of all of this please? I’d be grateful for any help / suggestions. Thanks
I gave up trying to understand it years ago. The only time I check is for some mutuelle stuff that has to be manually claimed by submitting a relevant Ameli page. I think you generally get back whatever is due, less the small charge on every médication item
Sorry Stella, not possible. They only accept ONE account - understandably. And OH pays all the bills etc. so the money has to go to his a/c. Also, he has his own medical expenses on a regular basis.
No. That’s why I set up the spreadsheet Angela. All of this has been very recent, so I’m zapping backwards and forwards between calendar / my bank a/c / Ameli / Mutuelle. What else would one do on a wet December day post Christmas!
Just a thought… reimbursements are only paid for “agreed charge levels/Band”… and if the specialist’s fees are above that Band… the excess is not accepted by Social/Ameli…
and quite often the mutuelle only pays its % of what Social/Ameli actually pays…
(although some do pick up the entire difference).
Is the cardiologue secteur 2? One of my specialists is secteur 2, and the excess I pay her never shows up on Ameli. So montant payée is the max Ameli price for whatever she did, and the base de remboursement is the amount of that that qualifies for reimbursement. And then of course the remboursement percentage they pay, and thus the amount I actually get. I always pay 10€ more that the montant payée (actually now 15€ this year I think).
For years I checked my statements carefully, and they never made a mistake so I have just about given up bothering!
All of that I understand and those figures are shown in the second and third and fourth columns of the Ameli table. It’s the FIRST column that worries me because if I’ve paid out 160€ why is that not the amount shown in column 1 - montant payé
Ameli are quite friendly if you phone them. I think their phone line even offers a button for bill or reimbursement queries or something close to that when it first answers
Thanks everyone. Just to confirm, I understand the reductions (eg your suggestion @JaneJones ) and why, but I do not understand if the figures in column 1 are NOT the totals I paid. Or bizarrely even MORE than I paid!
Except that I saw the same guy Friday 10th - I paid 75€ and that shows up as 85€
And then saw him again Monday 13th - I paid 160€ and that shows up as 75€
Something’s not right surely?
@KarenLot I will Karen, once I’ve got my ducks in a row, so comments / suggestions here are very helpful. Means I have to think it through properly first.
I quite agree. @AngelaR has been extremely patient and helpful explaining the working of the finance side of the Fr health service but I also have taken to the idea of not trying to understand it because it is clear as mud.
As long as enormous [big 3 - 4 fig] numbers are not at issue, I trust that AMELIE and Co are not in the business of swindling me and I leave them to it.
It just seems odd to me that a country like France has not adopted the ‘free at point of treatment’ system of the UK, Spain and others. It’s not as if FR is a low tax economy and health services are a priority, as far as actual treatment goes, I understand.
As you’ve noticed, it looks as though the 160€ is for both the visits. The 75€ you paid is either an error or it is a charge for a service which is entirely outside the health system? The charges are all derived from a list of codes for each act so would not be in error.
I think column 1 is the amount Ameli has paid to the doctor, not you (which is why my extra payments to Secteur 2 people don’t show up) …… the last column is yours!
I don’t know enough about the Spanish system to comment, but the UK’s ‘free at the point of use’ model has at least one drawback: the system’s users have no idea how much anything actually costs - as far as they are concerned it is simply ‘free’ and the service is largely taken for granted.
In France, any medical intervention ends with us being presented with a bill. The state picks up part of the cost, your mutuelle another, and we are left to pay the rest. As a consequence, we all know that the treatment we have received has a quantifiable cost and we, perhaps, value the health service more and treat it as a privilege rather than a right.
