Dental devis and complementaire help needed

Health Care & Carte Vitale
1

Hello to everybody, I’m new here but browse for advice sometimes. I find that I am in need of some help myself now.

I’ve got a devis for some dental work (eye watering, as expected) and contacted my mutuelle for reimbursement info and process etc. I’m on CSS, managed through Harmonie Mutuelle. Their response has baffled me. …

Bonjour, Vous bénéficiez de la Complémentaire Santé Solidaire (CSS) qui vous dispense de l’avance de frais pour tous les soins médicaux appartenant au « panier de soins CSS » sélection d’actes intégralement pris en charge. Pour information, si votre choix se porte sur des soins dentaires n’en faisant pas partie, le remboursement de la mutuelle s’effectue uniquement à hauteur du ticket modérateur (complément de remboursement du Régime Obligatoire sur la base de remboursement). Conformément à votre contrat santé, les soins « Non remboursés » par la Sécurité sociale ne peuvent pas faire l’objet d’une participation de la mutuelle. Nous vous recommandons vivement de préciser ces modalités à votre chirurgien-dentiste préalablement à la réalisation de vos soins Bien cordialement, Votre conseiller.

I’m okay with the translation, I just don’t know what they are saying! Particularly the final sentence where they ask me to tell the dental surgeon about the way ‘the system’ works.

Some background; my dentist, suspecting periodontitis, referred me to a dental surgeon. The dental surgeon confirmed and provided the devis for basically several sessions of cleaning and related work; one devis with a single code - HBJA634. The devis requests 1/3rd payment upfront, 1/3 after 3 months and final 1/3rd in 6 months (on completion).

I forwarded the devis to Harmonie and I get the bottom line of their response. The work’s not reimbursable, and I’m okay with that (it’d be negligible anyway). But what exactly are they suggesting I tell the dental surgeon? The dental surgeon will be well aware of the ‘modalities’, no? I don’t know if it’s that I’d be paying in installments rather than on invoice that’s the issue.

I think this is one of those situations where I understand the French (there or there arounds) but it’s the system that’s thrown me. Any help would be greatly appreciated.

Edit: the dental-surgeon is conventionné, and their initial consultation fee was reimbursed, so I know they are in ‘the system’.

2

I guess that this is a standard form of words and, given the cost of dental treatment, is just making sure the dentist knows that if the treatment is covered then they won’t get the upfront payment, and if it isn’t covered they won’t get anything beyond the SS base de remboursement.

Many people don’t get dental work done if not covered by their mutuelle, or get it done and don’t pay the final invoices which is a big headache for dentists.

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3

Yes, indeed… but the work they are suggesting might well NOT be reimbursable… and you might be facing a huge bill.
(there are different options of Dental treatment and your Dentist needs to ensure what he does is the option which is covered…)

You need to discuss with your Dentist.
(We used to get a Devis showing the work, SS paying xxx and Mutuelle paying yyy and zzz will be left for us to pay at the end… hopefully zero.)

4

The “panier de soins” refers to a specific list of basic treatments. They are saying is that for treatments on that list you have nothing to pay personally.
For treatments not on that list you will be reimbursed up to a fixed rate set by the health service for that particular treatment. Most practitioners charge above that rate. If yours does, your mutuelle cannot help you with the extra cost.
They recommend that you explain this to your dentist before accepting the devis because some people would worry whether they could afford it, and particularly people on CSS since this is a scheme for people on a low income. The dentist (or their receptionist) would then calculate exactly how much of cost will be paid by the patient personally, and if that is unaffordable for them, discuss whether there are ways of reducing the cost by substituting alternative, less expensive treatments.

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5

Yes, agreed, I too thought it had a ‘standard form of words’ air about it but then I’m not good with French so my own ignorance cannot be overstated!

Frightening that 2nd bit though; people not getting work done or simply ignoring the final bill. I didn’t know that.

6

Thanks for that Stella. I figured that because I’d been given a code that the work was, in theory, reimbursable. I don’t know what to discuss with the dentist. They’ve given me a devis based on their assessment of the work required. I’ve no reason to doubt that nor the methods they’ve elected to use. I’m a simple soul!

7

Being a simple soul is wonderful. But… (there’s always a but…) you do need to speak with your Dentist. show him the reply from the CSS if you can.
Ask the Dentist how much will be reimbursed by Sociale Santé and how much by CSS…
If you don’t ask and simply agree to the work, you will become liable to pay.

So, simply ask them to detail the Devis into who pays for what.

Being a simple soul myself… I’d shrug my shoulders, say
“my pockets are empty so please confirm I will have zero to pay…” and I’d want that reply in writing.
EDIT: Teeth need treatment, but it is how that treatment is administered and which of the various compounds/fittings/methods etc falls under the “umbrella” of SSanté.
A bit like a choice of housepaint… it all does the job but some are “paid for” and some aren’t.

8

Ok, thanks. That teases it out a bit more. I get the basics.

I’m ok with paying the total cost so financing concerns and who pays exactly what doesn’t cause anxiety nor problem. I’ll have to cash a small personal pension but if needs must, I’m good. Not ideal, nor my plan, but that’s life.

In that context though, I think I’m starting to see what Harmonie are saying and, more to the point, why. They’re just alerting me to a possible course of action I might want to take.

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9

Well, if you want to cash in a Pension, but careful about French Tax implications.

The whole point of Sociale Santé etc is that there is help for those wth Health needs.
I would certainly go the route of discussing with the Dentist what changes might be made so that his proposed manner of treatment would be covered… before cashing-in anything.

OH had a partial plate, which needed replacing . Dentist said… (more or less) we can do A, B or C (all very similar)
and we discussed the various options and ended up with what OH wanted “at the right price” (ie no cashing-in of Pension Pots).

10

Another thought - if it’s not urgent. We have friends who take out a higher level of mutual cover which includes dental treatment just for the year in which the dental treatment takes place and then they put the mutual back down again the following year.

11

If Social Santé don’t pay even a tiny %, then (I think) Mutuelles don’t click-in… or is that a myth…
I really can’t see any problem with talking things through with the Dentist…there are so many variables on what composites are used in Dentistry (just like Optical stuff).
I’d certainly get a fully itemised Devis (with SS etc showing clearly…) before cashing-in anything. Money is scarce enough these days, who knows what the future holds…

12

Hi @jwall and welcome to SF
The insurance expert on SF is @fabien
I have tagged him so he may well respond to you here or in a PM or you could use the image link in the top banner to address a question there.

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13

That’s been suggested to me by someone else but, believe it or not, I’m not comfortable with doing that! We applied for CSS precisely because we have next to no income (living off savings) and I don’t feel too good about that either tbh. My point is, we took the course of action we did (i.e. CSS) knowing full well there would be implications, so I see this dental work as that and take it in my stride.

14

Fair enough, but how many times can you do that?
You might kick yourself in time to come for not at least trying to discuss this with your Dentist…

15

I you don’t feel good about claiming benefits and money is not an issue, why not simply take out a good mutuelle? It would likely be a good investment in the long term.

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16

which is where @fabien comes in… he will have a number of solutions for you to explore all explained very clearly in English and with no obligation just for being a member of SF :slightly_smiling_face:

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17

The CSS is there as a free or low cost mutuelle for people on a low income, so why not use it. It is not a generous mutuelle so little dental work will be covered, just 100% santé stuff, but a good mutuelle that does cover non-standard dental work will be seriously expensive. The SS base de remboursement for dental work is very low, so you need a mutuelle with 300% cover to be reimbursed.

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18

Exactly, that’s my take too and well summarised. As I mentioned previously, we realised this trade-off (risk if you prefer) when we applied for CSS.

I think the tariff for this work is something like €240 and some way short of the actual devis. I would need a mutuelle that offered a dental coverage into the thousands of % to actually cover it! (and, no, I’ve not done the actual math!)

19

Believe me, I get the ‘discuss with your dentist’ advice. I think that’s what the mutuelle was saying to me.

The treatment I will be undergoing (as explained to me by the dental surgeon) is several seasons of non-surgical lithotripsie - effectively ultrasound. Exact number to be determined as needed. There are no components or composites to be discussed (as I understood it) It is what they propose and what they have the equipment for. It’s my take that there is no room for discussion - a take it or leave it proposition if you like. To get something different, I’d have to go to a different dental surgeon, and that’s not something I want to do (given how long it takes to get an appointment!)

No, I’m happy with their proposal and whilst I’d prefer not to have to pay quite so much, I’m prepared to do so. My question was really about the response from the mutuelle; that they aren’t reimbursing is a little confusing to me but, as I said, it wouldn’t have amounted to much anyway!

20

Yes it is zapping with ultrasound, usually in the context of kidney stones. Dental lithotripsie is a new one, I suppose to clean up roots.

What exactly is being zapped here? Scale? I am wondering why it is so expensive and why it needs " several seasons " (or sessions?).

Might it be an idea to get a second opinion?

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