Help! Information regarding health charges please?


(Karen Phillips 2) #1

I am so confused! I have had a carte vitale since the system was inaugurated and I have a mutuelle with Pacifica.


Until recently we were eligible for the CMU complimentaire and most things were funded without our making a payment. Now we have our UK pensions our income has surpassed the limit which is why we took out a mutuelle. I understand I have make payments in advance and these are refunded and this has certainly been the system we have experienced for the last 15 months. No problems there.


However, unfortunately I have recently been diagnosed with breast cancer and now the confusion has arisen.


I was sent by my GP to see the specialist. He works at a Clinique not the hospital. I was told there would be a depassement of 300€. My husband and I assumed this was normal. I see my mutuelle will refund 100€. We agreed that 200€ was not a lot ( however much a strain on the budget) to pay for life saving surgery. I then received a letter from the CPAM. The treatments for the cancer are at 100%. I updated my carte vitale. I went to see the anaesthetist. His secretary told me the card said 100%. I had to pay 70€. Another depassement I assume?


I am now totally confused. I had the op on Monday. I paid 372€ on leaving the clinique. I have a bill to send to the mutuelle. I had 2 other procedures as preparation for the op in a radiologists and nuclear medecine department of a different hospital. No charge. The taxi between hospitals was also no charge.


In this instance, if I am not reimbursed, I will not complain but for the future my question is How do I know before I see a specialist? Do you always have to pay a depassment or are there ways to have cheaper services? What should I be asking? I have a friend who is very worried she won't be able to fund treatments and what does the 100% on my card actually cover.


Hopefully someone out there will have the answers to my confusion.


(Peter Bird) #2

The fees are easily obtainable on request. You can even ask for an 'estimate' from the specialist/clinique. You can then speak with your agent and ask how much cover you are entitled to according to your contract.


(Katie Osborne) #3

It is very easy to ask, and frequently possible to be seen under either regime as many specialists will do both. My own ENT specialist is a professor in a teaching hospital - where I received my care, however, on a Wednesday morning he does private work. But this was made clear to me when I made the appointment.


(Chris Lawton) #4

This, Katie Osborne, is the nub of the problem; when you are referred to a specialist or a clinique, you don't necessarily know that their fees are above the "norm". It is a frustrating aspect of what otherwise is a marvellous health service.


(Peter Bird) #5

Discuss this with your insurance agent, check on your guarantees Chris. I had a total knee replacemnt fourteen months ago and everything was paid at 100%, I paid nothing extra because my insurance company plus the State covered ALL the costs. As i've stated earlier i've just changed my guarantees for things like dental & optical costs to cover my increasing needs but not the rest as all was covered sufficiently.

I, like most people on the forum can't answer your questions Chris but your insurance agent should be able to if not, change companies and look for a better deal.


(Karen Phillips 2) #6

Hello Chris

I am actually much clearer now as some of the people who answered my question last week, really explained things. If you look back at some of the earlier comments they may explain things to you to.

P.S.

I won't actually be hundreds of pounds out of pocket and if I have to pay the full 372€ for the current depassement, I can't fault the speed of the care I have had and I am still alive!


(Chris Lawton) #7

Hello Karen. My wife and I share your confusion. 100% of what?? My wife had aknee replacement and was told, like you, that "100%" was covered. WE had some things which were covered direct by Assurance Mal;adie, some where we had to send off brown forms for refunds, some which were "tiers payant" for our mutuelle and others where we had to send off our receipts to the mutuelle. Confused? You bet we were. But like you, in the end we find ourselves hundreds of euros out of pocket with no idea why or what to do about it. As for depassements, our insurance contract implies they are covered, so why aren't they? Answers on a postcard....


(SANDRA WRIGHT) #8

Agree with you Peter ...both my husband and I have been treated with excellent care here in France ...he will be 83 in February, and still has every treatment going ..he was diagnosed with very early onset vasculair dementia last year, but is reasonably ok so far ..this was following his second mini stroke ...I doubt if at his age in some parts of the UK he would have had such good treatment - age does not seem to be a barrier here ! I am 68 and probably would be the same for me in the UK ! I hope the UK remains in the EU and that the reciprocal health agreement stays, or it would probably be a death sentence for us !!

Karen - had another thought ! I never look up 'imagined' illnesses on the web, but once diagnosed, I like to know the ins and outs and found the site for the Mayo Clinic in the USA to be really comprehensive - they also have videos !(If you are like me and want to see them !) of every op and treatment ! The US forums (fora ?) are also helpful ...I found one for people like me called 'The Semi-Colons' ......just love it !!

I know the waiting around for results is difficult, hope you can find something to occupy your mind meanwhile !

All the best


(Peter Bird) #9

Thanks for your kind words Sandra. I've just remebered the protcol which caused the skin eruption, it was called Folfax. Really strong stuff and I recall it being used for a few weeks only when the problems caused outweighed the benefits. It was a nasty treatment and the wounds turning septic didn't help !

Strange about the liver regeneration. All subsequent scans for the remaining five years or so just showed a fatty mass and not new liver. I assume this was due to her general state of health.

All the docs were up-front and they answered any questions posed. The medical/nursing staff at Limoges and espcially St Junien hospitals were absolutely amazing. How lucky are we to be living within such a wonderful health service ?


(Karen Phillips 2) #10

Thank you


(SANDRA WRIGHT) #11

Hello again !

...keep my fingers crossed for you Karen - difficult time of year for you ....but hope the news is not too bad ....am thinking of you !

Peter - so glad you have met someone and that you are happy now - you deserve it ! It\s a pity your wife didn't go to the doctor sooner - like my husband, whose late wife did not go to the doc and by the time she did it was too late for her. I was very lucky, having no symptoms whatever when we moved to Charente and registered with a new doctor, she was very young and had just taken over her father's practice ...every new patient was referred for every test going, and I was found to have a polyp which was sent for analyses and turned out to be colon cancer .I had a lot of colon removed to start with, then ...I also had 50% of my liver removed, but I was fortunate in that it did regenerate quite quickly and then tumours were found in the upper corner of the liver the next year again, too close to vital organs for an op, so I had radio frequency ablation on those ....now so far so good ! My doc has the best advice ....just go and get on with living your life .....My friends kept saying I should have a bucket list ! Apart from the expense, I have no desire to climb to Michu Pichu (however you spell it !) or trek the Andes or cycle round Europe ....I just enjoy whatever each day brings .......oh and my chemo was also 5 Fluo combined with something else ....lovely docs here, but didn't tell me what I was having, so I read the label on the chemo drip and looked it up !! I also found if you ask for information, they will tell you - my liver surgeon even showed me the results of my scan on his computer and explained what would happen ....lovely Professor from the CHU Haute Leveque .....so if you have any doubts or questions, ask ! I don't think doctors expect you to want to know, but I do !!

Good luck on 9th December !


(Celia Ford) #12

Karen, thank you for posting this in such a non-emotive way, I'm sure it helps all who may have concerns about treatment should they have a similar diagnosis. It also prompts me to stop ignoring the mammogram reminders I receive every few months, ridiculous as my sister was operated in February and has made a full recovery due to catching it early.

I don't know the answer to your query. My hospitalisation during my spine op in January this year was paid without my having to contribute, although the surgeon's fees had to be paid by cheque. I never did manage to work out how much was reimbursed to our account, and I think my ongoing kiné fees are also subject to not quite 100% repayment.

I shall follow this with interest. Wishing you the best possible results in a couple of weeks!


(Peter Bird) #13

I'm absolutely fine Karen. I met a lovely french lady and we've been together for two and a half years. Life is must go on whatever happens and I intend to have as much fun as possible ! My late wife told me to have fun and make the most of it..

Forgot to say before the seven years of cancer, seven years previously my wife became severly handicapped following falling down the stairs at four in the morning ,she turned left towards the staircase instead of turning right to go to the toilet !!!

So basically I was a 'carer' for fourteen years - not a lot of fun as you can imagine !


(Karen Phillips 2) #14

Oh Peter............there is nothing that I can say here except to emphasise for you have certainly lost a lovely lady! Take care ofyourself now.


(Peter Bird) #15

Hi Sandra & Karen.

My good lady lost her hair twice over the seven years. She changed protocol every few months depending on test results every two weeks. From memory the chemo which caused her hair to fall out was Erbitux (spelling ?) though not every time strangely enough. She was pretty bad with the after effects of just about every chemo mix she was given but the only time she panicked was when one protocol involving a mix of Erbitux and 5FU (if i recall) caused her to have a skin eruption, mainly on her scalp which looked nasty. She wore a hat during this period as she felt it wasn't a pleasant thing for others to have to witness. The secialists found it interesting as they hadn't come across this side effect before ! Skin samples were sent to a lab in Paris where a clever man found a suitable treatment to ease the discomfort.

Sandra, my wife didn't go for Lucozade but Coca Cola and Macdonalds food. She became addiceted to chicken nuggets and chips immediately after the chemo sessions. Her 'site' (portocath) didn't bother her too much. When someone asked about it she would tell the truth explaining how the system worked.

She was originally diagnosed with a very large tumour in the colon which caused secondaries in the liver and lungs. A year after the tumour was eoved she had a further oeration to remove 60% of her liver. It didn't regenerate coontrary to popular belief. She had regula radio therapy to eliminate cancers on the remainder of the liver and the lungs. Six months before her death they found cancer in her spine which was succesfully treated making her last few months much more comfortable, something i'm eternally grateful to the CHRU at Limoges.

The really sad thing is she could have been 'saved' IF she had bothered to tell someone of her problems at the outset but, she was the kind of erson who worried about others first rather than herself. Basically she waited a few months too long before seeking help.......


(Karen Phillips 2) #16

Thanks for the tips. At the present time the tumour,tissue and primary lymph nodes are being further analysed and I won't know until Dec 9th what my next stage of treatment will be. However, I do know that thanks to regular mammograms this tumour was found early and so ladies,I will say again, 'Don't put off going!!'. You don 't have to be able to see or feel anything for it to be growing inside.

P.S. I am very lucky as my husband of 40 years, despite his own health difficulties is being very supportive and understanding.


(SANDRA WRIGHT) #17

What lovely comments you make Karen - and I agree with you that those ladies were very lucky to have such supportive husbands ! It must make a huge difference ....although the approach of my husband was very different ....as in he told me I was making it up and to talk about something else .......but I am used to him so took no notice ! Probably owing to the fact that his first wife (of 42 years !) died of cancer ....I don't think he could cope with it again ...so I just got on with it ! The type of initial cancer I had was colo-rectal, with secondaries on the liver (twice !) but that was from 2007 until now so I am officially 'clear !' just waiting for the nod to remove my portacath ...it gets some strange comments in the summer .....from 'is that a pacemaker ?' to 'what is that' ? - but I just find it amusing and try to invent something to explain what it is !! Like others, I did consider a wig, but although my hair got very thin, and still hasn't quite recovered, I passed on that one .mainly because I couldn't decide what colour or style .....I fancied red, never having had red hair .....but I didn't get one ....still look at them though - some look really nice, so I may one day buy one anyway ! After all, Joan Collins wears one, she says, most days ! Oh and a tip for the chemo sessions ...Lucozade !! brilliant stuff ! Even though my husband was a bit different to others, he did drive 30km to a shop here that sells it and bought me the whole box full !! bless him ! ......or you can get it from the British Corner Shop online if it helps ! I suppose everyone is different and it may not work for you ...........

Lovely talking to you and I wish you the very best ! Do keep us posted on how you are getting on ! ....oh, and if you go for chemo sessions, take some of the lingettes - like face wipes ...and a book or some music on an i Pad or some such so only you can hear it !


(Karen Phillips 2) #18

I want to thank everyone who took time to reply to me. I am sorry that my request for information has inevitably stirred sad and difficult memories for those of you who have lost loved ones and others who have fought this disease. I shall fight it too. I never meant to imply I was putting money before health but I did need to understand the more confusing parts of the health system I had not had to deal with previously.

To those of you who still battle with the illness I offer my wishes for your recovery and to Peter I want to say that I do hope your wife was able to appreciate before she died what a caring and loving husband she had. She may have been brave but I suspect reading your comment that much of her bravery came from your support. I think you can be proud ofyourself too.

Finally,using all the info I have been given ( and having the correct terminology to look up other information) I think I am now clear in my mind about how the payment structure works in my situation.

Less confused I will relax and recover!


(John Snell) #19

PS. you may remember the inspirational Mo Mowlam, who brokered the IRA ceasefire. At a key meeting (it is reported) she whipped-off her wig and said "right boys, no more pretences - how do we stop the killing?". Ignore the politics.


(John Snell) #20

I am sorry for your loss - it is a lottery, and dealing with something as b-awful as this is down to individual choices.

But you are right - dignity, pride and finding simple pleasures is key. My wife eschewed the wig; many in my own 'Tuesday Club' wanted them. It was a sobering day when I shaved my girl's head to spare her the further indignity of shedding. Bald women, scarf or no scarf, receive unwelcome attention from the ignorant, frightened and downright ill-mannered - this should not be about confrontation / seeking sympathy or making statements; suffering is downright unpleasant and has nothing to recommend itself.

Me? I found being in a coma was preferable; somewhere out there I 'lost' a month of my life, and a very frustrating six months followed before I was adjudged strong enough to withstand chemo'. Raw tobacco and mary-jane eased the nausea...on the advice of one of my nurses, and websites are full of anecdotal evidence. Coffee enemas are no substitute for clinically / empirically proven remedies.

What I was trying to say was the need to make one's own choices and as you say; those that matter don't care, and those that care, don't matter.

There are no rules for this - cope as best one can.