Mutuelles santé (health insurance). Is anyone else as confused?


(Chris Lawton) #1

I am reviewing Health Policy having had a bruising experience over the past twelve months when it appears that more is not refunded than is. The business with "dépassements" of fees I just about grasp. Why, though, are some places "tiers payant", in which case you can let Assurance Maladie and your insurance company get on with it, whereas in others you have to fork our, then send invoices, receipts etc to your insurer and hope they'll deal with them. Are some insurance co's better than others when it comes to "tiers payant"?


(Colin Morison) #2

We have found generally they are not too bad but last year the mutuel decided to be late the certificate (is that the tiers de payant) so the pharmacie asked to see a copy and then the hospital for an appointment. The phamacie were happy to wait for the new one but the hospital sent a bill so rather than the 3 letters and copies we sent last time we paid the bill and sent the receipt to the mutuel who then paid it. The certificate ran out in November but there was no stoppage in insatlments so why CPAM didn't carry on their normal way I fail to understand as they are the ones who usually tell the mutuel what to pay. Last week after 3 phone calls we eventually ended up with 2 identical certificates dated November. I do not think that there is much to choose as when trying to compare I agree with Chris some pay more for one thing but less for another and I have had both hips done here entirely using attestations because it took 2 years to get our cards. That involved lots of paperwork but refunds came through slowly but for the amounts stated. Once we got the cards we had the problems I mentioned earlier in my reply because the mutuel required receipts for a hospital checkup and x ray and 4 physio sessions. That took nearly 5 months to sort out.


(Alan Mallows) #3

My wife and I applied for CMUB in February last year, and on January 27 this year I received a letter saying that I have been accepted. Meanwhile we have been visiting doctors and pharmacies and getting refunds in almost all cases.

So, there we were thinking that it was all finished and settled and then these new issues that we've never heard of are being discussed on this forum.

I suppose that we will have to do "further study"!

Alan


(Steve Hayes) #4

My doc explained quite clearly that she had as much trouble as everyone else getting paid by the caisses and mutuelles and she didn’t want to employ someone for another 10hours a week just to chase the money. I see her point
However her locum told me about some research which showed that it did keep poor people away from the surgery when they should have gone. I see her point as well.


(Chris Lawton) #5

No David, not snippy at all; just my weird sense of humour. All suggestions and contributions welcome. IOn the end, I didn't change assurers (couldn't find anything noticeably better or cheaper) but just upgraded my package to get more dépassements and better dental cover. But it is confusing; there seems to be no agreement between insurers about "standard" cover or what is and is not included. Exclusions are many and varied. I am finding that all I can do is to submit all my receipts and see what they deign to refund!


(David GAY) #6

There's no need to get snippy with us Chris.I was simply enquiring as to your being in possession of an attestation. Why? Because when I was just off the boat my insurance company forgot to supply me with one for a twelve month.


(Marie-Claire Gauthier) #7

The Government is in the process of requiring Tiers payant to be accepted by all. Things are moving, albeit at a snail's pace. Just don't go to those who don't want to deal with the insurance and prefer to take money from you and let you haggle!


(Chris Lawton) #8

Oh yes, David and Marie-Claire. I may still have much to learn, but I'm not fresh off the boat! Having made some enquiries, it appears that it is not the Aviva attestation they don't accept, it's rather that there is a number of practices inCastres who don't do tiers payant at all. The Govt should require ALL practitioners to join the system.


(Marie-Claire Gauthier) #9

"Tiers payant" dépends on the pharmacist, laboratory or practician, not on your insurance. The only way to find out is to call and ask beforehand, and go elsewhere if you don't want to come up with payment in advance.


(David GAY) #10

I take it that your insurer provides you with an attestation de tiers payant to produce when presenting for treatment ,pharmacy etc?