Refund from Doctor

Hello All,
OH had a Doctors appointment on the 9th October and paid the usual €25,00. Since then - nothing, no refund (which is usually about €16,00.)
Has anything changed?
Also wrote to Ameli regarding charges made by our Pharmacy that we believe should have been covered as OH has an ALD. All the items were in respect of treatment under the ALD.
Wrote to Ameli under the ‘contact us’ section & they have said it cannot be dealt with on line- we have to phone them.
On the phone I can never get through, you hang on for what seems like hours & then you are cut off! Tried to contact Doctor but cannot get through to him either. I’ve been in a few times & he is never there, only a Locum so I’m not sure what is happening.
Any suggestions as to how we can deal with this?
Many thanks!

I’m just wondering if your Carte Vitale is “up to date” ie have you done the “mis à jour” which is necessary at least once a year…??

Other than that, I’m rather at a loss.

Is it possible for you to visit your local CPAM offices to speak with someone face to face ???

Just a thought… have you checked your on-line Ameli account… there is a section where they put monies paid (to whoever…)

For quite some time, I only pay 7,50 by cheque to my Doc… Ameli and the mutuelle click in… perhaps it is a Departmental thing… others will doubtless chime in.

As Stella says, check your online account and it is likely that all will become clear! If your OH has an ALD it is very possible that he has been racking up the 1€ and 0.50€ forfaits and franchises - which are not covered by the ALD, and equally often excluded by mutuelle. Over time these can easily add up to 25€, and voila! The next time you actually pay for something any possible refund is absorbed by these costs……

Oh, and not all treatments are covered by an ALD. If it is something that the seçu doesn’t reimburse anyway, then it’s not reimbursed when you have an ALD either. These days if I am prescribed something new I always ask the pharmacy what the reimbursement is before I request it. My doctors have a habit of proposing things that are not reimbursed - just had a prescription for my eyes (eyes are part of my ALD) but had to pay 20€ as the cost of this product was far greater than seçu base de reimbursement.

(Some doctors are not yet connected, so you still have to pay and get reimbursed. With others the ayatem allows you just to pay your part).

Many thanks, however the card is definitely up to date & OH was told by his specialist in Bordeax that the prescription we took in was no charge. Not sure where to go from here!

In my experience, things don’t often go wrong. You will get back what you are due. There are hidden costs everywhere, be it just 0.5 € on a box of doliprane…Read the small print :wink: @fabien

Was the prescription one that said “relatives au traitment de l’affection de longue durée reconnue” at the top? Quite often specialists think they can do whatever they like, and use the wrong form, whereas pharmacies stick to the rules…. What did your pharmacy say as to why it was chargeable?

You’re very knowledgeable @JaneJones, you are correct in both your statements. The presence (or absence) of the mention for the ALD on the prescription changes everything and you were also correct to assume that the “mandatory contribution” (0.50€ or 1€) will also stack up eventually.

There is also the possibility os the card not being processed properly (not up to date for example, just going at the pharmacy to ask the pharmacist for an update wouldn’t hurt) that’s why it is of paramount importance to double check on your online account if you can see that claim on the “relevé mensuel” that you can download for each of past months.

Finally you still have the CPAM’s English speaking helpline although it’s kind of flipping of coin as some agents are helpful and others are… more of a typical French public workers :wink:

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But what is showing on your online account? As several people have said, that is the first place to look because it will you a good indication of what data CPAM has currently and what it thinks the situation to be. Is the consultation and the prescription showing at all?

Many thanks for all your replies. All the prescriptions from Bordeaux had the ‘exemption’ printed across the top so it was quite clear.
I’ve also looked again at our Amreli account and found the payment for the Doctors visit. However underneath there is a list of ‘items’ that are mostly 0.5€, 1,0€ & 4,0€ so I presume these are the amounts that he has to pay which in turn seem to add up to the amount that we would have received as a refund of the Doctors fees. It appears to be the first/only time this has happened but explains why no refund was paid back to us. I’m going to print the statement off & ask the Pharmacy what exactly the items are for so we will know next time!
Thanks again! T.

All the 0.50€ will be for drugs, the 1€ are usually for consultations, and the 4€ will be for when you had several things at the same time, like blood tests. They are unavoidable.

If you rarely pay for things with “real” money they add up, so I’m surprised you’ve not noticed before!! If you regularly pay and get reimbursed then in general you don’t notice as only tiny amounts at a time.

This is the link to franchise, and you can also look up forfaits

If it was clearly and ALD prescription then check with the pharmacy that it was for a reimbursable item. More and more things now receive no contribution for social sec, and you have to pay the lot.

Many thanks Jane, really useful. I’m pretty sure we’ve not had this before as I’m pretty ‘on the ball’ with checking the payments and I don’t ever remember seeing the refund not arrive in full! So lots to think about there, as now I can look through years of payment/refunds (when I’ve had a lie down!).
Thanks again, T