I had 3 teeth removed at a dental clinic in Angouleme. My dentist referred me. I paid a total of 253 euros and received 113 euros of this from CPAM.
The remaining amount of 140 Euros (on a separate facture) was forwarded to my Assurance Sante. This amount has not been paid. A few emails later I recieved a reply with the line “Vous trouverez en pièce jointe un document en anglais vous expliquant le fonctionnement du système français concernant la santé.” I see nothing in this doc that excludes me from this payment and I have written another email explaining this. So far , no reply.
Has anyone on the forum any idea why?
Hello Ian and welcome to the forum.
Could you please look at your Registration page and click on “preferences”… that will allow you to upload a photo… 
We are a friendly lot and seeing an anonymous “letter” is a bit bleak… 
Now, talking teeth, what was outlined on the Devis for the work…it should have shown costs v reimbursements…
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What was the “base de remboursement” for this surgery, and what percentage of that did CPAM pay?
And what cover for you have for dental work from your mutuelle?
For example, if CPAM paid 100% of the base then you would only get extra from your mutuelle if you had cover for 150 or 200%.
Or if CPAM paid 70% of the base, and you haven’t selected dental cover for your mutuelle then equally you would get nothing.
Hello and thank you for your responses.
With regard to a Devis I was referred by my own dentist and she made the RDV for me. This is because I am on blood thinning meds and the teeth were deep rooted. The first time I met with the surgeon was on the day of the procedure. So no, I did not receive a Devis.
The feuille de soins was broken down to show 2x @ 33,44, 1@46,89.
My assurance Sante pays dental costs at 100%
The other part of costs was a Facture for 140 e (Montant des honoraires) so the total paid at the clinic was 253,77 e.
Difficult for us to come up with a defining answer… can you post the letter that you received from your Mutuelle… hide your private details… just the wording, so we can take a look…
Thanks , I will post it.
Monsieur,
J’ai bien reçu la facture que j’ai transmis à Allianz.
Vous trouverez en pièce jointe un document en anglais vous expliquant le fonctionnement du système français concernant la santé.
Je reste à votre écoute si besoin.
Cordialement.
Sorry, just got a message to say I cannot send the doc attached to the email , new to the forum?
Well, firstly, I notice the contract is with Allianz. Do you have an Allianz office near you… where you could pop in and ask face to face…?? and/or the broker who sold you the health contract… ??
This came from my local office. I had no reply from their head office.
I am not too impressed with this company. I have sent an email to Fabien whom I found on your website.
Ok so it looks as if the clinic you went to was not standard sector 1, and they have what is called a “dépassement des honoraires” where they are allowed to charge more than the standard rate. This would not be covered by your mutualle if you only have 100% cover.
Ian…
Great idea to talk with Fabien.
Meantime… why not ask the folk who sold you this current contract… so you can see what/if something is adrift. Ask them, face to face, why such-and-such has not been paid…
I suspect it will be something to do with “limits” as Jane suggests… but you do need to understand how this happened… otherwise you risk it happening again… in “whatever sector” of Health Care…
On the clinic website it states that it is “Conventionne” I checked this after the event.
Had I had been sent a Devis then I would have known beforehand.
I won’t fall for this one again!
I have accepted I will not be reimbursed but I do need a new mutualle on cost alone.
Thank you all once again for your help.
Ian… sorry you had to learn the hard way.
Speak with Fabien… see if he can get you sorted with something to suit your needs…
and, in future… always ask for a devis… It should show you what is being charged…and for what “services/bits” etc… what will be covered by the State… and what is left for your Mutuelle and/or You to pay… and if it is unclear what the State will Not pay… check with your Mutuelle before going ahead.
OH and I do that religiously and it does put you in control of your money and your health.
Conventionné, but at secteur 1 or secteur 2? Makes a big difference! Look at the ameli website which sets out the difference, here
https://www.ameli.fr/jura/assure/remboursements/rembourse/consultations/metropole
Hi, It doesn’t say on the dental surgeons website 1 or 2, just Conventionne.
and Liberal Integral.
I have looked at your link but if it does not say 1 or2 on the website I am non the wiser. I will have to put this down to circumstances.
I may get an answer from my own dentist, I will mention it when I see her.
Liberal basically indicates that this is a private clinic, not a public one (although that doesn’t mean quite the same as private doctors in UK) so most likely that they will charge above the secteur 1 fees.
Thank you Jane. Your info is much appreciated.