In simple terms, can someone explain how the system works? I have a Carte Vitale and Mutuelle. When I visit the Doctor, pay him 30 Euros, I do not get reimbursed from CPAM, I receive back from my Mutuelle. Would appreciate assistance.
@SueM11
My Doc takes my Carte Vitale and puts it into his machineā¦ at the end of my medical I pay him 9 euro by cheque which I get back from my mutuelle. The Doc gets paid the balance of his ābillā by CPAM (French SantĆ©)
~Does your Doc take your CV and āplug it inā ???
How much does your mutuelle pay you??
Hello Sue and welcome to Survive France.
Iām not an expert, but hereās my experience of the financial side of the French healthcare system.
In simple terms, the state (via your carte vitale) pays a percentage of all healthcare costs. The percentage varies but is generally between 60% and 100% of the total cost.
You are left to pay the remainder. However, if you have a mutuelle, that will usually pay the remainder - or a part of it, depending on the terms of your mutuelle. Note that for most doctor visits or prescriptions there is a forfait (usually 1ā¬) that you will have to pay yourself - i.e. it is very unlikely to be covered by your mutuelle.
With some medical needs (such as , in your case, your MT visits) you have to pay the remainder then claim it back from your mutuelle (assuming your mutuelle covers MT visits).
Other medical needs (eg medications obtained from a pharmacist on prescription) are often charged directly to your mutuelle so you donāt need to pay at all (assuming your mutuelle provides full cover on prescribed meds).
(edited to add info about forfaits)
This explanation might help.
Our doctorās practice does all that for us. When we arrive for an appointment they take our carte vitale and our mutuelle card and so we donāt pay anything.
There are also certain health scenarios (eg high blood pressure, heart disease, cancer) where the patient is designated ALD (affection de longue durƩe) and the consultation cost is covered.
I am surprised you are having to pay the full amount and are not being reimbursed from CPAM. Have you checked on your Amelie site? Does it show the name of your doctor? If not, you need to get your doctorās practice to register you. (I think they have to do it - not you.)
Is your doctorās practice a small one man band? Most group practices these days do all of the registration and paperwork for us (or at least they do round us).
What type of doctor?
Are you going to a private doctor and does your mutuelle pay the whole ā¬30,?
Weāve had two different MTs in the past 20 years. The first was a one man band but since he moved away weāve been part of a much larger pĆ“le santĆ©.
Both of them charge/d the full amount & we then have some back from CPAM & the rest from our mutuelle. We end up covering 1ā¬ ourselves.
It would be a very expensive mutuelle that covered the forfaits!
Indeed.
I added the detail to make it clear to the OP how, in my experience, the system works.
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I am surprised there is so much variation.
The last time I saw the Doc I paid him ā¬26.50 (was ā¬25 and now I think ā¬30) and he put my CV in his machine and the total was divided completely by the CPAM and my mutuelle directly into my account. Thus I pay nothing. At the pharmacy I pay nothing, all done on the CV
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CPAM/Ameli will total up the 1ā¬ forfaits and send you a bill - probably when the total is 50ā¬.
I hope you have read our posts on this thread which you have startedā¦
everyone is trying to help you.
Are you able to answer my questions?
Theyāre getting a bit laggedly then, canāt remember it in the last 25 years, then again, perhaps I am healthy enough not to have got to ā¬50 yet.
Isnāt tbe reimbursement rate less if you have not given tbe form to CPAM to declare your doctor as MĆ©decin Traitant?
Also are your bank details correctjy entered into your espace on the CPAM website ameli.fr.
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As I said above. OP needs to check her details on Amelie site to see whether MT registered. Good point about the bank details.
Hi Stella, Yes my Doc does āplug inā my CV, my Mutuelle (Allianz) reimburse me 9 euros. I am not registered with a Doc, just visit local chap when needed, he is not taking on new patients, I wonder if this is the reason I (and my other half) do not get reimbursed from CPAM. Thank you for your help.
Hi, I think my Doc is a Sector 1 doctor.
Then sounds like CPAM donāt have your bank details as others have said.
Hi Sueā¦ can you visit your local CPAM and discuss this? there are various formalities to be completed but, when thatās all done, it should be easy peasy for reimbursements in the future. Worth giving it a whirl I would think.
As suggested, CPAM will need bank account details as wellā¦ as I sayā¦ go and see 'em and set the ball rolling.
best of luck
There is another circumstance where a visit to the Medecin Traitant will not result in any reimbursement from the CPAM. This where the running total of all those little ā¬1 and ā¬2 Forfaits and Franchisements outstanding, exceeds the amount of the usual reimbursement made, in which case the value of the outstanding Forfaits etc is reduced by the amount of the reimbursement for the doctor visit that would otherwise have been made. There are lots of little charges that arise at the pharmacie when medications are dispensed, so if you make regular visits to obtain medications, then the previously described scenario can easily arise.
Another possibility is that the patient has a Carte Vitale which is on the Ayant Droit (having right) system, in which case the reimbursement will be paid to the account of the principle Carte Vitale holder rather than the person who actually did the paying.
As others have said, a visit to the patientās Personal Space on the Ameli website should reveal what is happening as all expenses incurred and reimbursements made are listed, as well as the payments made by the Assurance Maladie to healthcare professionals.
Unfortunately, not all healthcare providers are as connected to the Assurance Maladies computerised system as they could be, and this leads to variations in practice and procedure between different healthcare providers.
For example, I recently had to have an echographie at an imaging center who did not want to even see my Mutuelle card, and so I had to pay the amount of the fee over and above that which the CPAM pays to the imaging center. They gave me a receipt for me to send to the Mutuelle.
At other establishments they take the Mutuelle card details and are repaid automatically through the system by the Mutuelle so that I donāt have to pay anything at all.
So it really does depend on where you are situated as to what happens. I think it is because some of the medical providers donāt wish to spend the money to upgrade their computer system to fully integrate with the CPAM / Mutuelle system.
Like any system, it does of course develop faults from time to time. Recently I had a message from the CPAM to the effect that I did not have a Mutuelle registered with them, which wasnāt actually true as I have had the same Mutuelle company registered with the CPAM for many years. So I had to contact the Mutuelle, send them an Attestation de Droits to prove I had a Carte Vitale, and get the Mutuelle to re-register the existence of my Mutuelle policy with the CPAM.
The variances in the system are a bit of a pain in the neck, but then the actual medical care is excellent, so one canāt complain too much really.
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