Why bother with a mutuelle?


(Suzanne Fitzgerald) #1

So this week having had an annoying cough for 4 weeks I decided to see the Doc. She sent me for an x-ray (radio) of my lungs and a variety of blood tests which showed I have inflammation and an infection. A follow up visit to Dr for the prescription and review of results and I am now on a lovely selection of antibiotics, inhalers and cough syrups.


I was told to rest (not easy with 3 kids, an active renovation project and an impending move next Thurs.


So last night was my daughters ballet spectacle in Pezenas. At the interval I took my 2 year old to the loo and on the way back tripped over a chain at the edge of a pathway and ended up falling. I couldn't break my fall as I instinctively protected my babe in arms so my left knee and right elbow took the impact. Almost immediately the knee swelled up and changed colour to a delightful bluey green. It was annoyingly painful but not so painful that I thought it needed medical attention.


After a night of not sleeping very well friends told me to go to get it checked out. The Dr examined me and sent me straight to urgences. There I had another xray and after 3 hours was concluded I have probably fissured the knee cap. Not a massive fracture but enough to annoy me. I've now got my leg in a brace for 10 days and my hospital bill covered by the state and my mutuelle.


So far: 3 x 23 euro medecin visit, plus xrays plus medecines and A&E treatment...how much does that add up to? Well certainly far more than my monthly cotisation for the whole family.


My daughter has seen the Ophthalmologist for the second time following a school eye exam and has been given a prescription for glasses, 200 euros but mostly covered by the mutelle.


Last month I had a root canal filling - 960 euros. Of this about 40% was paid for by mutuelle.


It is bad enough when these sort of things arise when you have insurance but if you don't have insurance then the financial uncertainty about your exposure must make the situation extremely stressful as well as painful.


I previously posted about a friend whose insurance had run out as they'd stayed too long in France...they have just had the bill 2m later for the 8 day hospital stay...circa 2000 euros.


So I would recommend if you are new to France or are considering moving to France you organise yourself a Mutuelle. Yes it can appear like an expense you didn't budget for in your original plan but can you really afford to pay for the 20% or more when you need medical help?



(catherine taylor) #2

Jane, I am almost certain it was chronic asthma or perhaps French for COPD, I have the paperwork somewhere, although I don’t have COPD based on U.S. definition and thankfully no asthma attacks in last 2 years. The 100% paid by CPAM was only for costs related to the asthma, or COPD, and yes, the paperwork had to be initiated by my médecin traitant and has to be renewed every so often. Sorry to be vague about that part but we moved from France last November so all my health files not relevant here are buried in a box.


(Jane Williamson) #3

Peter, I will try that, but there is a list on ameli.fr which says which conditions qualify for 100 percent.


(Peter Scawen) #4

Jane

Obviously I do not know your situation, but my experience suggests that the responsibility for having a condition that qualifies for 100% payment rests with your GP. Certainly, I had a document recently that I had to get my GP to sign off which dealt with this problem.

Have a chat with your GP and see what he says as a bit like the UK it is the GP that determines what treatment you receive and in this case how much is paid for by the state.


(Jane Williamson) #5

Catherine I don’t know how you managed to get 100 percent on your chronic asthma? As far as I can see it is not on the list for ALD, though it should be. I have the same problem, plus osteoporosis, neither of which will ever leave me. I get 100 percent for cancer, but the CPAM have made a mistake and have taken it off my carte vitale when they took my husband off as my dependant.
No matter ne seems to either follow the rules or they interpret them as the feeling takes them.


(catherine taylor) #6

We had private insurance our first to years in France until my husband turned 65 and recived S1 from the UK which covered both ys for the CPAM 70%/80% plus 100% of anything related to my chronic asthma condition. We planned to get around to signing up for a mutuelle but in the meantime had an unplanned 5-day hospitalization. After CPAM paid its share we had an 800€ charge for the stay. That covers about 7 months’ premiums on a middle of the road mutuelle–hospitalization, all doctors’ fees, prescriptions, tests, medical devices but no dental or vision. Some years you win, some you lose but we didn’t want to gamble and were pleased with our policy, 132€ per month for two mid-60s old farts.


(Peter Scawen) #7

Comment by Peter Scawen

Well I have a question. I am now 75, shortly to be 76.

I had a note recently from CPAM apparently suggesting that all my medical costs would be fully,100% that is, paid.

I gave up using the Mutuelle save for Hospital work as having had cancer much of the rest was 100% and what wasn't I either:

a) Could afford it

b) The amount paid by the mutuelle for glasses, dentistry and hearing aids was so trivial as not to be worth the premiums.

Anyway, am I right in thinking that now I am 75+, 76 in a few weeks time, that my medical costs are fully paid and in which case why do I need a mutuelle at all.

Does anyone know, or give advice or tell me where to look?

Thanks

Peter S

Stage directions: Sounds of creaking bones, stage left (well and right, back and front!)


(Steve Hayes) #8

It’s about figures. The mutuelle don’t refund 23€ for a doctor’s visit, they refund 7€. And so on. Can you work out how much they refunded in the last couple of very unfortunate months and compare that with what you pay.
Your friend’s hospital bill - well if they were living here as you are the bill would be nothing like 2000€, it’s hard to be certain, but my guess would be the mutuelle would have to stump up a few hundred at the outside and perhaps nothing at all.


(Mike Kearney) #9
Delete Comment

Right Brian.
I should have spelled out that what I was saying only applied to retirees who had made a full contribution in the UK. I seem to remember that I previously mentioned that it could get extremely complicated if you have worked in more than one country and I was glad that I had waited for retirement before moving over here.


(Brian Milne) #10

Mike it only gets passed on to the UK if people are not contributing here. Anybody working and paying out to the system or making voluntary payments here is NOT passed on to the UK. Do not give people the impression they are all stuck with the NHS in some way, plus the fact it is (quirky but there you go) the DWP who actually pay for it from the UK and not out of the health funding at all. So, not all people are in the same boat as you and given that you are giving the impression that it is a 'one size fits all' system they should find out the actual situation. If they are working and pay their 26% or so social contributions, or voluntary contributions instead, then they are 100% in the French system and an S1 is of no earthly use whatsoever.


(Mike Kearney) #11

Dominique,

I don't believe it is quite so simple.

As a retired person with full UK contributions, I have a Carte Vitale that entitles me to receive health care as if I were French. But this means that I might be able to get treatment that the NHS would not pay for, or I might have to contribute towards the cost of treatment that would be free in the UK. This is slightly crazy, because the bill gets passed back to the UK anyway. By having a mutuelle, you can insure against having to pay your contribution towards the cost of treatment, but what you get out depends on what you put in and insuring against everything can be rather costly.

I think I am right in saying that anything chronic or life-threatening is entirely free. But if you don't have a mutuelle, you need to go to your doctor who will raise your case with CPAM. If you have already started treatment and find you have something more serious than you first thought, you should do this quickly, because there is no provision for retrospective repayments.

If you ask me why it is this way, I can only say that it was decided by politicians and civil servants. Logical thinkers need not apply!


(Dominique Micallef) #12

Me again !

Found this on www.cleiss.fr

Seuls les soins dispensés sur le territoire français feront l'objet d'une prise en charge par la caisse primaire d'assurance maladie auprès de laquelle vous serez inscrit. Les prestations de l'assurance maladie servies seront les prestations françaises selon la législation française.

According to this paragraph, the health cover is the same under an S1 as if you were a fully-affiliated French or whatever, in the French healthcare system - I wonder if it means that people pay and then send their feuille de soins for reimbursements ? Is there any way you can find out ?

Best regards,

Dominique


(Véronique Langlands) #13

I have everything through the MGEN - I added their mutuelle as it means my daughters hideously expensive orthodontics cost a lot less & I free specs etc every 2 years should I want to - more frequently should my prescription change. The charges are deducted at source from my salary so it is painless. I can't remember what the percentage is.


(Dominique Micallef) #14

re :I think there is a minimum provided you have made some contributions (about 450 euro a year) and it used to entitle you to health care in France when you stopped working or reached retirement age, but I am nearly sure this has been stopped for the last two years.

I meant the minimum pension is something like 450 euro a year, and not that contributions of 450 euro a year will get you a pension .

Dominique


(Dominique Micallef) #15

Thank you Brian and Peter; I think I now understand : you get the same cover that would you get in the UK ?

I have no idea about Ireland but I do not know that when in Ireland, I paid to go to the doctor and various specialists, so I could be in a worse situation than if I had a UK S1 (I will get a tiny pension from the UK but the bulk of my retirement pension will be from Ireland so I doubt the UK will give me an S1).

Peter : I have a Carte Vitale as I declare my small income here in France, but I don't think it will be enough to qualify for a pension in France. I think there is a minimum provided you have made some contributions (about 450 euro a year) and it used to entitle you to health care in France when you stopped working or reached retirement age, but I am nearly sure this has been stopped for the last two years.

The cheap mutuelle you were talking about must be the "CMU-Complémentaire".

You can always join the CMU and pay 8 per cent of your income, but I have read that some doctors, specialists, surgeons, etc, are not very keen on it as they receive limited amount from CPAM and when they learn you are on CMU, they refuse to take you on as a new patient, for example.

I'll start making enquiries at some stage and will post my findings - although I am French, we all know that health care here is based on contributions and not on residence, unlike the UK and Ireland.

Anyway thanks again for the replies.

Best regards,

Dominique


(Brian Milne) #16

Dominique, I have my kinesi-therapy, acupuncture and a few other therapies plus homoeopathy occasionally that the NHS do not offer and comparing with people with an S1 who I have recommended ask their doctors for the same, they do not have the cover I have with my carte vitale and mutuelle, therefore do not get those 'free' (OK, nothing actually free...). I believe cosmetic surgery is the same.

I am not sure where there is an official source of info to tell you exactly because I only know it from people who tried unsuccessfully, and not just the odd one here and there at that, and my kinesi-therapist who has told me that I am her only UK patient who has full cover with her. All others need to pay for her. I am working and therefore paying into the system whereas I suspect that all others, at least the majority, are retired.


(Peter Scawen) #17

Hi Dominique I am not sure about the Irish S1 but basically that covers you for a limited period of time. If you are resident in France then you must get a Carte Vitale to make use of the French medical services and then you will be treated as if you were "French". But of course that also means that you must declare your income to the French tax Authorities etc., which many ex-pats seem to act as if that is not necessary but I know that the French authorities can demand and will receive your "dossier" from the UK, maybe Ireland as well.

The other day I mentioned a low cost "Mutuelle" from the State but I learnt today that it is only available to individuals/ families with a low income but you can check your eligibility or otherwise on the Ameli web site.

Peter S


(Dominique Micallef) #18

Good morning, I cannot remember if I have already introduced myself or posted to this forum ? Dominique here in Lyon.

I have a question from Brian re : Not everything is covered by the S1 though, particular therapies that are only available to people within the French health system will not be paid by the UK.

I don't understand that one at all and it is the first time I have seen a mention of not all healthcare being covered by the S1 (I'll get mine from Ireland not the UK, I think)

Brian: could you tell me where you have seen this information and/or do you have any idea how to get more info from official sources ?

Your reply would be much appreciated and thanks in advance.

Best regards,

Dominique


(Mike Kearney) #19

It is difficult for Europeans to understand the widespread opposition to ObamaCare. We may occasionally complain about the costs and inefficiencies of our system, but we couldn't contemplate life without it.

Surely, even out of simple self-interest, nobody would want to live in a country where people who prepare their food and care for their children are suffering from diseases that they cannot afford to have treated?


(Kirsten Monteil) #20

WOW! That's in response of the €2000 8 day hospital stay for someone without insurance. Here in the States you'd be lucky if all you had to pay was $200,000.00 WITH insurance, that might be your share, and that's after paying about $1000.00 per month for said insurance. One of the main reasons I want to move to France is this very issue. Healthcare in the U.S., or should I say the lack thereof is a joke, would be a joke if we were laughing!