orthodontist

[hoverfrog]

I know it's not strictly education, but my 13 yr-old has just started orthodontal treatment here in the UK. Yes, I know - it wasn't my idea to become homeless at this stage in her life!

We've both been working fulltime here so should have no problem with the E106 even though we won't have jobs to go to immediately. However, is orthodontal teatment covered, and what is the service like in France?

[Miki]

I can only speak about what happened to our daughter and the payments we paid out.

She had treatment, including the appareil (brace) for over 5 years and we paid quite a bit out in those years. An E106 will only cover you for so much. Not sure if you can get a top up for an existing problem, maybe somebody else will know that much.

The treatment was very good but towards the end of it, some drunk driver forced her and her boyfriend off the road and all the work was undone in a flash, as her teeth were pushed back 4mm and so had to have an operation to correct that and 2 years later the insurance company are still dragging their feet over payment.

 

 

[Teamedup]

Our eldest son's treatment lasted four years. The total sum that we were left to pay ourselves, was, getting on for a thousand pounds and that was with decent mutualist cover.

Remember many mutualists don't cover for the first three months of membership.

The rules here used to be quite strict as to what age the secu would reimburse for this, and that meant that the mutualists would reimburse only on these age limits too, as the mutualists follow the secu's payments. However, I seem to think that someone told me that the age limit has changed in some way and is more flexible now. I do believe that the secu would have to authorise this too.

So you would have to find an orthodentist and get authorisation. Then the secu will probably only give you a tiny bit of reimbursement, and once you have a mutualist running they will probably give you some help towards this treatment. However, the amount of mutualist reimbursement for this will depend on the amount of cover you take with the mutualist. And the rest will be down to you, this is not cheap here, but there again I don't suppose that it is anywhere.

[hoverfrog]

oh dear, looks like we'll have to budget some!

Still, kids are more important so if she needs it we'll have to manage!

Thanks for the quick replies, even if it wasn't what I wanted to hear! Forewarned is forearmed as they say...

[Jennys]

My children were both referred to an orthodontist by their dentist.  I asked my French friends whether the treatment was covered and was told that the Secu reimburse the normal 60/65%.  They said it can get expensive so it was best to have a Mutuelle to cover it.  We only had basic cover for hospitalisation so I upped the cover and for the children, we were covered after 1 month (for adults it was 3 months).  We were also going through the post accident stage after my husband fell off his bike and broke the neck of his femur.  I was amazed, but the Mutuelle immediately started covering all his outpatients bills, physio etc, even though he had already had the accident.

As it turned out, the orthodontist said that it was too early for treatment for the children, so we didn't need the extra cover, but it has been worth it for the other treatment.  We used to pay about 15 Euros a month for basic cover for 2 adults and 2 children.  Now we pay about 50 Euros a month but we have full cover for all doctors visits, pharmacy, dental, optical, private room in hospitals etc.

Hope this helps

Jenny

 

 

 

[Miki]

Sorry but 15€ a month  for a family of 4 ! and now you say you have upped it to 50 euros per month and have full cover with everything paid ? and full remboursement.

With a normal job, say a macon, artisan or like us, commercants, I have never heard of such a low amount especially the 15€ per month that you paid previously.

I know agricole workers pay less, so are you in that kind of mutuelle ? or if not, can you explain a bit further, as we pay, for the 3 (2 plus daughter of 20) of us nearer 1200 euros annually just for the "top up" that's without the obilgatory cotisations that also have to be paid.

That 1200€ is still not the top cover and I would call it very much a "middling" complementaire and we certainly don't get all the opticians or lens and frames money remboursed or indeed all the dentist fees back and certainly didn't with her orthodontiste.

Don't mistake "100%" to be actually be 100% remboursed, I know that's what it sounds like but when it comes to dentistry and opticians, you need a lot more cover than "100%".

 

 

[Jennys]

Dear Miki

If you read my previous reply, I said that CPAM reimburse 60-70% of our healthcare costs (I am employed full time, therefore I pay charges on my salary and are in the French health system).  The Mutuelle covers the rest and the figures I quoted are correct.  For full cover, i.e. if you are not employed in France or if you are self-employed, I have no experience of, so I don't know how much this costs.

Hope this is clearer.

Jenny

 

 

[Teamedup]

Jennys, the CPAM only cover 'some' health care costs at 60-70%. And year by year certain  reimbursements are diminishing.

You could be very lucky and have very good mutualist cover, but I personally don't know of anyone that has one that makes up all the rest to 100% of all costs, for all things, in all circumstances.

 

And yes, we used to pay 60ff a month for our mutualist cover, it has now gone up to 30euros a month. That is because the CE participates. However, the CE has limited ressources and as there are now a lot of company retirees who remain under their cover, the cover has been reduced for everyone.

For anyone who didn't know, a french company with more than a certain number of employees must have a Comite d'Entreprise. A sort of social committee. They give financial assistance towards holidays, health cover and various things that help, there are employees from the company who are elected to the board of the CE and run it and there are people employed by the CE as secretarys, accounts clerks, etcetc . Some of the big CE's have their own CE's.

And the EDF CE has had millions and millions of euros that are unaccounted for or fraud ?, there is a book out about it at the moment, it was certainly in the little bibliotheque section in our local Super U.

[Miki]

Dear Miki

If you read my previous reply, I said that CPAM reimburse 60-70% of our healthcare costs (I am employed full time, therefore I pay charges on my salary and are in the French health system).  The Mutuelle covers the rest and the figures I quoted are correct...........Hope this is clearer.

It was crystal clear the first time thanks,.

My biggest surprise was that you say you were getting 100% (in the term and meaning, of absolutely everything all expenses paid out and all treatments being remboursed) My experience of family and friends, (French or otherwise) who have gone through the orthodontiste route for their kids, have never been repaid all the monies paid out and I was surprised at how little you paid to get the best cover available.

I agree with TU, it takes one hell of a good cover to get you the FULL genuine 100% cover for *ALL treatments ( which includes teeth and glasses etc) and we have not found one that does, well not in the price brackets we have studied anyway, in the case of the orthodontiste the CPAM did not cover us that much.

*This does not include the treatment for the maladies that require the health service to give on the fullest cover possible for the maladie.

 

 

[Alexis]

I reckon to have got back all that I had paid with this last lot of dental treatment, I would have had to have had 400% cover.

Not saying that the dentist laughed when she saw my cover - which I pay 30+€ a month for and I have cover with the MSA too - but I am sure she sniggered.  I hadn't taken a lot of notice to be honest.  100% is 100%.  Not in France it ain't.

I really think that I shall have to change my policy to a more mature one with better offers for glasses and teeth. 

Get rid of the pregnancy bit for a start......

[Jennys]

I have to admit that as my children haven't started their orthodontist's treatment, I don't know how much we are covered.  All I know is that I specifically asked the Mutuelle when I changed the level of cover, that I wanted it to cover orthodontics for children.

As all our other medical costs (including a hospital stay, home visits by nurses, home visits by physiotherapists etc when my husband broke his leg) have been covered 100%, I assumed that 100% was 100%.

We shall see for the orthodontist, but it won't be at least until September 2005, as the dentist said it was too early, not enough teeth have come through yet!

I must add also that I do get a discounted rate with the Mutuelle via my employer, but I'm not sure how much.

Jenny

 

 

 

 

[Teamedup]

Hello Jennys. Yes a broken leg probably would be covered a 100%. This is what our mutuelle says

2003

Orthodentie Acceptee 350%tc

Orthodentie refusee par an 250%tc

 

This  reduced  for 2004 and is now

orthodentie acceptee 325%tc

refusee par an 250%tc

 

My son's was accepted and I still ended up paying around £1000 over the nearly five years that he had to have it. Some kids don't need it for that long and it is cheaper.

Not all mutualists pay out if it is refused by the SS either.

You will have to look on your contract and see what it says and maybe increase your payments, may well be worth doing it and paying less later. Also, have you seen the orthodentist yet. If you haven't then I would make an appointment and go and see them and ask how long they think the treatment will take and how much AND show them your mutualist contract, then you will have a very good indication as to how much it will all cost if accepted. 

 

I know so many kids who don't get this done these days. I should have had this and didn't resulting in arthritis in the jaw joint as my teeth were not in line. And that is why I was very much in favour of my son having this done, in spite of the cost;