Is this a scam?

[Cathar Tours]

I get my dads post forwarded to me and I received a letter from somebody called l'Assurance Maladie asking for 50 Euros and what seems to be if it's not paid in 30 days it goes up to 127,70. On the back it has such things as Pharmacy 1 Euro, Parmancy (again) 4 Euros, Generalist 1 Euro repeated a few times all of which add to 50 Euros. Thing is it is for Sept 30th 2019 thru to Jan 6th 2020 and he is dead. This it the content of the letter (in French as I can't translate it).

"Pour certaines consultations, examens et produits de santé, une participation forfaitaire et une franchise sont à la charge des assurés. Quand cela est possible, celles-ci sont directement déduites des remboursements de soins.

Vous bénéficiez de la dispense d'avance de frais pour la plupart de vos soins. Ces participations et franchises ne peuvent donc pas être déduites de vos remboursements et doivent alors être réglées directement à l'Assurance Maladie.

A ce titre, le montant total de vos participations forfaitaires et franchises (pour vous et vos éventuels ayants-droit) pour les années 2015 à 2020 s'élève à 124,70 Euros.

Afin d'échelonner votre paiement, vous recevrez régulièrement un avis d'un montant maximum de 50,00 €.

Nous vous invitons donc la régler la somme de 50,00 Euros dont vous trouverez le détail ci-après, dans un délai de 30 jours.

Pour régler cette somme, un service de paiement en ligne est mis à votre disposition. Il suffit pour cela de vous connecter sur le site ameli.fr en utilisant la ou les référence(s) des avis correspondants. Vous pouvez aussi procéder par virement bancaire sur le compte FR7611808009230002000690196 CMCIFRPAXXX ou par chèque libellé à l'ordre de l'agent comptable CPAM DE L AUDE en rappelant la ou les références) des avis correspondants.

Toutefois, vous pouvez dès à présent payer la totalité de vos franchises et participations forfaitaires, soit la somme de 124,70 € par virement bancaire ou par chèque selon les indications ci-dessus.

Avec toute mon attention, votre correspondant de l'Assurance Maladie"

Don't know if it is incidental but he got his S1 in 2015 and that date caught my eye in the letter.

[nomoss]

L'Assurance Maladie is the French equivalent of the UK's NHS.

Every time one sees a doctor or gets medicine, there is a fixed charge due. These charges accumulate, and are deducted from any future reimbursement for money paid out by a patient.

The amount is 1€ for a doctor visit, 50 cents or 1€ for each item of medicine, and so on.

They are not reimbursed by the UK if you have an S1, nor by any top-up insurance.

If there are not enough reimbursements, the fixed charges accumulate, and are eventually billed, as in your father's case.

The debt should be paid by your late father's estate.

You should also inform L'Assurance Maladie of your father's death via the local CPAM whose address should be on the letter you received..

[Cathar Tours]

Treatment for his diabetes for example was 100% covered by the French state system so would he still pay the extra money for that?

[nomoss]

[quote user="Cathar Tours"]Treatment for his diabetes for example was 100% covered by the French state system so would he still pay the extra money for that?[/quote]

I don't think so, but only items directly connected with a registered long term condition would be 100%, and some medicaments may not be 100%, especially if they are not generic versions.

I had a scan which was 100% reimbursed, not connected with any long terms condition, but the charge for the interpretation of the scan was only partly reimbursed, and also attracted a 1€ fixed charge (forfait).

Maybe someone who has direct experience will answer your question.

[NormanH]

The 100% covers medicines and medical acts such as blood tests, but even with 100% the small charges such as 50cents on boxes of medicines or 1€ for "forfaits" are still payable.

[Cathar Tours]

With the GP he paid up front and has done since he and my mum arrived in France all those years ago. This would mean that he received the government reimbursement, minus a Euro and the insurance paid the rest. Why are they now trying to charge him a Euro when he had paid cash? Was the GP on some form of fiddle? Like I said he ALWAYS paid the doctor up front.

Same with some specialists and treatments but then they only paid the insurance top up amount which was paid back to their bank account automatically. Both of them never paid for any medicine apart from the odd thing that was not reimbursable like homeopathy medicine.

The other thing I don't understand is how can he be charged for things like "soines infirmiers" five times this January when he was dead!

Don't get me wrong 50 Euros is not a lot of money these days it's just I keep mulling this over thinking hang on a minute some of this is not right, perhaps none of it right. I guess I will have to find somebody who speaks French to give them a call. I mean the letter looks official, it has his name on it but there are a lot of clever scammers around these days.

Thanks anyway for your help.

[nomoss]

No-one is fiddling anyone.

Maybe you've been Germany too long, they seem to regard every other country as backward and dishonest.

The system here is weird in a way, but not difficult to understand:-

In general, it works like this.

"You" represents someone covered by the French Illness Insurance - l'Assurance Maladie, (AM)

You pay the doctor the full amount of his bill.

The l'Assurance Maladie reimburses you 70%, and if you have a mutuelle, it pays you the balance. If you suffer from a long term condition (ALD) the AM reimburses you 100%, but I don't know whether the "forfait" for each visit is applied.

But, AM charges the "forfait" to your account, rather than deducting it from the current reimbursement, and deducts it from the next reimbursement, if any. So if there is no reimbursement due, the total forfaits will accumulate. Maybe they are not billed directly until a certain amount has accumulated.

If you get prescribed medicines you pay the pharmacy direct for the amount not covered by AM unless you have registered your mutuelle with the pharmacy, in which case the mutuelle will pay this part directly to the pharmacy, and you have nothing to pay them.

AM pays the pharmacy the 60% or whatever % they cover, but you owe the forfait, of between 50 cents and 1€ for each item, which is also added to your account. I don't know whether the forfait applies to all medicine supplied to treat an ALD, but according to NormanH it applies to at least some.

The soins infirmières (care by nursing professionals) are probably the cost of treatment by nurses which he received after he was found collapsed last year, but which has only just worked its way through the system. Many cabinets of nurses and and physiotherapists delay sending their accounts to AM so that the patients get the reimbursement before they have to pay the bill.

I think you should be more appreciative of the attention your father received before you criticise the people and the system that provided it, and accuse medical professionals of being scammers.

124€70 is not a huge amount to accumulate in forfaits over 5 years, and if you had made the effort to use Google translate or similar, you would understand that to lighten the burden you have been offered the opportunity to pay it in three instalments, starting with 50€.

I'm sorry this seems such an imposition to you.

If you think that the charge for nurses is wrong you can pay someone fluent in French to write and appeal the charge to AM via the local CPAM. It will cost you more than the bill, but might give you some sense of satisfaction and superiority.

A typical bill from a nursing professional is about 3€, and around another 2€ for a house visit. WOW! They are severely underpaid, and I never begrudge their dedication to a thankless job.

If you find my response somewhat rough, believe me, I feel like saying much rougher things.

[nomoss]

Since it is such a problem for you to understand the letter, for which you didn't give any date, here is the Google translation:

"For certain consultations, examinations and health products, a fixed contribution and a deductible are the responsibility of the insured. When possible, these are directly deducted from the reimbursement of care.

You benefit from the exemption from advance fees for most of your treatments. These contributions and deductibles cannot therefore be deducted from your reimbursements and must therefore be paid directly to the Health Insurance.

As such, the total amount of your fixed contributions and deductibles (for you and your possible beneficiaries) for the years 2015 to 2020 amounts to 124.70 Euros.

In order to stagger your payment, you will regularly receive a notice of a maximum amount of € 50.00.

We therefore invite you to pay the amount of 50.00 Euros, details of which you will find below, within 30 days.

To pay this amount, an online payment service is available. You just have to connect to the site ameli.fr using the reference (s) of the corresponding notices. You can also proceed by bank transfer to the account FR7611808009230002000690196 CMCIFRPAXXX or by check made payable to the accounting officer CPAM DE L AUDE by recalling the reference (s)) of the corresponding notices.

However, you can now pay all of your deductibles and fixed contributions, the amount of € 124.70 by bank transfer or check as indicated above.

With all my attention, your Medicare correspondent "

[idun]

Send a copy of the death certificate and ask for confirmation of the dates involved.

[Cathar Tours]

The date of the letter is 3/3/2020.

Perhaps France is backwards and dishonest after all it seem to be able to charge people for services they received after they are dead. By that I mean on the reverse is a list of each individual "Nature de la participation" with a creance number and date the service was used and there are 14 Dates des prestations which come after he was dead so how can he have seen these people?

You clearly have a problem reading because I said he never paid the pharmacy for anything other than for items not covered by the "system". Indeed neither he or my mother ever paid for a prescription since they joined the French system in 2002.

French nurse are paid the going rate. If they don't like it they can move to another country like UK nurses do. Indeed come to Germany and they will get aid more and treated better.

Now then having found the Ameli website via google in an attempt to pay via card there is no facility to pay like it says in the letter. If I use the link in the letter there is a facility to pay which is odd. I would send them a cheque but being more advance than the French we don't have them anymore. (thought I would belittle the French a bit as you seem to have a problem with Germany).

So the bottom line is that assuming the solicitor or whatever he is called should have dealt with all this prior to handing over his property and funds which I have read here means there are no further "charges" on the estate I can only assume it is a scam and I will not pay. I mean what are they going to do to me here in Germany, send the boys round?

Thank you for the translation.

[nomoss]

I do not have a problem reading. In fact I can read in English, French, Spanish, and Catalan.

I tried to write a basic summary of how the French health system works which could be understood by someone with limited intelligence. I'm sorry you were unable to understand it, so I have edited it to clarify it more.

In an earlier post on this forum, in a thread which has been deleted, you said:

"As to Nomoss if he keeps away from me I will keep away from him. It is strange

however that whenever I post anything at some time or another up he pops. You

can check that for yourself."

I suppose the reason I have done this is because I was on good terms with your late father, and felt some obligation to him. I will not trouble you again in this way.

[sid]

I think Nomoss has covered this pretty well and I doubt very much that there's any dishonesty or scam here, who would benefit ?

We often see items on the Amelie statement that appear long after the event. This business of the accumulation of forfaits is something that has puzzled us, but we've concluded that it's the 100% ALD situation that's causing the problem; the forfaits accumulate but never get settled, whereas someone on the standard 70% basis pays the forfait as part of his/her cash payment... I think !

As Idun says, a visit to the CPAM should clear it up.

[Cathar Tours]

Thank you Sid. I can't go to a CPAM office because I don't live in France and I don't speak French.

My point being what happened to the years between 2002 and 2015 and why are there no charges for them. It just seems strange that the first of these charges came up the month after my dad's S1 was sent to CPAM.

It's also strange that his social security number which I assume is the "Numero de l'Assure" does not work on the website when I go to try and pay it says it needs a 13 digit number when the number on the document is 15 digits and the last two digits roll over to the day date of the year he was born. The problem is that if that isn't his number which the document says it is then I have no idea where or what t looks like.

[Cathar Tours]

Why the need to add extra languages that you can read?

You are a liar. You didn't feel the need you deliberately posted because you thought to annoy me.

"I will not trouble you again in this way."

Good and make sure you keep to your word.

You still don't get about the missing 13 years do you but never mind and don't bother answering.

[suein56]

CT wrote : My point being what happened to the years between 2002 and 2015 and why are there no charges for them. It just seems strange that the first of these charges came up the month after my dad's S1 was sent to CPAM.

Sid explained it well as did Nomoss .. because your Father was ALD covered it meant that a shortfall due to Assurance Maladie accumulated over the years.

As sorting out a succession can take years in France it would be expected that this bill would be picked up and paid by someone .. I don't know who, when the succession was completed .. perhaps you as the inheritor of your Father's estate.

It is not a scam .. it is a bill just a bit delayed because of the way the French system works.

When accessing Ameli don't input the last 2 digits of the social security number .. just the first 13.

[idun]

And just how do you know that your parents did not pay in the past, have you got all their statements from ameli?

Get in touch with someone from Ameli the CPAM where your father lived and speak english, from certain posts on here and those ruddy tv programs, many expect it and it is a region that is wick with brits, so maybe they will speak english.

Suggestion, don't go in all guns blazing, like you do on here. Ask for their assistance, be apologetic saying that you don't understand. I am not saying that blazing guns are never necessary in France, but, you need their help.

This should be a live link and the phone number for the Aude is there. Your father went under quillan on here didn't he, so I take it that is the Aude.

https://www.ameli.fr/aude/assure/adresses-et-contacts/un-autre-sujet

And notaires, well, some things one is expected to know about, the old expression.......... 'I don't know what you don't know' comes into play here. They may well have expected you to sort out health bills amongst other things and they have simply dealt with the parts they consider pertaining to their remit.

Remember french authorities have in the past at least, not hesitated to reopen bank accounts and withdraw the necessary funds to pay bills, putting the account into debit. I don't know whether they can still do this, but they used to.

Incidentally don't german banks still do bankers drafts/cashiers cheques? 

[Cathar Tours]

"When accessing Ameli don't input the last 2 digits of the social security number .. just the first 13. "

Thanks for the tip but I did try that last night and it still did not work.

[NormanH]

There is no scam.

nomoss explained  system with great patience, and I cleared up the point that the 'forfaits' are still payable with an ALD 100%

The ameli accounts are often in arrears

but I have never found them to be inaccurate.

[Cathar Tours]

Idun, I didn't know you got statements nor what they looked like. I just got a big box shoved every bit of paper I could find into it and took it to the Notaire (thanks for reminding me of the correct name). I assumed his job was to ensure everything was done and dusted before releasing my dads estate.

The reason I asked about it being a scam is because I know this happens in France (and probably other countries) although I have only heard of it in France and the UK. I remember my parents getting a bill when they first came to France. It looked like a bill and had the words facture on it. Turned out it was unsolicited mail for insurance against calcium build up in their pipes. I remember my dad saying things like this were quite common down the years and normally addressed to women for some bizarre reason. Perhaps the senders thought that women were a soft touch which is a bit insulting.

There are certain weird things that rang warning bells. Firstly the dates, then there was no place to login on the Ameli website that I could find. I did find a place where you could create an account using your social number but as I explained that didn't work with or without the last two digits.

I was wondering about this bit about them reopening by dads bank account then taking the money from that. How will the bank follow that up because none of my dads money or assets are in France. Indeed being dead he does not have any.

As I said I don't understand the French state healthcare system and I have never been a part of it which is why I asked.

[woolybanana]

Could you drop a lone to the relevant CPAM office, CT just to make sure. I am sure they will explain the situation. Offer them a cheque, perhaps.

[idun]

I have looked to see if they can still reopen his account and for the moment cannot find anything, which is not to say there is nothing on the web either.

I believe that recovering money is called ADT

d’avis à tiers détenteur.

Call Ameli, there is a number on that link I gave you. Only they can help, not us and hopefully explain which method you can use to pay them.

And notaires, do not get me going on about them... too many that simply don't care. If you look upon them as government agents, then you get the idea, they don't 'work' for their client, but in general make sure that the state gets their money.

Scams, well when we had our first baby someone called round one evening. She implied she was some sort of  nurse/health visitor, but as I had had no ante natal classes at all or any personal help in general, it seemed strange that someone would just turn up.

I didn't speak much french then, but I understood a lot and I told my husband to tell her to get out and that she was flogging something and not there to 'help' in any way at all. She was selling something or other and he told her to leave and I opened the door for her.

 

[sid]

"Thank you Sid. I can't go to a CPAM office because I don't live in France and I don't speak French."

Apologies CT, I missed that fact that you are in Germany.

I doubt that you'll be able to access an Ameli account unless your father had already created one and given you the password.

Everyone has tried to explain and help and point you in the right direction; I don't know what else we can do. When it gets down to the nitty-gritty of an individual's details they can't be sorted out on here, you have to do it yourself. You need to contact CPAM and I'm sure you'll find them helpful. There are the odd one or two awkward characters but keep calm and be polite.

Good luck.

[Cathar Tours]

No problem Sid. Having read all the replies I did a transfer of the whole amount last night and hope that will be the end of it. It was just the dates the treatment was carried out and the dates some of the nurses attended were after his death. I have to assume this is due to what others have said i.e. these people putting their paperwork in late, like several years late.

I don't have any problem with the level of care he received in France contrary to what somebody implied. t seemed nearly as good as what we get in Germany.

Idun - I forgot to answer one of your question. Supermarkets and shops you use a bank card (or mobile phone) anything other you transfer the money which takes a minute or two. Indeed it is almost instant. You can get bank cheques I believe but I asked my mates at work and they said nobody uses them either. If you go to buy something expensive like a car you just do a transfer via your mobile phone. People don't use cash much either. I drew out fifty Euros last month and still have forty left.