Jump to content

Percentage coverage Carte Vitale


frexpt
 Share

Recommended Posts

Looking at an article published in Le Figaro, it appears that the cost over and above that covered by the sécu varies by region, so any answer you get from someone outside where you live might not be valid for you.

Le Figaro also published this simulator, if you are able to try it in French, which gives the supplementary fees for 150 common operations. It also seems to take into account where you live. I haven't checked if it works for a hip replacement but you can try!

http://leparticulier.lefigaro.fr/jcms/p1_1509864/simulateur-de-depassement-d-honoraires-en-chirurgie

Link to comment
Share on other sites

You can get the charges for any hospital, service, or doctor etc. on the ameli site - https://www.ameli.fr/

After selecting your "caisse", by entering your post code, you choose "annuaire santé" by hovering over the coloured list on the RHS and clicking the stethoscope image.

You can then use the search facility presented to find a professional or hospital, together with charges.

Sorry I can't give you this information in English.
Link to comment
Share on other sites

You will not really get a useful percentage. The refunds are based on the standard tariffs available for your region on ameli.fr. But hospitals, surgeons, anaesthetists, etc. may all charge a higher amount and any refund will only be based on the standard tariff.

This page indicates 77.3% of hip operations were charged at more than the standard tariff with an average being 113% and a maximum of 300% (from 2016).

This page gives an indication of costs for one establishment: (Base remboursable 489€ à 732€, le complément

est à la charge du patient ou de sa mutuelle de 400 à 1000€ selon prise

en charge)

You will get a more realistic idea of costs by identifying where you want the operation to be done (hospital/private clinic, etc) and then get the surgeon of your choice to give you an indication of the hospital room, surgery/anaesthetist, after-care charges together with the corresponding Ameli refunds.

Link to comment
Share on other sites

Thanks for the replies.

I had a replacement done in France a few years back before we were resident, but that was paid for in its entirety by the NHS under the Article 56 provision.

Much cheaper than the cost of the op in the UK and one less person on the NHS waiting list. A very convenient arrangement for everyone.

I am now anticipating the other hip may need to be done somewhere down the line and looking for what might be the most cost effective option.
Link to comment
Share on other sites

I am still trying to work out how much I paid myself for my hip op last year, but as I took out a top up mutuelle entirely for that reason, its not entirely easy.  It wasn't a huge amount. My surgeon (I would highly recommend him to anyone in this region, and he speaks English pretty fluently, I'm sure he worked in the States, but it all went perfectlyt as planned ..), is certainly sector 2, but as far as I can see all the op costs were covered ... but I am not sure whether that was the state / CPAM / CV or whether it was the mutuelle.  But I suspect it was the CV. The mutuelle covered the surgeon's "extra" fee. Transport was certainly covered, plus the clinic after and the kine at home.  Only had to pay for the extra bed bit for the hospital and clinic, single room choice, and something else small but I cannot now remember what.  Maybe not what you wanted to hear, but certainly no reason why the CV would not cover the 65-70% as usual ...

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

×
×
  • Create New...