Jump to content

Mutuelle Reimboursements

Rob Roy

Recommended Posts

I'm going into hospital for a total knee replacement in November. I've already seen the Specialist at the Clinic and had x-rays taken. I've also had 6 sessions with a physiotherapist for pre-op exercises, visited the dentist to ensure I have no tooth infections and have appointments with the cardiologist and anaesthetist next Tuesday.

We have a mutuelle with 300% cover for hospital care but I don't quite understand when and how I inform the Clinic of this and how I get reimbursement for the physio sessions and the initial payments to the Specialist and for the x-rays. Can anyone advise please?

Link to comment
Share on other sites

You should have a pre-admission form to fill in with the details of both your Carte Vitale and your Mutuelle which you take to the clinic before you are admitted (when you go in for the appointment with the anaesthetist for example. That gives them all they need to know.

The specialist should have given you a prescription for the various check-ups and the Physio and when you presented the prescription the other health professionals  should have asked for the Carte Vitale and the Mutuelle. Once they have those and the prescription the re-reimbursement is automatic provided you have  the link between the Assurance Maladie and the Mutuelle.

The AM sends the details through to the Mutualle for them to pay the top up after they have paid their part.

I'm not quite sure why you had to pay,  for the ' physio sessions and the initial payments to the Specialist and for the x-rays' unless you were just paying the part that will later be reimbursed.

One other  thing to check is whether your Mutuelle pays the 18€ a day charge direct or whether you have to pay it in advance and claim it back.(Similarly if you have asked for a single room)

In any case be sure to ask for a "Bulletin de Situation" when you check out

Link to comment
Share on other sites

Thanks Norman for your reply. I don't think I have got a pre-admission form, but will check my paperwork again.

I got prescriptions for the physio for pre-op sessions and for items from the pharmacy - compression bandages (can't wait for those!), elbow crutches and splint for the knee with freezer gel inserts, had to pay an additional 22€ for all that. The Specialist's secretary made the appointments for the cardiologist and the anaethetist (on the same day, next Tuesday), and I had to arrange to see the dentist which cost me the usual 23€ fee, so I'm not that bothered about that.

The physio said she normally invoices me for payment that I can then send to the Mutuelle; she will also be coming to see me when I get home. No one asked me for any information about my Mutuelle when I had my consultation with the Specialist and the x-rays, so that is why I was asked to pay them. I then sent these to the Mutuelle who said they would be reimbursing me automatically when they get notification from the Carte Vitale.

This is the first time I will be entering hospital in France so I'm just trying to make sure I do the right thing!
Link to comment
Share on other sites

Good luck. I have always had excellent treatment and the last time I met some extraordinarily kind staff.

The problem is that each clinic or Hospital has it's own admin procedures, so it is hard to advise, but normally they ask you to fill in a list of your details before you are admitted. If not they might take them on the day.

You migt find that they will ask for a chèque de caution which they don't cash as a deposit against the room and the daily 18€ charge.

You will probably have to pay if you want TV in the room, or a telephone to call out and there may be a Wifi code.

Don't be afraid to ask for more information since many of us have spent time in hospitals here ..

Link to comment
Share on other sites

Thank you Mint, that's very kind of you. Once I've recovered from this op I'll be having the other knee done, the specialist mentioned 3 months later, but the phsyio was slightly horrified by such a short time frame regarding my recovery! Hopefully by next summer I will be pain free (can't remember what that's like!) and fully mobile again. :)

Norman, many thanks again for all your helpful advice. I'll update this thread when I find out more as it might help others.
Link to comment
Share on other sites

Just a quick update - I saw the cardiologist on Tuesday then had to see the anaesthetist; when I arrived at the desk for the second appointment the receptionist asked if I had done my pre-admission registration - 'No' - please go back downstairs, take a ticket and wait your turn, did that and that was when I gave my Mutuelle information, was asked whether I wanted a single or double room, TV, given the Clinic information booklet etc. Back up to the anaesthetist, had appointment and all is now in place for 26th November. I have to say I've been very impressed so far with the system.
Link to comment
Share on other sites

Good it's all going according to plan[:D]

Best of luck for November

Here's a copy of the list of some simple hospital vocabulary that I posted a while back but has disappeared.

You probably don't need it but it might help someone

After recent stays in hospital, and a

number of pms from people here who have had contacts with health

professionals in France I thought it might ba a good idea to post a

basic list of vocabulary that I found useful, and invite everybody to

add their own, as we have diffent experiences

I am not trying to make a comprehensive

list of medical terms.

There are sites that so that better

than I could.

My idea is  to

observe the terms and phrases heard everyday which might not be

obvious, and translate them.

I have left out the most obvious things

like 'douche' which I imagine most people know

So in no particular order: (just a

start, please feel free to add)

Haricot ' areeco' (kidney bowl, for

being sick)

Bassine (plastic bowl)

Bassine du lit (bedpan)

pistolet (plastic urinal for men in


Pansement (dressing)

sparadrap 'sparadra' (sticking plaster)

plaie (wound)

les points 'pwan' (stitches)

le poing 'pwan or pwang' serrez le

poing  (fist, as in make a fist when having a blood test)

perfusion ( a drip, as in the arm)

une protection/absorbex (absorbent


potence 'the arm over the bed which you

can hold onto)

bocal (a sort of jar to collect fluids

or waste, often to be measured)

couche (a nappy )

Penilex ( a way of helping urinary

incontinence in men with something like a condom with a tube to drain

away the urine )

tension (blood pressure)

prise de sang (blood test)

globules rouges/blancs (white or red

blood cells)

service (ward, as in service de

chirugie, a surgical ward)

surveillante (the ward supervisor-

Sister? )

de garde (on duty, usually a Doctor

covering at weekends stc)

radio ( Xray)

IRM 'ee er em ' (a MRI scan)

sonde (a catheter)  although

catheter (pronounced catetere also exists as in.....

pac  ' porte à catheter' a semi

permanent catherter in the upper chest or neck for chemotherapy

poche ( a bag, for example part of a


fauteuil (armchair/wheelchair)

compress (swab)

brancard /brancardier (stretcher, and


added from suggestions below thanks

douleur (pain)

Ce pansement est trop serré  - This bandage is too


Douleur aigue  - Sharp pain

à jeun nil

by mouth

 avoir des démangeaisons

(itching) ça gratte 'sa grat' (it itches)

des boutons (spots)

calmant - a painkilling drug

une piqûre" = 

an injection  

but also (a sting as

from an insect)

"faire une piqure",

or "piquer" = to give an injection =.

"faire une prise de

sang" = to take blood.

Je pique (said by the

nurse as she puts the needle in)


= day patient. Usually for a procedure where you are in and out the

same day.

"aller à la

selle" =  to go to the toilet (number


les selles (stools)

Link to comment
Share on other sites

  • 1 month later...
It's now been over three weeks since my knee replacement surgery (four weeks on Christmas Eve) and I've been very impressed with the care I've received. The Clinic in Brive was excellent, very clean, food tasted good and was hot (even if not always very inspiring to look at!) and the nurses kind and helpful and always checking I was not in any pain. I saw the consultant a couple of times during my five day stay, but the physio came every morning to put me through my paces, walking and doing stairs.

Since leaving hospital I've seen a district nurse every day for heparin injections, to prevent blood clots and blood taken every five days to check platelets. As I went and stayed with friends for ten days post-hospital and she is a physiotherapist I didn't see the local physio although I was given a prescription for treatment with one if I'd needed it.

Before we left the hospital I had to 'check-out' and pay my bill, which came to 520€ and was given a receipted invoice to send to my Mutuelle - still waiting for that to be paid! It amused me that there was a 1.5 lt bottle of water on my bedside table when I arrived at the hospital, for which they charged me - what's wrong with tap water?

Now walking without elbow crutches at home, but using one when outside on the uneven ground. I'm due for a follow up appointment on the 4th January with the consultant, after first having x-rays done, so all in all a positive experience.

I forgot to mention I had to pay the district nurses who came to my friends' house 220€ when I left, and will also need to pay the nurse visiting me here at home once she finishes the daily injections (next week). I'm not sure how people manage to pay these bills, or what happens, if they don't have the money available.
Link to comment
Share on other sites

If people are strapped for cash, well, I would imagine that people do what they have always done, and handed over a cheque which would get cashed in a few weeks time, giving the reimbursement chance to get through.

The problem is the depassement d'honoraires these days, which can be hefty and not always reimbursed by the mutuelles. That I'm sure would be difficult for many.

Re the water, not all tap water is potable in France. Ours was in our village, and yet I knew a LOT of people who only drank bottled water.

Not sure if the mutuelle would reimburse for water, curious to know if they do.

Link to comment
Share on other sites

Surely the nurse takes your carte vitale?

That's what happens for me. The Sécu pays its part and passes on the rest(if any) to the Mutuelle.

I have never had to pay the nurse directly in 20 years.

I am also surprised that your Mutuelle didn't pay the hospital bill directly.

Mine does, but for that I have to make sure they have had the fax from the clinic before to ask them to agree, as I outlined earlier.

Glad to hear it is over and that it was by and large a positive experience.

Link to comment
Share on other sites

Rob Roy - do you have a Carte Vitale? Or maybe you only have a european health card?

In my experience your CV should cover an operation like yours, nothing else to pay.

I had a hip replacement with only CV cover, no mutuelle, and didn't pay anything.

But as others say, different hospitals have different rules.

Link to comment
Share on other sites

NH, bear in mind we left nearly 8 years ago, but in 2008 one of our GP's still would not accept a carte vitale.

In 2005 or 2006 my husband had surgery and the nurse wanted a cheque and issued a form, cannot remember the colour of it, but we had to send it in to the CPAM and by that point the CPAM was passing everything directly on to the mutuelle.

I know it was this time of year, as she came round twice on xmas day.

Link to comment
Share on other sites

Last year I underwent surgery for a triple heart bypass (triple pontage cardiaque). Prior to the major surgery my local cardiologist refered me to the clinic where for two days I was examined by umpteen different 'ologists' and underwent exploritory surgery to determine if it was at all possible to fit a stent (une intervention coronarienne percutanée).

They decided I would need the full bypass job.  I was then referred up the chain again, so to speak, to a cardio specialist
of our region who was concerned about performing surgery as my carotid arteries (artères carotides) don't function as they should. This resulted in a further referral to the regional cardiologist who ultimately gave the go ahead.

Following the surgery and a week in hospital I was transferred back the clinic for three days and then to a residential re-education centre for three weeks.

During all these procedures there were numerous ambulance taxi journeys taken.

My local medicin attested me at 100% for Assurance Maladie purposes. So should paying upfront for any of these procedures be an issue here? You'd think not. However every appointment I have undertaken with the local cardiologist, 5 so far and I will need to see him every 6 months indefinitely, have resulted in me having to write a cheque (cards not accepted - credit that is). This is subsequently refunded by CPAM. The odds and sods that CPAM seem to retain (which to my mind makes it 99.99%) are picked up by my mutuelle.

If you have not already opened an online account with Assurance Maladie you can here.

With an online account you can interogate your repayment schedule with ease at any time and research all your other health entitlements.

Best of luck throughout your recuperation period and future surgical procedures.

regards & seasons greetings


Link to comment
Share on other sites

Following an operation I had daily visits from the nurse and I received a bill from them on their last visit. Apparently it is their practise here to suggest writing a cheque dated 2 weeks in advance so that the reimbursement by the mutuelle should be settled before the cheque is presented.

Link to comment
Share on other sites

Well, some interesting points here.

Yes, I do have a Carte Vitale which had to be presented at every opportunity (as you do!); of the two nurses who visited me during my stay with friends one took the CV details (they have a smart little mobile machine no bigger than a phone these days that reads it), the other nurse hadn't asked for it so I got given a form for her attendances to send to CPAM for repayment (brown, like those from chemist or GP), which was duly sent off.

Since writing the last message my Mutuelle have paid the money into my account that I paid at the hospital the day I left. I have yet to see anything regarding the nurses payments, and presume I'll have another cheque to write next Tuesday when I finally finish the heparin injections (thank goodness!). CPAM have paid some small amounts into my account but I must access my account on- line to see to what they refer - not that I ever find the CPAM statements easy to figure out and I have forgotten my password, so will have to ask for another!

The hospital in Brive were dealing with people as they left, it seems to be normal in this area to ask for payment before the patient leaves then give a receipt to send to the Mutuelle; goodness knows why they can't send it direct to the insurance company themselves as they already have the details when you are admitted.

I'm having the other knee done in the Spring, better start saving up now!

Happy Christmas to you all, Peace and Good Health for 2016.
Link to comment
Share on other sites

Glad you got your money back Rob Roy - it just goes to show how these things vary between depts., and between hospitals.

I read an article this year sometime which pointed out that each hospital runs its own finances, so their charges vary according to their budget, and it doesn't make sense to compare one with another.

Maybe ask in advance to see the hospital social worker to find out whether the same thing is likely to happen again. This is what I did before my hip op. but she didn't know the answer ! As it happened, I didn't have to pay anything and that was without a mutuelle.

Difficult for us from the UK to understand, as we're used to such a different system.

Link to comment
Share on other sites

Rob Roy, I'm surprised you mention getting a brown form (feuille de soins) from nurses, chemist and your GP.

I haven't been given one of these for years, except by a stand-in doctor when mine was on holiday, or if I have visited a doctor away from home with whom I am not registered. I assume you are registered with your GP.

Our registered doctors, and all nurses and pharmacies around here have a card reading machine which passes the information directly to the Assurance Maladie, who pay our refunds directly into our bank.

Also, does your mutuelle provide hospital cover only, or are you covered for all expenditure?

We are changing to a full cover for next year, with a different company, but until now had cover for hospital in-patient care only, and the company we used defined this as care when occupying a hospital bed.

This meant that they did not refund expenses incurred before actual admission into the hospital.

In taking full cover we have reduced our hospital cover from 300% to 100%.

Our local hospital does not charge more than the conventional tariff for any services, although some specialists working there may do so, but that is a risk we are prepared to take, intending always to ask first!

Anyway, I wish you a successful and speedy recovery and all the best for Chrismas and New Year.

Link to comment
Share on other sites

I only had the feuille de soins (couldn't remember the name) as one of the nurses who visited hadn't taken details of my Carte Vitale; I haven't had one from GP or Pharmacy for some time.

We have 300% hospital cover, plus other expenditure (kine, pharmacy etc) but not much for dental or optical.

I've had a look this afternoon at my 'Amelie' account (CPAM) and it was interesting to see how much they have paid out for my procedure, hospital stay, x-rays etc., etc. I've said for many years that NHS patients should be presented with an itemised bill every time they attend hospital, not to be paid but to show them how much the treatment actually costs; I think a lot of people would get quite a shock and maybe think twice before taking it all for granted.
Link to comment
Share on other sites

Nomoss, I was very interested to hear you say that you are extending your cover.

We have always had cover for doctors, pharmacy, hosp, etc.  Just had our mutuelle bill for next year and it's gone up quite a bit, I suspect because of our advancing age[:(]

Just as a bit of an exercise in looking at costs, last year the cost of our mutuelle less the cost of our regular médicaments was just over 1000 euros.  I was thinking of asking for a quote for hospital cover only, if only to see if we should, in following years be thinking of changing our cover.

Now you say that that covers you for when you are occupying a hospital bed only.  So, once you are in hospital (even as a day patient occupying a bed for the day), is everything such as blood test, anaesthetist, drugs, etc paid for?  How about ambulances or cars to ferry you to hospital?

Chances are, having paid all these years and, until a couple of years ago, making hardly any claims, I won't be reducing the cover without heart-searching (plus number-crunching!)

I'm just curious as to what cover we can expect if we do change.  We also live in an area where most doctors are conventionnés though increasingly many charge dépassements honoraires which nobody reimburses you for anyway.

RR, OH has used a hospital in the "public" sector and also a clinique in the private.  Didn't have to pay anything in advance in the former case but do need to pay at the point of use in the latter.  No faffing about with the feuilles des soins, however, they do sort it all out themselves but certainly paying up front.

Link to comment
Share on other sites

Mint. As I said, up to now we have had cover only for

hospitalisation, up to 300%, which for 2015 cost €761.19 each, with Exclusive

Health Care.

Last year my wife had 2 falls (resulting in a broken ankle and a

broken rib), which did not involve any hospitalisation, simply treatment as an

outpatient, so our hospitalisation cover did not apply.

Our total health cost for the year, for the mutuelle, plus

the sums we paid out which were not reimbursed by the Assurance Maladie,

amounted to €2,413.

If we had taken a policy for 100% full cover, this would have

cost €2,335, so we would have been slightly better off, and my wife might have

continued her physiotherapy, and kept her wheelchair, a bit longer, so we

decided to take out complete cover for 100% in future.

This would have cost €2,406 with the existing company, and

although I managed to negotiate a small discount, I found the same cover with

another company, SOFICA’s, for €1,800.

This company also reimburses costs for emergency treatment

in those EU countries where, similarly to France, only part of the cost is

covered by the national system when the EHIC/CEAM is used.

The previous company will only reimburse costs incurred in

other EU countries if a French CEAM is used, not our UK-issued EHIC, as they

consider that an EHIC is not the same as a CEAM.

Regarding your question about what is covered, you will have

to check your policy for that, but usually all charges incurred while actually

in the hospital are covered, within the limits set out.

Link to comment
Share on other sites

Thank you, nomoss, for your comprehensive answer.

As I said, I was only comparing figures and certainly won't change for next year as I am a bit of a belt-and-braces person and this will need some thinking over and discussion.

OH is also reviewing his fitness for driving (no special reason to do that apart from growing older) and, if we do get rid of one of the cars, I daresay we will keep the full cover as we have now.

If only one knew how long one has to make the little cache last![:)]

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

  • Create New...