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Going on about health care


idun
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 We do go on about health care on this board and so we should.

On french news last week, they said that some patients were being asked to pay up front for hospital treatment as the hospitals have huge debts where people have not paid. And when I say huge, I mean it, 120 million euros.

One person owed approx €30k (could have been €36k)for under a weeks hospital treatment, and they said that there had been nothing 'major' that needed doing.

So even if you are in the system, for most things they do not reimburse the full amount, so as far as I am concerned mutualists are essential.

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We've only had a mutuelle for a few years and before that had a couple of hefty bills which we paid off over a few months.

But I wouldn't be surprised if many people just "do without". Not everyone can afford a mutuelle.

I believe those who are really short of money can get everything covered by the CMU, topup as well.

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Many of the retired farmers this way don't have top up insurance. I think you're correct that people on very low incomes can either get CMU C, in which case everything is reimbursed and they don't pay anything upfront, or they can get help towards the cost of a top up. I think it's mainly the people that fall just outside the limit for help that don't have one. Our neighbours have suddenly found themselves both in need of a lot of hospital treatment , including rehabilitation, and they took out mutuelles just before. It's worth saying that the very large bills are usually run up in cliniques or hospitals that don't charge the conventionee fees. In these cases often the additional charges are not covered by top up, unless you have a very expensive one. Part of the deficit in relation to hospital budgets might be their poor accounting system, with people not being sent bills until 5 years after their treatment. In reality there can't be that many people owing 36000 euros as the vast majority of people have their CV and top up insurance.
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 The point being illustrated on french news, and on french web sites and in french papers about a week ago was that those running up the debts have been foreigners, however, it does not stop the bills being big, there were not special charges for les etrangers. The establishments cited were not private clinics, but state hospitals.

My 10 days cost over 7000€ and they did just about nothing to me during my stay, no surgery, just a couple of small tests. I was glad that we had the mutualist which covered it all.

So my point was, that no matter, bills can be huge bills very quickly and not having a mutualist is something I would not risk. And I would hope that the french would not entertain people moving to France and getting all their health care covered if they were too poor to pay up themselves. I hate the 'usage' in the UK of many things, and hope France has a bloody sight more sense.

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I think if you meet the criteria for legal residence in France and your income is low enough to qualify for CMU C you don't have to be a French citizen. Plenty of our non French neighbours qualify. However, when they do the assessment they do take into account whether you own your own home and whether you have savings, as they would for any French person.

France is subject to the same EU laws as the rest of Europe and so cannot refuse benefits to someone just because they are not French if they are an EU citizen. For example, as I have an ALD my health care is reimbursed at 100 %for anything related to that illness, as it would be for any French person. As long as I am legitimately in the French healthcare system there is no difference between me and a French person in that respect.

Were the people who owed money foreigners who lived here or foreigners who lived overseas? The latter I can believe as at the end of the day, if someone bug*ers off home after treatment then it's quite difficult to get your money. I'm not surprised they ask for payment up front. I have heard of this happening for visitors from UK using their EHICs while on holiday and then having difficulty getting the money back from CPAM. I have never heard of people with Carte Vitales having to pay up front for hospital care, although that is generally the practice for things such as out patients, blood tests and GP services.. you pay and then you get the reimbursement from your health caisse and/or insurance.
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What irritates me somewhat is that recently I had a test which cost 289 euros, so I had to give a cheque.

They gave me the brown form, even though they asked for my CV. The cheque has already been cashed and I know we will wait weeks for reimbursement from both CPAM and our mutuelle. Meanwhile covering that cost is heavy on the bank account.

Don't these hospitals realise that reimbursement is not particularly quick?
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I think they do Mogs, which is why they would rather you had to wait for it rather than them! It's why the GPs don't want to move to the system where the patient doesn't pay first. The pharmacists seem to manage it though. Whenever I get any medication I only pay the bit that isn't reimbursed and they get refunded the rest directly. As usual with these things there are regional differences. My caisse is RSI, but administered through mutuelles du soliel and I usually get the money back in days.
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Yes you're probably right Lindal, I did mention when handing over the cheque that I would wait weeks for reimbursement, the secretary agreed with me!

One thing though, normally when I give my CV (say to GP) and pay the 23 euros reimbursement is within a week. With this hospital why did they bother to take my CV and then give me a feuille de soins? Bit confused about that one.

Our mutuelle won't refund until CPAM have issued the statement, which of course will take weeks.
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A couple of years ago, after an operation, I had to have the nurse in daily for an injection. The bill at the end of the month was about 400 euros. Without my asking, what the nurses said to me was to post-date the cheque for 2 weeks and they would not present it until that time to allow reimbursement from CPAM/mutuelle. I thought that was really a kind thing to do.

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We always pay the Doc 23 euros for a consultation. We present our CV, which he puts in the computer and brings up our records. I understood that this is how it generally works in France. The Government want to change it to the system which you seem to have, but of course the CV itself will not give the Doctor the 23 euros.
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That is how it works in a lot of places and that is why the GP's do not want to be paid by the Secu, but by their patient, hence the problems that have been in the news recently. They get paid little enough, why on earth should they wait for their money.

It was always so for everyone in the past, but, if there was a big bill, then it was very usual for the dentist or who ever to ask for three cheques, or one to cash in several weeks time. The only problem was that the Secu sometimes took longer, and a worse problem would be was that they would not reimburse the amount one expected. Which would also affect the amount the mutualist would reimburse. Ah what fun!

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I don't know why we pay the gp even for ALD appointments I thought this was just standard procedure. At least we get the reimbursement quickly and after all it is only 23€.

Minnie some kind professionals do hold fire on presenting cheques quickly, I guess I was just unlucky this time.

Anyone remember the days around 12 years ago when you were reimbursed exactly what you paid? It's very confusing now
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[quote user="powerdesal"]Why do you have to pay the 23 Euros to your GP when you have given him your carte vitale ? We certainly don't. We never have and Mrs PD has to see the Quack at least every 3 months and has had to for years.[/quote]

My OH now does not have to pay his MT if the appointment is anything to do with those of his  problems which carry 100% ALD cover. If he goes to the Doc with, say, a sore throat then he pays the 23€ and is then reimbursed in the usual way.

Only in France ? [:)]

Sue

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[quote user="powerdesal"]Why do you have to pay the 23 Euros to your GP when you have given him your carte vitale ? We certainly don't. We never have and Mrs PD has to see the Quack at least every 3 months and has had to for years.[/quote]

 

4 reasons, one hinted at above.

1.  Unless you have an ADL, you will not get 23€ back.  So you have to pay up front and get payback from the caisse  (usually CPAM for us folk) and from your mutuelle equivalent to a total of 22€.  1€ goes direct to the doctor.

 

2.  Cash flow for the doctor.  You give them 23€ today.  It is in their account.  Later you get 22€ back from the caisse and mutuelle.   If it were done otherwise, the doctor would have to wait for a payment from CPAM and probably even later for a payment from the mutuelle.

 

3.  Some people might tell their doctor they have a mutuelle when they don't.  A mutuelle card or an attestation is a form of guarantee but is not an absolute guarantee.  Indeed even a CV may not be an absolute guarantee.  Situations can change and payment can be refused by the caisse. 

 

4.  Paying up front simplifies the position for the doctor.  They do not have to be accountants or debt collectors.  They have the money.  If there is a problem, the patient has to chase the caisse and mutuelle.  Otherwise the doctor would have to chase op bad payers, defaulters etc.

 

 

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Having given this some thought, there must be computer software able to deal with this. When we go to our pharmacy we just give our carte vitale and pay nothing. Every January the pharmacy copies our mutuelle renewal and that's it for the year. No problem....Maybe that's the way that some Doctors do it. Nevertheless, that way, they still have to wait for payment.
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My doctor told me that she would have to have separate contracts with more than a thousand mutuals in order to go cash/card - free. I'm not sure haw many there are, it was certainly more than a thousand a few years ago.

I guess pharmacies have some collective agreement while generalists are more independant.

Steve
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