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Claiming Transportation Costs From a Mutuelle


Grecian
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I wonder if anybody can help me, I am seeking information as to how the transportation element of a mutuelle works please. As some of you may well be aware I may be having an operation in Bordeaux which is about 245 kms from where I live, the distance limit for the ambulance taxis is 150 kms from where you live. My mutuelle policy says that I have 100% cover for Transport du malade, can anybody explain to me as to what this may mean please. Does it mean that I will be reimbursed for all my travel expenses incurred with my treatment, even if I make the journey by taxi, and if so what sort of proof will I need to make a claim. Sorry to sound a bit dense here, but it is something that I have never experienced before possibly making a claim with my mutuelle, usually all refunds are paid into our bank account automatically.

Also does anybody know if I approached the ambulance taxis could I have the first 150 kms paid for by CPAM, and then I pay the extra mileage myself.

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It looks to me as though at least 65% will be covered by Assurance Maladie itself rather than the complementaire, as long as you jump through all the right hoops.

As for the complementaire that would be down to the terms and conditions of your particular policy

http://mutuelle.fr/infos/securite-sociale/remboursement-reste-a-charge/frais-de-transport/

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I would ask your GP, or the tranport people as they are the ones who want to be paid.

In any case as BJSLIV's link says

Certains transports, même prescrits par votre médecin, doivent

bénéficier de l’accord préalable du service médical de l’Assurance

Maladie   

-Transports de longue distance (plus de 150 km aller)

That means that it will be paid BUT you need to ask l’Assurance

Maladie  
before the trip.

Normally any 'extra' will go through to the Mutualle automatically, but again you could fax or email a note for an

l’accord préalable   (prior agreement)

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Thank you both for your replies, that makes the whole thing a lot clearer.

It certainly seems that I should be entitled to 65% back from CPAM and the rest from my mutuelle, but obviously I must obtain some sort of letter from either my GP or the surgeon's secretary in Bressuire. It was the surgeon's secretary in Bressuire that flagged up the 150 kms limit, but never offered any documentation for claiming back the 65%. As per Norman's advice we e-mailed CPAM yesterday afternoon telling them of my upcoming visit on Tuesday and asked them what I need to obtain for any future visits. Not sure if it will be too late to claim anything back for Tuesday's visit, but if there are to be any further visits, it would be nice to be able to use the VSLs and save a lot of hassle. Not sure how I would be expected to get home after any operation that may transpire in Bordeaux without the VSLs.

I will try and go into the VSL office in Bressuire next week and have a word with them, I am afraid telephoning is a non starter even for my wife, with a fairly complicated scenario to present to them. Not quite sure when we will manage to get in, off to Bordeaux lunchtime Monday, and return Wednesday evening, then off to Poitiers Thursday lunchtime to see the oncologist. I looked at my own mutuelle website yesterday, but could not find anything on the website relating to payments for transport costs, I then tried to log into my personal account, and I do not think I have ever tried this before, so went to set up an account, was unable to proceed online as the e-mail address showing was my old orange one, and I could not find anywhere to change it, so I had to request a password to be sent to me via la poste.

Thanks for the advice, things are now a lot clearer, but still throw up problems in obtaining the relevant paperwork, at least I know what I have to do now.

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Well haven't got very far in arranging transport, visited the secretary at Bressuire hospital this morning who gave us two bonne de transport for my upcoming visits and hospital stay in Bordeaux, we handed these into the VSL office, he informed us as to what time the taxi would pick me up for next week, everything seemed fine. We then received a phone call at lunchtime from Bressuire hospital informing us that we could not use the taxi for my trips to Bordeaux, and then the secretary started having a go at my wife, who could not fully understand as to what she was saying. I telephoned the CSF lady who telephoned Bressuire, she said they were prepared to pay for a taxi to Poitiers but not Bordeaux, brilliant thanks a lot. The CSF lady then suggested that my wife telephone Bordeaux and ask for the paperwork from them, not sure why but this secretary then launched into my wife, and reduced her to tears. Whilst all this was going on I was in a taxi going to Poitiers to see my oncologist.

I find it totally unacceptable that they are not prepared to supply a taxi for me to my operation and return me home afterwards, especially as movement will be very painful I guess. I certainly could not drive myself and my wife surrendered her licence over 20 years ago. So I have decided to pay for the taxis myself, a bloody awful lot of money but I am fed up with all the stress this situation has brought, especially for my wife whose health is not very good at the moment.

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I don't quite understand why the Bresuire hospital is involved in the transport to Bordeaux, except in that the Bressuire consultant will have prescribed the visit.

It is for the  CPAM to give permission (which has to be asked for in advance) and the bon de transport would come from Bordeaux.

I'd go into

Caisse primaire d'assurance maladie (CPAM) des Deux-Sèvres - accueil de Bressuire

3 boulevard Alexandre-1er

79300 Bressuire

Du Lundi au Jeudi : de 09h00 à 12h00 et de 13h30 à 16h00

and make a fuss..

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Well this is turning into a nightmare, I phoned the CSF lady this morning who very kindly telephoned Bordeaux for us, the CSF lady agreed that the secretary was a bit sharp, she told the CSF lady to tell us to ask the anesthetist on Thursday for a bonne de transport, but she does not think he/she will give us one. The CSF lady then said that she was concerned for me on the return journey from Bordeaux after my operation.

We went into the VSL office in Bressuire this morning who did not know that the taxi had not been granted, he suggested that we see our own doctor, which we tried to do this morning, but he is on holiday. The guy in the VSL office said that our own doctor can issue a Demande d'entente préable, we must then take the form if granted to Niort some 35 miles away on Monday, as time is very short and see if they will grant the transport, then return and ask our own doctor for the bonne de transport. What a ****** situation, trying to get geared up for a major operation, and now I am being shunted from pillar to post trying to arrange transport. If nothing else it is essential for an ambulance taxi after my operation, as if it is major surgery then I will probably have to be laid out in an ambulance to come home.

I am now of the opinion to pay for all transport whatever it costs, and just get the French bureaucracy off my back, totally fed up with the whole scenario.

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If you were a bit less honest you wouldn't have told the firm, just let them take you and then try to get the money back.

Are you sure that the Bressuire office in my link above can't deal with the form? They have contact with Niort for F sake..

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[quote user="NormanH"]just let them take you and then try to get the money back.

[/quote]

Good advice for next time Norman [;-)]

I wish we'd done that when we had a big ambulance transport bill, which we dutifully paid in installments.

Grecian - I hope your operation goes successfully, that's the main thing.

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Well Norman you are right that the Bressuire CPAM is the place to go. We went back to Bressuire hospital this afternoon and saw the nice little girl who gave us the bon de transport originally. She told us that she was sorry but it must be Bordeaux that needs to issue the bon de transport, not Bressuire as you rightly posted. We told her that we appreciated that but could she not issue us with a Demande d'entente préalable, to which she again said no, at least so we could approach CPAM to see if they will sanction the journeys. She advised to go to the CPAM office in Bressuire and explain the situation, and that time is short to get the journeys sanctioned. We will be going in first thing Monday morning to try and sort something out.

I know it was our fault for not asking for the relevant paperwork at Bordeaux, but having taken in the whole operation scenario that had just been explained to us, and then being given my date for the operation, not to mention that my wife was having a hypo at the end of the consultation so I needed to give a sugary drink into her as quickly as possible, as the jelly sweets she carries with her were not bringing round, somewhat threw me off the subject of transportation.

Going back to the original consultation I had with the surgeon at Bressuire a couple of weeks ago where he told me that he had arranged a consultation with the surgeon at Bordeaux, we did ask for a bon de transport then, it was a different girl on the desk who told us that it was not possible as the journey is over 150km, so we assumed that we would have to pay for any transport ourselves. It was not until I posted this thread asking about the situation that BJSILV and Norman flagged up that it is possible to claim some of the journey cost back, and hopefully have the rest reimbursed by my mutuelle. So not knowing anything about the Demande d'entente préalable at the time and with the female not forthcoming with any information on the subject we were somewhat thrown at the time. It seems like with everything else in France if you don't ask you don't get.

Trying to keep calm now until Monday and hopefully we can sort something out at the CPAM office in Bressuire. I must  to be psychic in the future and book any transport needed over 150kms before the illness strikes!

Pat sorry to hear of your transport disaster, as Norman said best not to be honest!

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Good luck for Monday.

As I said on the other thread this is something the aide sociale at Bordeaux could have helped with, but most Brits don't like to bother them, feeling somehow that they are for other people, even only for poor people, when ih fact they are there to arrange things like transport, form filling, getting a place in a convalescent home if needed, and in your case helping with your wife's care...

I also appreciate that you haven't had much contact with that hospital yet...but don't be afraid to ask to see an aide sociale and ask for one who speaks English.

In my specialist unit there are specific provisions for other languages and Bordeaux is a major city with a large anglophone population..

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We went to see our own doctor this morning, well we saw him eventually, Monday morning is open house and we had to wait 2 and quarter hours in the tiny six seater waiting room, with a dozen people waiting when we got there. He gave us a Demande d'accord préalable, I asked him if I should take it into the Bressuire office, but he told me to send it off to Niort. I am not very confident of the taxi for Thursday will be paid for as I am sure they will say it is too close to the date when they receive the form tomorrow. I should have driven down to Niort and handed it in personally, but with having now spent 3 days trying to get this poxy form, I just could not face it. I will be really annoyed if they do not pay for the taxis for my operation journeys, as I have to be at the hospital in Bordeaux on Monday at 8.30am, so I guess higher rates will prevail when the driver picks me up at 5.30am. I know I will certainly be asking the hospital at Bordeaux for a préalable for any further appointments that they give me.

We went back into Bressuire this afternoon to see the owner in the VSL office, he was very annoyed that Bressuire hospital did not issue me with a préalable, and equally annoyed when Bordeaux also refused after being contacted by my wife. I know everybody is tightening the rules when it comes to the state paying for anything now, but when CPAM lay out the criteria on their own website saying that journeys over 150kms are refundable at 65%, but require notice in advance, I would hope that they will take it into account that sometimes it is not possible to obtain the Demande d'accord préalable form in advance for the notice they require. Guess I better dream on as this is French bureaucracy in action!

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You shouldn't have to worry about all this. You have enough  on your plate already.  Many people here in France  would whinge and moan at an aide sociale until all was sorted out for them.

I have a lodger who has amassed nearly 2000€ in parking fines and other driving offences and sure enough she went to see  her assistante who phoned up and wrote a letter to get the fines crushed as she has a very low income....

I had one other nasty thought. Each time I have been in a Hospital or Clinic it was very much assumed that I had family around to take care of such things as doing my laundry or getting me things I needed.

When I came out it was equally assumed that there would be someone at home to care for me hand and foot (it was only after I really insisted the opposite that I got a place in a convalescent home)

Now you are married, and forgive me if  am wrong but I have the impression that it is more you look after your wife that the other way round.

Make absolutely certain that they know that and don't send you home expecting you wife to cope with your first few days at home without help. 

I would get an appointment with the hospital aide sociale to explain this on one of your prlimenary visits.

You have seen bureaucracy in its awful inaction, but  French systems come badly with unusual cases such as yours: a married person whose partner needs as much if not more care than the patient.

You have to insist..

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Grecian, please get onto the assistante sociale, that is what they are there for, to help.

In everyday living things like paperwork can be terrible, but as I said days ago, you need to get extra help, and it is there, it won't come to you, you have to ask for it. Especially, as by all accounts you are a carer who is currently very ill.

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Well, the plot thickens...

I asked the lady from CSF if she would telephone Niort this afternoon to see if they had received my Demande d'accord préalable, but she was informed that the post is not processed until 4pm, so no joy there.

However my wife plucked up the courage to telephone the secretary at Bordeaux, as we should have received a letter containing paperwork from the hospital that she told my wife last Thursday we would receive, in between shouting at my wife and telling her to drive down for my appointment. Well the letter has not shown up, but we noticed that the barcode sheet that was generated has the wrong name of our route on it, everything is fine, we were concerned that there may have been some prescriptions in the letter that I needed to get made up. The secretary told my wife that the letter had been sent, and there would be no prescriptions in it, but there are two bon de transport for my forthcoming appointments. I give up, one minute she is saying no you can't have them, now supposedly they are winging their way to us. Just got to hope now that the letter shows up, or I guess we will have to ask for duplicates on Thursday, that should go down well!

Norman and Idun, will ask to see the aide social when I am in hospital, many thanks for that.

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Good luck Grecian.

I do hope the aide social can help you. I saw one here on Monday re my transport problems and she promised to contact my caisse to find out why they are not paying for me.Have not heard yet but I am going to ring her tomorrow to get an update.

Do hope all goes well for your op and please take the advice to ask for help. Sometimes it seems not very forthcoming but usually it can be sorted.
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Thanks Bertiebe, I know now that if you don't ask you don't get in France, as you say I am sure the help is out there but I have found it never forthcoming, very frustrating.

My own situation took another twist today, we received a letter from Bordeaux this morning expecting to find our transport papers inside, unfortunately it was only the extra appointment that they have tagged onto my visit tomorrow to see the stoma nurse. Maybe the magic pieces of paper we are expecting will come in another letter. However my CSF lady has been in action this morning, she telephoned CPAM at Niort for me asking if they had received my Demande d'entente préalable form, to which they replied 'non', and asked if my doctor had marked the form urgent, which unfortunately he did not. My CSF lady then telephoned my own doctor for me and explained the situation, my doctor told her that he would fax the form to them today, and told her to advise me not to pay for my taxi tomorrow, as he said he would sort it. He also told the CSF lady that there is no way that I should be driving there tomorrow. She then telephoned the VSL office and explained the situation, and they seemed to have accepted the situation as it stands for now. Obviously if nothing transpires from CPAM then I will face the bill myself. This situation has now been dragging on for about 2 weeks, and since last Thursday has totally consumed our time in trying to sort the problem out, something quite honestly at the moment I do not need.

So I hope your aide social is able to sort your own situation, as like mine yours has been dragging on for a long time as well.

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Grecian, I know it's easy for me to say things on here, sitting in my bedroom and with nothing worse wrong than a bad cough.

But, please do not lose sight of the wood for the trees.  It seems to me that you ARE getting the help with transport you need though I admit that, so far, it's not been very joined-up or coordinated.

Don't pay for the taxi tomorrow, go in as good spirits as you can muster to see the specialist because THAT is really the but , is it not?  You want a good outcome after all the visits, hassle, fear, worry, pain, patience etc and be restored to health.

If it does transpire that the CPAM won't pay, then as you yourself have said, you will settle the bill.  It's pas grande chose, if push comes to shove, who amongst us wouldn't stump up a taxi fare in order to access the specialist services that we require and that could save our lives?

Believe me, I understand totally your frustration and everything else.  It is BECAUSE you have such a serious health problem that you are worrying about inconsequentials.  We all do that, worry about a smaller thing to take the mind off bigger ones.

Bon courage, Grecian, you will get there.........and I don't mean just to Bordeaux!

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