Top-up, mutuelle - why?

[Benjamin]

Then they really are convinced that I am insane.

Of course we don't think that Chance [:P]

Now just go and sit in a quet room wit the curtains drawn and I'm sure you'll feel calmer later.  [:D]

[NormanH]

two extended stays in hospital with multiple operations and another

overnight stay for a booked coloscopy including medical transport there

and back I can tell you categorically that you would have to try very

hard or be very unfortunate to end up paying anything more than Pocket

money

We have discussed this before with all the rest, and the point is that you were very lucky to have come across a very incomptent accounting department (or a very socialist one) since that procedure is not reimbursed at 100% unless you are resgistered with a relevant  ALD. (These tarifs are publically available)

Good for you, but I don't think that you should advise others on the basis of the administrative incompetence you benefited from.

There has been considerable tightening up on these 'rogue' departments and Doctors as part of the cost-cutting campaign

A different example is one of my lodgers who had suspected lung cancer (later confirmed)

She had to pay the cost of transport to Perpignan in a taxi ambulance and the cost of the specialist scan because at that point the cancer had not yet been diagnosed.  It was only once she had the ALD accepted that her transport and treatment covered at 100%

This is the usual pattern as I have advised someone in another thread.

[idun]

Chancer, our mutuelle used to send us a statement of all the medical charges we had incurred, what the state picked up and what they paid. So there was not any smoke and mirrors for us, everything was dead straight and perfectly clear. And we did have some big bills picked up by our mutuelle.

You have always amazed me when you have had such small bills, I don't doubt you in any way about these, but believe me, I have seen the medical bills for all four of us, including visits to les urgences and we had nothing that I would consider small change and nothing to make me regret paying for a mutuelle.

[lindal1000]

This link takes you to the ameli page that tells you what percentage is reimbursed by the state.

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/releve-et-taux-de-remboursement/les-taux-de-remboursement.php

[Chancer]

[quote user="idun"]Chancer, our mutuelle used to send us a statement of all the medical charges we had incurred, what the state picked up and what they paid. So there was not any smoke and mirrors for us, everything was dead straight and perfectly clear. And we did have some big bills picked up by our mutuelle.

You have always amazed me when you have had such small bills, I don't doubt you in any way about these, but believe me, I have seen the medical bills for all four of us, including visits to les urgences and we had nothing that I would consider small change and nothing to make me regret paying for a mutuelle.


[/quote]

And I get the equivalent one from Ameli which shows the same bills either being paid 100% by assurance maladie or 70% and any factures of the 30% to me and my payments etc, also the remboursements that  get from when I pay the pharmacies 100% and claim back the 70% less one euro or whatever.I

Where I am charged by the hospital as detailed before, the out patients etc, initially I was charged 100% and then claimed back the 70% but now they bill me only the 30% (€6.60 for a consultation) and bill Assurance maladie directly for the 70%, like you I get to see all this on my statement.

I believe you 100% and I am sure that it is mutual, I Wonder whether as part of my conspiracy theory when there is a mutuelle, in cases where someone like me (without one) would be 100% prise en charge that they actually split the charge 70/30 and later repay the mutuelles in a discreet manner, I know it sound like I am fantasising but it would indeed perpetuate the myth and I think we all see that the current system is to the great benefit of the mutuelles and they are keen to retain the status quo. There are frightening sheets with all the hospital and ambulance tariffs printed on most doors and walls in les urgences, they alone are enough to convince people to get a mutuelle, they certainly scared the Wind out of me the first visit yet neither I nor assurance maladie ever got billed at anywhere near these tarifs, were they just there to scare or to be applied to those with the means to pay, the mutuelles etc? I really do wonder. The thing about it is everyone gets frightened to see a huge bill that but for their mutuelle they would have to have paid but where are these poor misguided people who did get stuck with paying them? The closest I get to it like most urban legends is someone that (claims to) knows someone else who did.

Norman, yes I recall you mentioning that before, all I know is I asked my medecin and he was fairly certain, but not 100%, I could not contemplate 30% of a surgical procedure so at the pre op consultation with the specialist I asked him severl times and he was unwavering in his conviction that it would be 100% prise en charge as it indeed was, maybe its was because I am deemed at high risk having lost my mother to bowel cancer when she was very young.

[idun]

[quote user="lindal1000"]This link takes you to the ameli page that tells you what percentage is reimbursed by the state.

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/releve-et-taux-de-remboursement/les-taux-de-remboursement.php[/quote]

Yes, I agree that these figures look 'good', but they are only based on the tarifs officiels and not the amount billed, because if some things are standard, others are not.

[idun]

Chancer, maybe the picards believe that they have their own interpretation of the rules[Www]......... after all the Alscace-Moselle people have their own special rules.

I'm not against conspiracy theories, but I have never thought of that before, or heard it even suggested by anyone.  I would have thought that I would have at some point or another. I shall be having a few interesting conversations with friends in France about this.

[lindal1000]

True but round this way almost everywhere charge the tariffs officiels. Except for the dentist doing my implant and bone graft..but then his fee would not be reimbursed by most mutuelles either. I am actually getting 40 or so euros reimbursed for the crown. If I had a mutuelle I would get back an additional 60 euros, but nothing close to the 1200 or so euros for the entire procedure.

I'm not necessarily against getting a top up and if I thought I would be better off in the long run I would and also if I didn't think I had some money behind me if I got an unexpected bill. In fact I remain open minded to the idea at some point in the future, but so far I haven't seen anything to convince me.

[NormanH]

I suppose I will have to repeat some of what has already been said since apparently people can't be bothered to use the search facility.

It is of course entirely a matter of personal choice, and I am not trying to persuade others to do as I do.

I have a Mutuelle because

1) I could never be sure of having spent enough years free of illness to build up a big enough 'pot' of money to pay a big bill. One can say that the 1500€ I pay each year would bring in 15000€ over ten years but who can say that my need will be at the end of the period and not at the beginning?

2) I know from considerable previous experience that I can't tolerate being in a double room and I can't relax if I am worried about money so it is important to me to have these things taken care of, so I pay a premium for them.

Even with a Mutuelle I had a bill of over 3500€ for my stay in a convalescent home after my operation, and the Mutuelle had picked up just a bit less  at the hospital (for single room 60€ and daily charge 18€ ) for over a month. Neither of these charges  is covered by the Sécu.

I chose a Mutuelle where one takes modules  of different levels for such things as Hospitalisation , Pharmacy Consultations, Dental, Optical etc. I have high levels of cover for some and low for dental and optical since neither of these is ever covered very well anyway.

[HugoK]

I am overwhelmed by the advice I have received from forum members and I would like to thank you all for sharing your experiences. It seems most people think having a mutuelle is a good idea and a few think otherwise. I will probably do it but I'm am still not absolutely sure I need to. I am 66, reasonably fit but joints are creaking and my over consumption of the local wine (Cote de Malepere) is probably not good for me. So, the issues are - which company to choose and what level of cover; difficult decisions.

[Chancer]

[quote user="idun"]

I'm not against conspiracy theories, but I have never thought of that before, or heard it even suggested by anyone.  I would have thought that I would have at some point or another. I shall be having a few interesting conversations with friends in France about this.
[/quote]

You wont have heard it because this insane delusional person has only just made it up [:D]

Or to paraphrase my mentor, the chairman of the group of companies I worked , an ex professional footballer back in the Bobby Charlton/Stanley matthews era when they were gentlemen,the wise of which went on to forge other careers, - "it must be true because I have only just made it up" [:D] 

[mint]

[quote user="HugoK"]I am overwhelmed by the advice I have received from forum members and I would like to thank you all for sharing your experiences. It seems most people think having a mutuelle is a good idea and a few think otherwise. I will probably do it but I'm am still not absolutely sure I need to. I am 66, reasonably fit but joints are creaking and my over consumption of the local wine (Cote de Malepere) is probably not good for me. So, the issues are - which company to choose and what level of cover; difficult decisions.

[/quote]

Well, whatever decision you make, it's now going to be an informed one, n'est ce pas?[:D]

Just to tell you one more petite histoire, my OH who, until last year, barely knew the name of his médicin traitant, has since managed to get on to the list of no fewer than four different specialists for four different maladies [:-))]

I can assure you that when he was in intensive care for a brief period last year, the very last thing I needed was to worry about what it would all cost us...............so there was the definitive reason why we needed our mutuelle.

[Patf]

Another piece of advice - Sorry!

If you decide to start a mutuelle there will be various different levels on offer, so make sure you know what level you want, and what it covers.

Not so easy when it's all in french.

I admit I'm not sure what ours covers.