Applying for ALD

[sueyh]

Last year I was found to be a carrier of the mutant BRCA2 gene, which increases my risk of breast, ovarian and other cancers.  I have therefore had my ovaries removed (last August) and am opting for preventative surgery for breast cancer (double mastectomy and immediate reconstruction).  This will lower my chances of breast cancer from 80% to about 2%. 

I have been advised by a French lady who also carries this gene that I need to apply for ALD.  Does anyone know what this entails and how I should go about it.

Many thanks in anticipation for your advice.

Sue

[Benjamin]

The first thing that you have to establish is if your condition is one of those which qualify as an ALD.

Your French GP is a good place to start as s/he will need to complete an application form if the condition qualifies.

[NormanH]

As Benjmin says you have to find out if your illness is on the list.

• Accident vasculaire cérébral invalidant
• Insuffisances médullaires et autres cytopénies chroniques
• Artériopathies chroniques avec manifestations ischémiques
• Bilharziose compliquée
• Insuffisance cardiaque grave, troubles du rythme graves, cardiopathies valvulaires graves, cardiopathies congénitales graves
• Maladies chroniques actives du foie et cirrhoses
• Déficit
  immunitaire primitif grave nécessitant un traitement prolongé,
  infection par le virus de l'immuno-déficience humaine (VIH)
• Diabète de type 1 et diabète de type 2
• Formes graves des affections neurologiques et musculaires (dont myopathie), épilepsie grave
• Hémoglobinopathies, hémolyses, chroniques constitutionnelles et acquises sévères
• Hémophilies et affections constitutionnelles de l'hémostase graves
• Maladie coronaire
• Insuffisance respiratoire chronique grave
• Maladie d'Alzheimer et autres démences** (voir ci-dessous « carte d'urgence maladie d'Alzheimer ou maladies apparentées »)
• Maladie de Parkinson
• Maladies métaboliques héréditaires nécessitant un traitement prolongé spécialisé
• Mucoviscidose
• Néphropathie chronique grave et syndrome néphrotique primitif
• Paraplégie
• Vascularites, lupus érythémateux systémique, sclérodermie systémique
• Polyarthrite rhumatoïde évolutive
• Affections psychiatriques de longue durée
• Rectocolite hémorragique et maladie de Crohn évolutives
• Sclérose en plaques
• Scoliose idiopathique structurale évolutive (dont l'angle est égal ou supérieur à 25 degrés) jusqu'à maturation rachidienne
• Spondylarthrite grave
• Suites de transplantation d'organe
• Tuberculose active, lèpre
• Tumeur maligne, affection maligne du tissu lymphatique ou hématopoïétique

I am no Doctor, but yours might come under

Maladies métaboliques héréditaires nécessitant un traitement prolongé spécialisé

If it is your GP has to write and apply for you to the 'médecin conseil'  Once it has been accepted, you are given an 'attestation' valid for 5 years.

There is also a document called a 'protocol de soins' which lists exactly what you have the ALD for.

ONLY that illness is eligible for 100% cover.

This should help you. Don't be afraid to ask if there is something in the French you haven't grasped, as it is quite complex ..

ww.ameli.fr/professionnels-de-sante/medecins/exercer-au-quotidien/les-affections-de-longue-duree/qu-est-ce-qu-une-affection-de-longue-duree/les-ald-exonerantes.php

[woolybanana]

Yep, basically you GP fills in the form which goes to the CPAM (you can take it yourself if it is convenient). It then goes before a medecin conseil who layout what is what, as has been said above. You will then get a letter telling you that it has been done. I was quoted a couple of weeks for this to happen. You then have to update your carte vitale at the local pharmacie, again so I was told, so that chemists and the like know what you are entitled to.

 

[sueyh]

Thank you all so much for the very concise information.

Sue

[Gardian]

Just to add that it'll take a month or so from when your GP sends off the form, for it to be approved.

It might be quicker, but don't hold your breath.  

[cooperlola]

[quote user="Gardian"]

Just to add that it'll take a month or so from when your GP sends off the form, for it to be approved.

It might be quicker, but don't hold your breath.  

[/quote]Note also Sue that it is retro-active so once you get it all costs from the date of diagnosis and initial treatments will get reimbursed so you need to keep your top-up insurer (if you have one) in the loop too.  Make sure the p de s (as per Norman's post) has the right date on it. This may also get you a discount on your premiums in the future (I think Sunday got one for his, iirc.)

[woolybanana]

Just an update on the ALD thingy: when I went to the doc about a fortnight ago he has the acceptance form on his desk. So he now gives me different coloured prescription forms.

The pharmacist updated the details on the carte vitale and handed over my diabetes meds free.

One thing I am not yet sure about is the status of the medical tests that the doctor orders every so often just to check out the status of the diabetes? Logically, as they are related to the ALD as well, they should also be fully reimbursed. We shall see what happens when next I have to have them done.

[Benjamin]

[quote user="woolybanana"]

One thing I am not yet sure about is the status of the medical tests that the doctor orders every so often just to check out the status of the diabetes?

[/quote]

Covered 100%. (save for the little deductions).

Money saving tip. Get your doc to prescribe a three month pack of pills (if available) rather than monthly ones. This way you only pay he same deduction (50cents?) per prescription item.

[papillon13]

Hello

My Dad needs to apply for ALD. He went to his medcin traitant to request that she complete a protocole de soins, but she wouldn't do it without a letter from his doctor in the UK (despite the fact that she knows he had a heart attack and other issues)

Is it absolutely necessary to get a letter from the GP in the UK, that will not only be extremely annoying but also costs about £50/£60!

His medcin traitant gave him a referral letter to see a dermatologist (he's had skin cancer in the past and may have another bout) Yet she won't do the request for the ALD?

Thanks.

[cooperlola]

I have never heard that one before, Papillon.  In fact, my experience has been that the docs here want to start afresh and aren't all that interested in what the UK medics have to say!

However, I do know that the possibility of a return of a cancer is not an ALD per se - only if they find anything, then you'll get 100% back.  My own ALD status only lasts four years from the diagnosis date, then the protocol de soins needs to be renewed, afaik.  It may therefore be that they want a confirmation of his cancer history before making a decision about that one. But this is all jut my own experiences and is off the top of my head; clearly different doctors have different ways of doing things.

[papillon13]

Hi thanks for getting back to me.

It seems a bit much to me too, kind of like she's trying to cover her back, despite the fact he has the scars to prove the Heart attack, skin cancer and a sac full of medication!

Even if we wait for the rediagnosis of skin cancer ( I hope it isn't) they should still do the protocole for his heart problems etc.

[5-element]

If your father has had a heart attack, then he should see a cardiologist here in France (with or without a letter from UK doctor). It does surprise me that your GP doesn't at least refer him to one.

However, you can still make an appointment for your father with a cardiologist, it is not strictly necessary (just cheaper) to do it without a GP's referral. All you have to do is to ring up a cardiologist, and say you want an appointment (not like in the UK where you MUST be referred by a GP!) The cardiologist should then be able to pick up the heart trouble, and the ALD can be sorted out in that way - have you actually ASKED the medecin traitant to give you a letter for a cardiologist appointment?

[papillon13]

Hi

Thanks for your reply.

No, no one asked for an appointment with the cardio. Also, I hope that there are cardios in secteur1!

Obviously Dad needs to be covered at 100% for his medication and for any consultations/treatment he has in connection with all of his pre existing conditions.

Dad only received his carte vitale very recently, surprisingly it was the UK pensions dept that held it up this time and not France! They said they sent the form, when they hadn't and then even denied receiving a request from him, so it was sent months later.

Dad has since received the ACS.

The only other thing he needs is the ALD.

[NormanH]

If you look back over the thread you will see that there is a sort of inexorable logic in the process.

1) You have a problem which might be one covered by an ALD.

2) You need to see a specialist and have it diagnosed. Up to this point you are not covered at 100%

Your French Doctor may be trying to avoid that by asking for the report from the UK Doctor..

Usually they won't take anything on trust from before.

3) Once the tests have been done etc your French GP has to apply on your behalf.

4) Once this has been agreed you are covered.

[papillon13]

Hi thanks for your reply.

So what you're saying is he has to see a specialist for each ALD. He can be referred to these specialists by the medcin traitant or he can get an appointment himself, but he won't be fully reimbursed if he goes direct.

OR

He pays 60quid to the GP in the UK.

Then the medcin traitant will agree to complete the protocole.

[NormanH]

[quote user="papillon13"]Hi thanks for your reply.

So what you're saying is he has to see a specialist for each ALD. He can be referred to these specialists by the medcin traitant or he can get an appointment himself, but he won't be fully reimbursed if he goes direct.

OR

He pays 60quid to the GP in the UK.

Then the medcin traitant will agree to complete the protocole.

[/quote]

I don't know about the second bit 'He pays 60quid to the GP in the UK.

Then the medcin traitant will agree to complete the protocole.'..

You would have to discuss that with his GP.

The first part is right in that the ALD has to be properly diagnosed, and as Cooperlola says it has to be current.

For example I have one that is nearly up for renewal, one that has still 3 years to run, and one that I had in the UK but has never been diagnosed here, so when my GP tried to add it to the list it wasn't accepted by the Médicin Conseil

Things have become much tighter in the last 3/4 years.

In any case his medicines (if prescribed by a French Doctor) would be reimbursed in part by the Assurance Maladie, and in part by his Mutuelle, so it is not as if he has to go without them..

If he hasn't got a Mutuelle either he would have to find the balance, or if he is VERY hard up there may be some help available and he needs to see an Aide Sociale

[5-element]

The médecin traitant is unlikely to process ALD registration unless the patient has consulted the specialist for that medical condition. Anyway the specialist himself/herself can do the ALD registration for the ailment that concerns him/her...

Cardiologists can be found just by looking in the yellow pages directory under "Médecins- cardiologie"...unless you get a personal recommendation for a specific cardiologist...

If I had a heart condition, I would want to be sure to be monitored by a local cardiologist in the area where I live, whatever it takes...

[idun]

I wouldn't bother with the UK GP's letter.

 

Surely he has a mutualist? Depending on which he has, they will pick up the rest or most of the bill that the secu doesn't, until the ALD's have been agreed, or not.

[papillon13]

Thanks everyone for your answers!

He now has a carte vitale and a mutuelle, so I will tell him not to bother with the UK GP and to get referrals to the relevant specialists.

Dad speaks fluent French, but he's retired, he's been ill and I think he's afraid of / doesn't understand the system (the unknown) - He gets anxious.