CPAM 70% under carte vitale

[oldgit72]

I recently visited the doctor (my first time in France) and duly handed over my carte vitale with the 22 euros fee. I expected to get back 70% from CPAM but on checking my bank statement I have received 10.40 from CPAM and not the 15.40 I had expected. Have I misunderstood something or will I get the 5 euros back from someone else?

[AnOther]

The experts in this particular area will no doubt be along however what I can tell you is that on the occassions I have visited my doctor I have never physically crossed her palm with cash.

Are you actually registered with the doctor in question or was it an ad hoc visit, it makes a difference to the cost.

[Polly]

Old git, there is a 'franchise' or recuperation of 1 euro which is not re-imbursed. If you have had any prescription medecines there is a franchise of 0,50€ on every box which is recovered from you every so often by CPAM not paying you back in full for a consultation.

All the details will be on the statement you get from CPAM.

[Gardener]

If you complete the form on this site

http://www.ameli.fr/assures/soins-et-remboursements/comment-etre-rembourse/le-parcours-de-soins-coordonnes/choisir-et-declarer-votre-medecin-traitant.php

and declare the doctor you prefer to use as your medecin traitant, you will get a better remboursement.

[cooperlola]

I'm with Gardener here, that sounds like you haven't nominated your GP yet.  The measure was introduced to stop hypochondriacs (sp?) from rushing from doctor to doctor in search of second/third opinions and getting different medicines from each!

[krusty]

[quote user="AnOther"]I have visited my doctor I have never physically crossed her palm with cash.

[/quote]

Interesting .........is there anyone else who does not pay ?

In our 4 years here , with our registered doctor we have always paid for each visit every 2 months.

[AnOther]

I didn't say or mean that I haven't paid, simply never handed over cash, neither has my OH.

[Benjamin]

[quote user="Polly"]Old git, there is a 'franchise' or recuperation of 1 euro which is not re-imbursed. If you have had any prescription medecines there is a franchise of 0,50€ on every box which is recovered from you every so often by CPAM not paying you back in full for a consultation.

All the details will be on the statement you get from CPAM.

[/quote]

Just to add a bit to Polly's list of franchises blood tests attract a deduction of €1,00 for each element tested. So if the technician in the lab takes four different vials you end up with a deduction of €4,00.

[Benjamin]

[quote user="AnOther"]I didn't say or mean that I haven't paid, simply never handed over cash, neither has my OH.

[/quote]

Does paying by cheque or cc get you any better treatment?  [8-|]

[cooperlola]

I assumed ANO meant his was automatic, as our pharmacy is?

Perhaps a more sophisticated practice than the little one woman show I go to.

[bubbles]

We always have to pay our doctor for consultations.

(to be reimbursed at a later date through our CV's)

And it tends usually to be cash since she can never get her credit card machine to work!!

But then we are in a little village in the PO and probably years behind the times.

[AnOther]

Our doctor is also a one woman show but she has a machine - and it does work, I thought they all had them but there you go [;-)]

For total clarity Benjamin in the doctors surgery neither of has ever used anything other than our Carte Vitales, no cash, no cheques, no credit cards.

We have paid the visiting nurse by cheque and had the reimbursement automatically to our bank A/C

[krusty]

[quote user="AnOther"][;-)]

For total clarity Benjamin in the doctors surgery neither of has ever used anything other than our Carte Vitales, no cash, no cheques, no credit cards.

I didn't say or mean that I haven't paid, simply never handed over cash, neither has my OH.

[/quote]

This is confusing ....so you get your consultation for free and the rest of France pay 22e ?

[cooperlola]

[quote user="AnOther"]she has a machine - and it does work, I thought they all had them but there you go [;-)]

[/quote]I think the majority of docs have CV readers but they don't settle the bill automatically as, say, the one in our pharmacy does.  For ourselves, the reimbursement is therefore automatic (via CPAM and top-up) but we still pay at the time.  ANO, I think from what others are saying on here it's your doc who's the more unusual, not the other way about - although it may be more common in, say, Paris, for example.

[AnOther]

I don't know how more plainly I can say it Benjamin, just like everyone else we pay (or supposed to - but see below), by Carte Vitale and consequent debit from our bank A/C, but we have never paid the doctor herself directly one cent by any medium.

Having said that I've just asked 'er indoors, the bookeeper, who tells me that even though out Carte Vitales are routinely swiped when we attend without trawling through a sheaf of statements she cannot recall seeing any corresponding amounts going out and the only credits have been reimbursements for dental and optical bills which we have paid by cheque.

In her case that might be because she is 100% for her diabetes and nearly all her visits will have been so related, and for my own part because I have really only visited in earnest a couple of times.

Or perhaps our doctors machine does not work after all [blink]

[Sunday Driver]

Unlike specialists, pharmacies and medical laboratories, not all CPAMs automatically provide direct reimbursment of fees (tiers payant) to GPs so they have to ask for payment at the time of consultation.  The exception is for patients who qualify for 100% cover such as those registered under CMU-C or categorised as having an affection de longue durée (ALD) or having had a workplace accident or having an occupational illness. In such cases, CPAMs have an obligation to provide tiers payant facilities to GPs with no advance payment due from the patient.

This can result in hardship for people of limited means who do not fall within the above categories and have to pay up front and the Syndicat des Médecins Généralistes (GP's union) is currently lobbying for changes to the process.

 

[Benjamin]

How can you have a National system which works differently in different Departments? Crazy.

As far as ALDs are concerned Mrs Benjamin, here in 85, still pays the Doc and has to wait for her 100% re-imbursement less of course €1.

[oldgit72]

I registered with the doctor at the visit. I had not registered in advance. The 22e was for consultation only, no medicines. I am still confused as 22e seems to be the 'approved' consultation fee and 70% is the amount I should get back. Do I get a statement from CPAM detailing why they refunded 10.40 and not 15.40?

[krusty]

Actually in my case my doctor has finally got CPAM to accept me on ALD due to my heart , and I no longer have to pay him any fee for my 2 monthly consultation for my prescription , but this has only just happened after 4 years in the system.

[Benjamin]

Yes. It comes through every two or three months. It's possible your re-imbursement was processed before your medecin traitant was registered.

[krusty]

[quote user="Benjamin"]Yes. It comes through every two or three months. It's possible your re-imbursement was processed before your medecin traitant was registered.

[/quote]

You get me wrong , I am not say I got a re-imbursement (it has been that way for the past 4 years) .

What I am saying is I no longer pay my GP any fee at all.

[Sunday Driver]

I think you'll find that Benjamin was replying to oldgit's post just before your's......

 

[dragonrouge]

May I please pose a question? My wife has 100% due to a long duree as in RA. However for repeat prescriptions the Dr continues to charge his normal fee. Is this 'normal' please?

[Pommier]

Just checked our CPAM account on this as my husband is covered 100% ALD.

He pays the full €22 to the GP but it's refunded in full (but less the franchises and participations forfaitaire which means that there's never a refund of the full €22)

[Tony F Dordogne]

[quote user="Pommier"]Just checked our CPAM account on this as my husband is covered 100% ALD. He pays the full €22 to the GP but it's refunded in full (but less the franchises and participations forfaitaire which means that there's never a refund of the full €22)[/quote]

That's what happens with me also, I pay the generalist and then get reimbursed, less the forfait.  And forfait on  the drugs I take are offset against my reimbursement on the drug 'bill'.

I don't pay anything when I go to the hospital to see my specialist nor do I pay anything if I have a domestic blood test.