maude Posted April 22, 2010 Share Posted April 22, 2010 Mon ami has recently had hospitalistion for keyhole surgery to the shoulder and vertebrae.On leaving hospital after 4 days ,300e was demanded as payment for surgery.His top up mutuelle will not pay this as it is deemed to be the discrepancy between what the State pays and the surgeons latest payment demand.I was told this was a new "alteration" to the system brought about by surgeons wanting a bigger payment and the government passing these onto the punters.Can someone re explain this in words of simple meanings!If true will vacate this place irrespective of any losses.Already food bills are stronomic without worrying additionally. Maude Link to comment Share on other sites More sharing options...
krusty Posted April 23, 2010 Share Posted April 23, 2010 Moving because of a 300e bill ?You must be living close to the edge. Link to comment Share on other sites More sharing options...
cooperlola Posted April 23, 2010 Share Posted April 23, 2010 This, I am rather guessing I admit, is a graphic illustration of the difference between the percentages on top-up policies. If yours is a 100% policy only then it will pay only the amount which the state deems appropriate for a specific treatment. If your surgeon charges more then yes, you are liable to pay the difference. If you have a 200% policy it will pay up to twice the state amount; a 300% policy three times, and so on. You must decide whether to bump up your policy (and pay more per month) or risk these kinds of charges in the future. Edit : When I first came here six years ago, my insurance company only offered 100,200 and 300 policies. Now it offers 400% in addition. That tells me something! Link to comment Share on other sites More sharing options...
Chancer Posted April 23, 2010 Share Posted April 23, 2010 The overcharging is called un dépassement d'honoraires and are much less likely to be found in clinics and hospitals in les petites agglomérations than in larger towns and citys like Clermont-Ferrand, Lille, Lyon or Orléans where they are quasi systématique.Some examples:49% of cataract operations have dépassements between €38 and €125057% of hernia operations, between €46 and €129869% of hip replacement operations, between €101 and €172062% of carpal tunnel surgery, between €49 and €542Figures from Le Particulier.I would say Maude that your friend got off quite likely, one should always ask for confirmation before any treatment that it will be carried out at the tarif de convention de l'acte especially if you do not have a mutuelle.There is new legislation being enacted where surgeons can opt for a new sector called optionelle whereby they will facture at least 30% of their acts at the terif de convention and limit thei depassements to 50% of the tariff for the remaining operations but this will not be for at leat another year. Link to comment Share on other sites More sharing options...
NormanH Posted April 23, 2010 Share Posted April 23, 2010 As I have explained before ( and Chancer's figures provide a good example) there are two catagories of Doctor.Secteur 1 and Secteur 21) A secteur I Doctor will charge the official tariff for the consultation or operation or whatever, and you are then partially reimbursed by the Sécurité Sociale, and topped up to 100% of that official tariff by your Mutuelle if you have one, with perhaps a euro taken off as a 'forfeit' So a consultation with a specialist has a tariff of 44 euros, you will be reimbursed about 28 euros by the Sécu and 15 by the Mutuelle giving you 43 euros.2) A secteur 2 Doctor can charge anything (it's called 'libre', but that doesn't mean 'free' it means they are free to charge what they like)The Sécurité Sociale will still only reimburse at the standard tariffthough, so if your specialist decides to charge 66 euros you will stillonly get back the 28 from the Sécu.Whether or not your Mutuelle will make up the difference depends on the policy you have.If you have 100% cover they will make up the difference to 100% of theofficial Tariff (in this case 44 euros) leaving you to find the extra22 (+I euro 'forfeit')If you have 150% cover the Mutuelle will meet the difference up to 150%of the tariff..(in this case 44x150%=66 euros), so there would only bethe 1 euro 'forfeit' to payThe same distinction applies to anaesthetists so you may find that notonly do you have to pay extra for the surgeon, but also for theanaesthetistFor the two together this can easily mount up to 300 euros and farmore, especially of your Mutuelle only covers up to 100%, or yourDoctor is particularly expensiveSecteur 1 Doctors are still common among GPs and in the publicHospitals. The best are to be found in large CHU (teaching hospitals)Secteur 2 Doctors and anaesthetists work in their own surgeries and inthe Private Cliniques, which exist to make a profit for the privatemoney which paid for them.In some cases these Cliniques make a point of doing as many tests andprocedures as they can in order to make money on them, and this ofcourse increases the debt of the Sécurité Sociale, and puts up pricesof the Mutuelles.As Chancer says there is a new category proposed in which the specialist agree to keep the extra within 150% Link to comment Share on other sites More sharing options...
vwill88 Posted April 23, 2010 Share Posted April 23, 2010 Last year, when it was thought that I would have to have a certain op the anethetist charged over the conventionee. I had to sign a form stating that I would pay. Isn't this normal? It should be, then it wouldn't come as a shock. Link to comment Share on other sites More sharing options...
Chancer Posted April 23, 2010 Share Posted April 23, 2010 Thanks for that Norman, I had forgotten about the different secteurs.Re having to get a signed agreement for tarif non conventioné that was also my understanding, perhaps the patient didnt speak or understand French. Link to comment Share on other sites More sharing options...
ROSECH Posted May 28, 2010 Share Posted May 28, 2010 Ineed advice regarding Medicare supplement insurance plan one of my friend suggest about it, As we are 5 members in the family including me, my wife and 2 children aged5yrs and 11 yrs my father is also staying along with us i need to myfamily to be medically secured please suggest some ideas whether can i takegroup plan or i hav to take individual plan for each member.Please suggest !!! Link to comment Share on other sites More sharing options...
AnOther Posted May 28, 2010 Share Posted May 28, 2010 I think it's individual cover as the cost varies strictly according to age. You need to speak to the providers themselves to see if they will offer group cover.As an aside, the corrupt format of your post suggests that you may be using Interent Explorer 4, please say that is not so !Normal 0 false false false MicrosoftInternetExplorer4 Link to comment Share on other sites More sharing options...
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