ALD Validity - Beware

[Gardian]

OH has an ALD which was granted in Feb 2005.

You've guessed: it has now gone out-of-date and a new Protocole de Soins will have to be completed by our GP. Turnround time is 6-8 weeks and we'll have to temporarily fund her very expensive medication in the meantime.

Now, we're partly to blame for this: we should have remembered that there's a finite date of validity. But it was 5 years ago and I usually have trouble remembering what happened yesterday, let alone in 2005. Needless to say, there's no warning from the Assurance Maladie (say) 3 months before, telling you that they're going to pull the plug and that you should start the renewal process. Incidentally, I believe that the period of validity is set by the doctor at the Assurance Maladie who approves your GP's original application, so it won't always be 5 years.

So, if you or your OH has an ALD, make sure that you have your act together, because you can't rely on the system! 

[NormanH]

Thanks for the warning.

Are you sure that it will actually happen like that in practise? Yuu are quite right on the principle, but in a case like this it would seem reasonable to hope that the Assurance Maladie would agree that this is simply a continuation of the previous treatment, and either agree to wait for the new demand, or at least say that the payments you make now will be reimbursed retroactively.

In my case as long as the Doctor writes the prescription on the right form the Pharmacie/ X ray/ MRI etc never question or ask for the protocol.

In any case you will get  the normal 70% instead of the 100% for an ALD.  Won't your Mutuelle cover the 30% in the mean time?

[Benjamin]

[quote user="Gardian"]

Turnround time is 6-8 weeks

Incidentally, I believe that the period of validity is set by the doctor at the Assurance Maladie who approves your GP's original application, so it won't always be 5 years.

[/quote]

Mrs Benjamin's took about a week but of course it will change from CPAM to CPAM.

As far as validity is concerned her's is also five years for a condition which is progressive and, currently, incurable so I would guess this is a maximum duration.

Although her first carte d'invalidité/macaron was issued for five years by COTOREP, MDPH issued the replacement for ten years and their paperwork clealy stated a warning on the time scales involved in renewing whereas the paperwork confirming acceptance of the ALD merely gives an expiry date.

Thank's for bringing this to people's attention.  [:D]

[Cat]

Thanks for the warning.

My exoneration is also for valid for 5 years.  In my case both the hospital and the pharmacy were happy to put all charges on hold until my ALD exoneration was issued. 

[Sunday Driver]

I have no idea when my ALD expires.

If it does, I won't even notice it because my carte vitale will cover the 70% of tariff and my mutuelle will cover the other 30%.

The only people who will be affected by the loss of ALD status are those who have no complimentary insurance cover.

 

[Gardian]

[quote user="NormanH"]Thanks for the warning.
Are you sure that it will actually happen like that in practise? Yuu are quite right on the principle, but in a case like this it would seem reasonable to hope that the Assurance Maladie would agree that this is simply a continuation of the previous treatment, and either agree to wait for the new demand, or at least say that the payments you make now will be reimbursed retroactively.
In my case as long as the Doctor writes the prescription on the right form the Pharmacie/ X ray/ MRI etc never question or ask for the protocol.

In any case you will get  the normal 70% instead of the 100% for an ALD.  Won't your Mutuelle cover the 30% in the mean time?

[/quote]

Norman .............

Oh yes, it has actually happened.  OH was having some physio this morning (related to her condition) & proferred her CV as usual. Last week, it was OK & showing the ALD, today not. Zapped.

We shot round to the pharmacie to double-check & they confirmed the situation. Now, when it comes to OH's next load of medication, due in a couple of weeks, they might issue it as normal, but I somehow doubt it. All that will happen is that their invoice to Assurance Maladie will get bounced and they then risk the loss even though they know us well.

As for our Mutuelle, I really don't know. In any event, they shouldn't be faced with picking up the difference. If that happened every time, everybody's premium would go through the roof.

I've rung CPAM and was told what I expected: you need an updated Protocole. "Why no warning", I said.  No reply.

[Sunday Driver]

[quote user="Gardian"]

We shot round to the pharmacie to double-check & they confirmed the situation. Now, when it comes to OH's next load of medication, due in a couple of weeks, they might issue it as normal, but I somehow doubt it. All that will happen is that their invoice to Assurance Maladie will get bounced and they then risk the loss even though they know us well.

As for our Mutuelle, I really don't know. In any event, they shouldn't be faced with picking up the difference. If that happened every time, everybody's premium would go through the roof.

[/quote]

If your ALD status hasn't been updated by the time your pharmacie next swipes your CV, then the assurance maladie will pay them 70% and notify your mutuelle to pay them the other 30%.  No invoice to bounce and no risk of loss to the pharmacie.

Mutuelles may not take into account people's medical situation when calculating their premiums.  If you are awarded ALD status, then that's a bonus for them. 

 

[Gardian]

[quote user="Sunday Driver"]

Mutuelles may not take into account people's medical situation when calculating their premiums.  If you are awarded ALD status, then that's a bonus for them. 

[/quote]

Well I understand what you're getting at SD, but it wouldn't be much of a bonus if their 30% equated to twice our monthly premium .............. which it does!

Anyway, fortunately we can finance anything that we may have to fork out until such time as we get reimbursed by CPAM. Not everybody will be able to. 

[Benjamin]

I'm getting confused here, but that's nothing new.

As Sunday Driver has pointed out you'll be covered one way and another , so long as you have a mutuelle for your OH?

[Gardian]

Benjamin ............

SD is quite right & the 30% would probably be met by our Mutuelle.

But:

• Our pharmacie gets very nervy about expensive medication and a situation where things aren't cut & dried. They know that OH has an ALD, but now it isn't on her record. They've probably been bitten badly before & their caution is understandable.
• And all I was saying in reply to SD's point (which he has made on previous occasions) that whilst ALD clients are quite good for a Mutuelle (because most of their costs are prise en charge by the State), this couldn't go on for long if the 30% was a lot of money. If I worked for the Mutuelle, I'd be asking questions sooner rather than later.

[Benjamin]

Why would the pharmacie get nervous? So long as they're

electronically connected (and I can't remember seeing one that isn't)

the transaction will just be automatic. As a safeguard if they are that

nervous just show them your Attestation de Tiers Payant from your mutuelle with your OH's name on.

As has been said before the mutuelle just have to grin and bear it. They are not allowed to pick and chose.

[NormanH]

I pointed out in the first reply in this thread:

In any case you will get  the normal 70% instead of the 100% for an

ALD.  Won't your Mutuelle cover the 30% in the mean time?

How has this suddenly become SD's idea 

"Benjamin ............

SD is quite right & the 30% would probably be met by our Mutuelle"

 and why the need for the re-iteration since?

[Gardian]

Oh, alright, alright. [:)]

[NormanH]

In any case I am sure you have no need to worry..or pay out. Good luck and good wishes to your wife in her situation.

[Gardian]

Just an update.

OH's medication was dispensed by our pharmacie in mid-March with no difficulty. I had asked to speak to the owner-pharmaciste in order to explain the situation: he was totally unphased. "It'll go round and round in the system until someone picks up the tab - but it won't be you or me!!"

Went back today for this month's dope: the pharmaciste said that she'd "mise a jour" OH's CV to see if there'd been any change (nothing yet heard by us or our GP). Lo & behold, it had been renewed with it's ALD status. So, five and a bit weeks, which everyone says is good.  [:D]

[NormanH]

Happy for you [:)]