Top up insurance questions

[Benjamin]

[quote user="Mr Wiggy"]

Hi Benjamin.

The dreaded smokers disease, no! not cancer, the other one!!

[/quote]

Sorry to hear of your problem.

The point of asking the question is, as far as I know, that there is no situation where someone is covered 100% for healthcare without top up insurance.

You get 100% re-imbursed if you have an ALD but only for the ALD condition. You can come close to getting 100% if you are classed as handicapped but even here you have to pay the 65% for any "blue label" medicines as well as paying the daily charge if you are hospitalised.

[Mr Wiggy]

Hi Benjami.

It's self inflicted so I have to face up to it, although I do always say that there are other people far worse than I am so you have to get on with life. I have lasted for ten years so fingers crossed, if I can make another five then I would be very happy with that.

I did have a couple of weeks in hospital early last year because of my problem, they thought I had T-B and all sorts, finally they did sort it out. Must admit my stay was very enjoyable thanks to all the lovely nurses, the French female has a wonderful sense of humour they were wonderful.

I did get a bill a few weeks later so sent off a cheque, a week later it was returned with a letter of appology because they didn't realise that I had 100% cover.

[Mr Wiggy]

Oi. Keep my Irish Jig outa this S-D.or I'll tell them about your wooden leg, Matey!!

[Benjamin]

Can we take it that you're suffering with emphysema and your doc has declared this as an ALD?

If so, you were not mis-sold top up insurance. The cost of treatment for any other and as yet unknown medical problems may far outweigh the cost of your monthly premiums, but that's your call.

I'm not "pursuing" you on this one, but it's important that others understand exactly what is and what is not reimbursed with an ALD.

Good luck.

 

[Mr Wiggy]

Hi Benjamin.

 

I certainly do not feel hounded at all, so don’t worry on that score.

 Yes I do have emphysema and yes I certainly do get a 100% from CPAM , tihs is certainly not a boast but a fact that have never paid for a single item in the past.

As I said in my last post to you, I spent 2 weeks in hospital in April / May last year. The cost of this for my bank was around 28€.

 Then this year I again went and had an eye test and then into hospital for a short stay for the removal of a Cataract. In both instances I have paid no contribution and basing this on my previous stay in hospital this would be about 5-10€ cost for the bank.

The total cost of the new pair of glasses is 364€ and the bank won’t pay any think like enough and CPAM will only pay roughly 12€ per lens. I have no idea what the cost on a new lens transplanted onto my right eye has costs.

This is the main reason why I object to paying my bank over 625€ when in total the annual cost they actually paid was exactly 67€.

Financially, I would be far better off, to the tune of 558€ and pay the 67€ out of my own pocket. This is the reason for me trying to cancel my contract with the bank as I made it quite clear to the individual on 4 occasions that I have a 100% cover from CPAM.

So was miss sold this insurance.

I have consulted my financial advisor on this matter and he did advise that I don’t need this cover, so WAS miss sold this insurance, so we are in full agreement, for once!!

 

And Thank you for your Good Wishes.

[Tony F Dordogne]

I'm really sorry Wiggy but I can't see that you were mis sold your health insurance.   Did you specifically ask them about your 100% cover and did they tell you that you would need more cover than 100%?  And remember, that is only 100% of the state contribution - as the glasses reimbursement shows - anything extra you have to pay for yourself, like specialists who charge 3 times the state tarrif and that's where your insurance would kick in.  The fact that your policy doesn't cover the difference between the state contribution and the actual price may be something to do with the type of policy and specific areas of cover within your policy.

Also, we don't know their side of the story, what you told them and how they understood your explanation so to say that you were mis sold, which implies a degree of dishonesty on their part, may not be fair.

I'm on 100% also.  I rang the insurance company/broker and discussed this with them and they were very sympathetic and suggested that I may want to scale down my premiums but I decided to stay where I am.  One reason is a good example of where I'm not covered 100%.  Every year my generaliste send me for a multi check up blood test and that costs about 95 euros.  As he doesn't give me the long form for the ordnance, it's not 100%.  Then CPAM repay a percentage and my insurance company picks up the rest of it, so I get 100% reimbursement, just a different way round.  Many of the tests I have are directly related to my ongoing sonditions (I'm on 100% for 5 different reasons now) but the GP just chooses to use this route, it still costs me nothing other than my insurance premium.

I think the bank may well argue that you knew what you were buying and that you over insured yourself when you should have been aware of what 100% actually implied, the contents of your policy with them was a matter for you to discuss and agree at the time of purchase and the fact that you get little from it can partly be attributable to those factors.

Not trying to be difficult here Wiggy, just trying to see another point of view.

[Benjamin]

I think that it sounds as if you have an E121 where the box that's ticked (section 3.1?)is for invalidity and not for old age. This would account for the fact that you are receiving 100% cover, just as French people who are incapacitated do, for items other than your ALD.

It would be interesting to know if this is the case so that others are clear on what is and isn't covered.

[Sunday Driver]

Wiggy's E121 is based on invalidity, not old age.

 

 

[Benjamin]

Thank you Sunday Driver as that now clarifies why Wiggy is getting most things at 100%.

Doing a bit of P. A. 'ing on the side then?  [;-)]

[NormanH]

So yet another Health tourist that France would be well shot of.

[Benjamin]

What took you so long Norman?  [:D]

[NormanH]

Been under the Doctor recently [:)]

[Mr Wiggy]

The Remark of a Cretin, N.H. are treated with the contempt they deserve.

[sid]

[quote user="NormanH"]So yet another Health tourist that France would be well shot of.
[/quote]

That's really cheap shot Norman. I hope you reap what you sow.

And just how would France be well shot of our Mr Wiggy...? And are you suggesting some sort of mass-cleansing exercise? Mr Hitler was fond of this sort of stuff.

Sid

[Will]

If a 100% top-up paid the whole cost of hospitals, dental procedures and optical prescriptions, then how come there are so many policies around that pay 400%? (And that doesn't mean that you make a 3x profit on any medical payout)?

For many people a 100% top-up is adequate, but neither it, nor 100% CPAM cover, covers everything at 100%.

[Tony F Dordogne]

Exactly Will, just what I said and it still doesn't mean that Mr Wiggy was mis-sold, perhaps he just mis-understood or the bank did!

[Sunday Driver]

Easy enough to misunderstand or jump to conclusions - as some have done here....[;-)] 

Having regard to Tony's earlier post, Wiggy wonders whether the bank may have misinterpreted his 100% as purely relating to an ALD, making the top-up a reasonable offer.  He has an appointment on Friday for an amicable discussion with his bank manager to clarify matters.