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ALD Reimbursements


Grecian
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I will try and explain the situation as clearly as I can.

We moved to France in the middle of September 2008, wife has a very long list of ailments I am afraid, which we knew could give us a problem in France, in more ways than one, but we are here. Having been here just over 4 months now, we still have not received our attestations, let alone our CV's. We have a new French doctor who is very nice, but because of no attestations we are unable to register with him, a real vicious circle.

Amongst all her ailments, my wife is an insulin controlled diabetic, and recently got a prescription from our GP for various bits to keep her going. On the prescription he listed the various items into two categories:

Prescriptions relatives au traitement de l'affection de longue durée reconnue (Affection exonéante) and Prescriptions sans rappot avec l'affection de longue durée (Maladies intercurrentes).

If I understand it correctly, the first one is signifying that the drugs prescribed should qualify for an ALD exemption. Having taken the prescription to the local pharmacy we were somewhere taken aback, when the lady behind the counter asked for 309 euros, fair enough I thought we would be reimbursed 100% for most of the prescription, so not a problem. I am finally getting to my questions, on the feuille de soins the reimbursement is only showing 65% for the items dispensed from the first part of the prescription. So have I misunderstood the bit about the ALD on the prescription?  Has the lady in the pharmacy made a mistake when keying in the reimbursement percentage? Or is it down to the fact we do not have our CV's and are not registered with our doctor, we will only get reimbursed 65% when we finally receive our CV's and present the feuille de soins to CPAM?

I really hope somebody can understand the above!

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My immediate thought is that your wife's ALD is not yet registered and agreed.  However, the doc' has rightly distinguished between the two categories of medicine so that once this has been sorted, you will be able to reclaim the outstanding percentage, or at least be charged correctly in the future. 

Chase your CPAM up straight away for your attestation (you may not get a CV if you are on an E106), appoint your new doc' as your medecin traitant, and get him to start the ALD process pronto.

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Registering the ALD is a fairly simple task. The French doctor you are seeing clearly acknowledges your wife's condition(s).

When you are finally registered, at least with an attestation the doctor will complete a protocole de soins which goes to your caisse (in our case the doc told us where this was and we took it in ourselves). About a week and a half later the letter of acceptance was received together with an explanatory leaflet.

 

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Hi!

Your quote:

About a week and a half later the letter of acceptance was received together with an explanatory leaflet

That is optimistic - in some places that can last 6 weeks( for the attestaion )

Same applies for ALD - I had 4 months ( for a quite evident case )

Yours,

giantpanda

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I have a feeling that g/p is French, Benjamin.

Grecian, when we registered with our CPAM, we got a social security number and a handwritten attestation on the spot, together with the medecin traitant form.  But we went into the main department office in LM and did the thing face to face.  I reckon you've waited long enough, even though I agree with Benjamin in that these things vary so much from place to place.  An ALD registration which I did for a friend came through in about a week after the papers were submitted.

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Looking at previous posts the OP only registered with CPAM via an E121 in the middle of November. Having said that he does seem to be rather confused about the health system if his other posts are anything to go by. If he is not yet in receipt of an attestation /social security number from CPAM confirming his entry into the French system then he will have to pay the full price for any medication. He cannot register his wifes ALD because he is not in the system, in fact it appears that he has not asked the doctor for the ALD notification

Perhaps someone needs to talk him thro the system from begining to end.

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It is worth going back to CPAM to ask how long you may have to wait for a Carte Vitale and at the same time ask for an "attestation provisoire", this should at least give you a temporary SS number which you can use to process your claims straight away.

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[quote user="Boiling a frog"]

Looking at previous posts the OP only registered with CPAM via an E121 in the middle of November. Having said that he does seem to be rather confused about the health system if his other posts are anything to go by. If he is not yet in receipt of an attestation /social security number from CPAM confirming his entry into the French system then he will have to pay the full price for any medication. He cannot register his wifes ALD because he is not in the system, in fact it appears that he has not asked the doctor for the ALD notification

Perhaps someone needs to talk him thro the system from begining to end.

[/quote]Grecian, if this is the case and you are just utterly confused, then do check out our website (link below).  Whilst I was asleep in hospital, my colleagues at FHI completely re-vamped the site and it now covers much more basic info' about the health system here than before.

On which subject, if anybody spots any howlers, do feel free to tell us.

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Well, I will ignore the response from Boiling a frog, as obviously he/she is either very rude, or just a bit weird, and needs to get out more. At this point I would like to thank anybody who took the trouble to answer my query with constructive responses.

If I am permitted to ask some more 'thick' questions, then I would like to continue with this thread.

This morning we received our attestion, although it was delivered to next door, as CPAM put the wrong number in the address. We went along to our local CPAM office, but there were about 20 people waiting, so we will try again tomorrow. What happens now regarding obtaining our CV's? When we first went to our local CPAM office we offered our passport photos, but he said later. At this stage nobody has any photographs of us, to put on our CV's. Can we expect to receive another form to fill in for our CV's, and then enclose the photos with that form. Or has something gone badly wrong?

Also, could somebody shed some light on how we fill out our medecin traitant form please, we have had it filled out and stamped by our doc (on the same day as we discussed my wife's ALD incidentally), it is just the bit we have to fill in I am not too sure about. We have only received one attestion with both our names on it, so on the medecin traitant form where it reads: L'assuré(e) do we enter my wife's name, and then where it says: Le bénéficiaire do I enter my name? Or do we both have to fill out a medecin traitant form, if that is the case then I am totally confused who's name goes where.

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[quote user="Grecian"]This morning we received our attestion, although it was delivered to next door, as CPAM put the wrong number in the address. We went along to our local CPAM office, but there were about 20 people waiting, so we will try again tomorrow. What happens now regarding obtaining our CV's? When we first went to our local CPAM office we offered our passport photos, but he said later. At this stage nobody has any photographs of us, to put on our CV's. Can we expect to receive another form to fill in for our CV's, and then enclose the photos with that form. Or has something gone badly wrong?[/quote]

Keep that preciously. The attestation proves that you are "in the system". The CV is less important than the attestation.

The CV is not vital, it just makes it easier to pay.
In time (maybe), you will be asked for photos for your CV.

[quote user="Grecian"]Also, could somebody shed some light on how we fill out our medecin traitant form please, we have had it filled out and stamped by our doc (on the same day as we discussed my wife's ALD incidentally), it is just the bit we have to fill in I am not too sure about. We have only received one attestion with both our names on it, so on the medecin traitant form where it reads: L'assuré(e) do we enter my wife's name, and then where it says: Le bénéficiaire do I enter my name? Or do we both have to fill out a medecin traitant form, if that is the case then I am totally confused who's name goes where.[/quote]

To the best of my knowledge:

  • You should each complete a form.
  • Assuming you have ONE Social Security number (as you have receive ONE attestation):
    • if the number starts with a 1, Grecian is the insured and the beneficiary on HIS FORM as well as being the insured on Mrs Grecian's form, where she is the beneficiary.
    • if the number starts with a 2, reverse the above.
[quote]Dans la rubrique "identification de l'assuré(e) et du bénéficiaire" :

  • si vous êtes l'assuré(e), écrivez, dans la zone "l'assuré(e)", vos nom, prénom et numéro d'immatriculation et dans la zone "le bénéficiaire", votre date de naissance,
  • si vous n'êtes pas l'assuré(e) - conjoint, enfant âgé de 16 ans ou plus ou autre personne à charge - écrivez, dans la zone "l'assuré(e)" , les nom, prénom et numéro d'immatriculation de la personne à laquelle vous êtes rattaché(e) et inscrivez, dans la zone "le bénéficiaire", vos nom, prénom et date de naissance,
  • indiquez l'adresse de l'assuré(e) dans la zone prévue à cet effet.
In the "identification of the insured (e) and the beneficiary"

section

  • If you are insured (e) write in the area "the insured (e)", your

    name and registration number and the "beneficiary", your date of birth,

  • If you are not insured (e) - spouse, children aged 16 years or

    more or other dependents - write in the area "the insured (e)", the

    name and number of registration of the person to whom you are attached

    (e) and write in the "beneficiary", your name, surname and date of

    birth,
  • Provide the address of the insured (e) in the area provided.
[/quote]

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As you have now received your (joint) attestation, that is the main thing. The CVs should arrive eventually, and you shouldn't need to go back to the CPAM office.

For the med. trait. form - I would say put both your names in both places because assuré and bénéficiaire are almost equivalent. Or take a copy of the form and do one each.

Once you have sent these off to CPAM go back to your doctor and ask him to send off the appropriate form/letter confirming your wife's ALD. Then, when you receive your CVs you take them to your pharmacy and they will "swipe" hers to bring her up to 100% cover for the medication relating to her condition.

(Other medicines etc will only be covered 60 to 70%.)

ps my post crossed with Clair's but I don't think they contradict.

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[quote user="Grecian"]

Well, I will ignore the response from Boiling a frog, as obviously he/she is either very rude, or just a bit weird, and needs to get out more. At this point I would like to thank anybody who took the trouble to answer my query with constructive responses.

If I am permitted to ask some more 'thick' questions, then I would like to continue with this thread.

This morning we received our attestion, although it was delivered to next door, as CPAM put the wrong number in the address. We went along to our local CPAM office, but there were about 20 people waiting, so we will try again tomorrow. What happens now regarding obtaining our CV's? When we first went to our local CPAM office we offered our passport photos, but he said later. At this stage nobody has any photographs of us, to put on our CV's. Can we expect to receive another form to fill in for our CV's, and then enclose the photos with that form. Or has something gone badly wrong?

Also, could somebody shed some light on how we fill out our medecin traitant form please, we have had it filled out and stamped by our doc (on the same day as we discussed my wife's ALD incidentally), it is just the bit we have to fill in I am not too sure about. We have only received one attestion with both our names on it, so on the medecin traitant form where it reads: L'assuré(e) do we enter my wife's name, and then where it says: Le bénéficiaire do I enter my name? Or do we both have to fill out a medecin traitant form, if that is the case then I am totally confused who's name goes where.

[/quote]

 

You do appear not to be aware of how the system works, so why is it that I am rude or weird, kindly explain.

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Just a quick clarification to Grecian about his carte vitale.

They have been rolling out the new photo carte to the whole of France and the changeover is being handled by a central agency rather than individual CPAMs.  That's why they aren't accepting photographs locally.

Now that your attestation has been issued, the agency will send you the necessary form containing your 'account details' which you sign and attach your photograph then send back.  Your new carte vitale should then arrive within ten days or so.

 

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Grecian - My experience, parts of which may be relevant to you...

I sent in an E121 in Mr A's name, on which I 'piggy-backed.'  So on my documents, he is the 'assuré', I am the 'bénéficiaire.' On his documents he is the assuré & the bénéficiaire .

When we received the first attestation it had one number starting with a 5 or a 7, I can't remember which.  The point is that this was a temporary 'emergency' number. Our local doctor used this temporary number to complete the two medecin traitant forms (doctor had to stamp the forms and sign them).

The temporary number was later replaced by two different numbers, on two separate attestations (numbers starting 1 or 2 according to sex).  We received Carte Vitales fairly quickly, Mr A's came first (no photo) mine a week or so later with photo. (Go figure?!)

Good luck with all of it, you have a lot on your plate at the moment but it will soon be sorted and once it is the system works brilliantly. 

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One other thing, Grecian. Regarding the E121, there is an important difference to reimbursements, depending on whether it was issued for 'invalidity' or for 'old age'. 

Perhaps somebody would quickly (but gently) correct me if I'm wrong about this, but as far as I know this applies to all E121's issued for invalidity.  If your partner has an E121 in her own name, issued for invalidity then all treatments are reimbursed 100%. (i.e. not just for a particular ALD but all treatments) 

A piggy-backer, like me, or someone with an E121 issued for 'old age' (that's what the E121 says, not my words!) gets the normal 70%-ish reimbursed.

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[quote user="Âme"]

One other thing, Grecian. Regarding the E121, there is an important difference to reimbursements, depending on whether it was issued for 'invalidity' or for 'old age'. 

Perhaps somebody would quickly (but gently) correct me if I'm wrong about this, but as far as I know this applies to all E121's issued for invalidity.  If your partner has an E121 in her own name, issued for invalidity then all treatments are reimbursed 100%. (i.e. not just for a particular ALD but all treatments) 

A piggy-backer, like me, or someone with an E121 issued for 'old age' (that's what the E121 says, not my words!) gets the normal 70%-ish reimbursed.

[/quote]

 

An interesting point and perhaps could do with clarification.

My understanding is that an E121 issued for invalidity covers not only the person to whom it was issued 100% for everything but it also covered 100% the piggy backer(if that is the right word).Perhaps I am wrong.  

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[quote user="Âme"]

Perhaps somebody would quickly (but gently) correct me if I'm wrong about this, but as far as I know this applies to all E121's issued for invalidity.  If your partner has an E121 in her own name, issued for invalidity then all treatments are reimbursed 100%. (i.e. not just for a particular ALD but all treatments) 

A piggy-backer, like me, or someone with an E121 issued for 'old age' (that's what the E121 says, not my words!) gets the normal 70%-ish reimbursed.

[/quote]

Sorry Ame, If I've read what you have written correctly. that isn't my understanding of things, from our own experience.  When we first arrived, I piggybacked on my OH's E121, she having reached retirement age.  When we got ourselves organised, I recieved my E121 for disability, which covers me for 70% of treatment for my ALD.  When I got that organised, I got - and get - 100% for my cancer and all the associated things that go with it.

Neither I, nor she, get 100% for anything else, tho in my case it's so difficult to determine what is or isn't directly related to the cancer, my GP and specialist tend to write everything off as 100%, like my recent RMI for something that may be related to it.  J has to pay as she goes (abopve the 70%) and reclaim the rest from the mutuelle, as I have to for things which clearly aren't related - for example, if I broke my leg - and then I'd claim from the mutuelle.

So all treatments aren't covered.

 

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The piggy backer (in our case me) is only covered for the standard level of reimbursement not 100%.

EDIT I need to clarify that my answer is in response to Boiling a frog and only relates to E121's issued for invalidity before a person reaches normal retirement age.

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[quote user="cassis"][quote user="Benjamin"][quote user="cooperlola"]

I have a feeling that g/p is French, Benjamin.

[/quote]

Well aware, hence the    [6]

[/quote]

I thought GP was German but had lived a long time in France?  Come on, GP!  [:)]
[/quote]

 

I thought he was half english half French but had lived and worked in Germany ,has never been to the UK and has only recently(in the past 5 or so years)  arrived in France

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[quote user="Boiling a frog"][quote user="cassis"][quote user="Benjamin"][quote user="cooperlola"]

I have a feeling that g/p is French, Benjamin.

[/quote]

Well aware, hence the    [6]

[/quote]

I thought GP was German but had lived a long time in France?  Come on, GP!  [:)]

[/quote]

 I thought he was half english half French but had lived and worked in Germany ,has never been to the UK and has only recently(in the past 5 or so years)  arrived in France

[/quote]

And that's without even mentioning the Russian mother and Argentinian father.

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[quote user="cassis"][quote user="Boiling a frog"][quote user="cassis"][quote user="Benjamin"][quote user="cooperlola"]

I have a feeling that g/p is French, Benjamin.

[/quote]

Well aware, hence the    [6]

[/quote]

I thought GP was German but had lived a long time in France?  Come on, GP!  [:)]
[/quote]

 I thought he was half english half French but had lived and worked in Germany ,has never been to the UK and has only recently(in the past 5 or so years)  arrived in France

[/quote]

And that's without even mentioning the Russian mother and Argentinian father.
[/quote]And of course you are assuming he is a he and not a she!

 

As far as the percentage of reimbursements for E121s of various sorts is concerned, my belief is that Ame is right.  However, after one reaches retirement age one loses the 100% entitlement, except for the ALD.  I don't know how old you are Tony but if over 65 then you would not get 100% for the lot.  I'm also not convinced that this is uniformly adhered to throughout France and at all CPAMs.

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