ALD's/100% - changes to payment process

[Magoo]

Does anyone have any details of the recent change to the 100% re-imbursement process?  I have just had the nurse in to take bloods for my Diabetic check and had to pay for it.  She said there has been a change and all those with chronic conditions must now pay up front.  She then handed me a dreaded feuille de soins that I thought I'd seen the back of after getting my nice shiny CV................ 

She said everyone is mystified as to why - patients and health professionals alike are annoyed by the change as it makes for extra work and puts some people under financial strain.  Does anyone know whether I would have to pay for my insulin etc up front?

I have tried to find info on the amelie site but can't see any reference to the change.

Thanks

[giantpanda]

Hi!

Nothing has been published on this.

It would be senseless, especially if this applied to ALD only.

Of course it all depends on how the single nurses ( or doctors etc. ) are registered with the Health Insurance. They have the possibly to opt for cash payment by the patients.

It could be something local.

Yours,

giantpanda

PS. There are vague reflections that ALD patients ( they represent only 16% of the patients, but generate over 73% of the health cost ) should participate with a franchise. Could be means tested. But still this would have to be presented to the public, and would generate massive opposition. So it is definitely not actual.

But it could be that somewhere down the line, they are working on a program which would take this into consideration, and that this could generate for some time an interruption of the existing program. They have to test it somewhere.

[Magoo]

Hi GP

The nurse showed me a leaflet briefly but had to take it with her for her other patients.  She said it was a National regulation that is now in place.  A lot was lost in translation which is why I am trying to find out more. 

There was a call for a petition in Dept 47 earlier in the year with regards the new regulation that everyone must pay for their treatment in advance - this is due to come into practise Jan 2009.  CPAM are countering this bad news by saying re-imbursements will be made in 5 days...............hmmmmmmmm.  I am wondering whether they are trialing this practise now.

Insulin is expensive and to find the money for it in advance will be an extra burden for me, but it pales significantly when one thinks of cancer treatments etc.

Regards

Magoo

[Tony F Dordogne]

I've not heard anything about this at all in 24 (doctor, nurse visits) nor when I was at the hospital in Bordeaux (33) last week nor is there anything displayed in the CPAM office at Sarlat.

Thought this was in one of the discussion papers out a few months ago that got kicked into touch.

And yes, my chemo is seriously expensive and although paying for it and getting it back on a 5 day turn around would be ok, wouldn't want the hassle of doing it - let alone for the other 14 drugs I have to take because of the associated conditions.

 

[Gardian]

Blood test taken for OH this morning: no mention whatsoever.

However, any news can take a while to get to the far outposts, as in down here.

[Sunday Driver]

Given that the carte vital was originally introduced to streamline the reimbursement of treatment expenses and reduce CPAM administrative costs, it's highly unlikely they'd revert to a 'cash up front' and paper claim system.

There was a proposal floated some months ago that certain blue label medicines and treatments for less critical ALD conditions would not be reimbursed in full with the difference having to be taken up by the mutuelles, but this was hastily dropped.....

 

[Jonzjob]

Sorry if this is a stupid question, but what is ALD please ?

[Clair]

Affection de Longue Durée

A list of 30 or so long-term illnesses as described here: http://www.completefrance.com/cs/forums/1180182/ShowPost.aspx

[Magoo]

With the Budget for 2009 announced Monday (and the Social deficit) it looks like ALD's and their 100% re-imbursements are up for discussion again!! [:(]

[5-element]

It seems that they are. I can't imagine how the top-up insurance could cover 75% of the costs of some ALD treatments, though, which seems to be one of the ideas that has been floating around.

Just think, about chimiotherapy treatment. Dialysis treatment. Transplanted patients on immuno-suppressants. Many others. Surely, the patients who need expensive treatments would not be expected to come up with 1,000+ euros a month to pay? Not yet, but maybe the day will come when they will be....

http://tempsreel.nouvelobs.com/depeches/economie/20080624.FAP1355/la_secu_preconise_de_transferer_le_remboursement_des_me.html

Laurent Fabius thinks it might be "une grave remise en cause de la Sécurité Sociale"

http://tempsreel.nouvelobs.com/depeches/politique/20080625.FAP1592/laurent_fabius_trouve_extremement_choquant_le_projet_de.html

 

[mint]

Just like the NHS in the UK then.  I've been hearing stories about how some cancer treatments/drugs are not going to be paid for.

Politicians, what do they care, as long as their own pockets are lined.......................

[Sunday Driver]

5-Element

Those links refer to the proposal that was floated earlier in the year by Frédéric Van Roekeghem, director general of the assurance maladie.  They were the ones that were objected to and were subsequently shelved. 

 

[5-element]

Yes you are right, the articles are from end of June 2008. Sorry about that, but not sorry that those proposals have been shelved....for the time being.

There is something in the pipeline though, as the idea keeps re-surfacing, I expect there will be more are attempts in that direction, although it may be gradual, and start with the "less significant" ALDs, i.e. the non-life-threatening ones, first.

[Jotty]

Looking at the Bercy site the only significant hints I can find are in this document  (look at paragraph 2)

where it is said that for example there will be a delay of 6 months before increases are put into effect, there will be an increase in the things for which prior permission is required , and a 'déliverance de grands conditionnements pour les traitements longs' which I read as meaning a tightening up of the rules which govern the ALDs, but I am open to correction by a French person such as 5 Element or Clair...

[Clair]

I read a similar report a few days ago (last week?)

• As far as "délivrance de grands conditionnements pour les traitements longs" is concerned, I remember reading that patients who require long-term medication (blood pressure tablets for instance) would be able to get them in 3-month packs, therefore paying the franchise once only rather than 3 times.This is something I remember clearly, as my blood pressure tablets come in 3-month packs (franchise = €0.50), yet the thyroid replacement tablets only come in 1-month treatment (=3 x €0.50).
• As far as "an increase in the things for which prior permission is required ", certain medical acts, which are known to be subject to abuse (medical transport?) will be subject to prior agreement.
• As far as those seeking appointments and or treatment without having signed a "déclaration de médecin traitant", they would see their reimbursement reduced from 50% to 40%, in an effort to push them into registering with a GP.
• Some prescription medecines seen as "less effective" will not be reimbursed as much as they are currently.
• There have been hints of discussions between the mutuelles and CNAM, to consider establishing "forfaits de soin" for people with chronic illness. These would replace payment at the time of the medical act. I take this to mean that the payment for treatment for those with chronic illnesses would be agreed and dealt with without the patient being financially involved (this is my take).
• Medication prescribed in hospitals will be suject to tighter control, as the costs have been increasing by 15% per year.
• Employees on sickness leave will be checked earlier into their leave and more often.

[Jotty]

Thanks Clair that is very helpful.

[5-element]

Thank you Clair, you understand it better than I do. When I read original texts, sometimes it is as if they were speaking in tongues.[:(]

[Clair]

I read several newspaper articles over the last couple of weeks, when the PLFSS (Projet de Loi sur le Financement de la Sécurité Sociale) was being discussed.

• Sécu : retraite et maladie concentrent les déficits 2009

• Assurance maladie : Sarkozy veut les comptes à l'équilibre pour 2011
• Médecins: la Cour des comptes exige des économies
• "Sécu" : toujours des déficits, toujours des taxes nouvelles
• Sécu : le gouvernement s'attaque aux "niches" sociales

Google translate

[Graham & Brenda]

I am ALD for my diabetes. My visit to the doctor yesterday, plus prescription,  was "as usual". 

[ebaynut]

[quote user="Jonzjob"]Sorry if this is a stupid question, but what is ALD please ?[/quote]

Affections Longue Durée (ALD)

Below is a more condensed list, based on Nickels post, which is on the FHI site.

http://www.frenchhealthissues.eu/reference/list_of_alds.htm

NB: The FHI site has had a makeover, worth another look [:)]

[Jonzjob]

Thanks Ebay for the FHI link. That's now in our favorites!! [:D]

Very usefull!

[Jotty]

Surely the best page is this as it is the official French position.

http://www.ameli.fr/professionnels-de-sante/medecins/exercer-au-quotidien/les-affections-de-longue-duree/qu-est-ce-qu-une-affection-de-longue-duree/les-a.l.d.-exonerantes_beziers.php