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Mutuelle


Carole
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I am confused. I have had a Mutuelle for just over a year and at the start I seemed to get some money back.

I then had to have my annual mammography due to cancer and the oncologist in Rennes confirmed I should be on 100%. When I went for the mammography I had to pay and I didn't get anything back from either CPAM or the Mutuelle.

Early this year I had to go into hospital for tests and everything was 100% and I paid nothing. Then had to go to optician which I think should have been 100% as I am diabetic and the visit was diabetes related and had to pay but no refund from either Mutuelle or CPAM. Finally had to go to the cardialogist and did not have to pay anything.

Since then I have to go to the doctor every other month or so for repeat prescriptions. The amount I get back from CPAM has just dropped to Euros 11.00 or thereabouts but nothing back from Mutuelle. I dont pay for any medications. I still seem to pay in full for monthly blood test and am not getting a refund on the amount I have to pay to the laboratory for the blood results.

I am highly confused - anyone any ideas what is going on. I must be doing something wrong and not sending off forms to the right place.

I know I should go to my local CPAM and they are very good but reckon I am going to get highly confused because my French is ok but not brilliant.

Sorry if this is so confused but look forward to hearing your views. Thanks

Carole
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Some answers here: http://www.completefrance.com/cs/forums/1397857/ShowPost.aspx

To begin with, have you signed the GP declaration? (form here)

Re 100% (ALD) status: has your GP got you the necessary OK from the CPAM advisory doctor? (Details here).

If this has not been done, you do not have an ALD cover. Unless you do have ALD cover for your diabetes, you will get the same reimbursement as everyone else (details for eye test here)

Re breast cancer screening, a check-up is offered every other year by the French health service for all women between the ages of 50 and 74. The costs are covered 100%. Maybe this is what the oncologist was referring to?

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Carole - you should contact your Mutuelle, as errors are not so unusual. It happened to me for nearly a year before I cottoned on that I was not getting any reimbursement anymore from the Mutuelle - all was due to some mis-communication between CPAM and the mutuelle, and took ages to sort out. If you have kept a record of everything, you should be able to sort it with them, but that would be my first port of call.
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If, as Clair suggests, you may be covered 100% for any affection longue durée the procedure is very straightforward.

Firstly approach your French doctor and explain that you think you should be covered 100% for one or more conditions. If they are in agreement they will complete a protocole de soins which you either need to take or post to your local CPAM. There is likely to be a special office which deals with these requests and your doctor will be able to tell you.

Once done, sit back and wait for about two weeks (this may vary from Department to Department) for a decision to be made. It's unlikely that your doctor's decision will be challenged but if it is you may be required to attend for a medical examination.

When the decision is ratified you will receive a confirmation letter together with an explanatory booklet answering the most common questions people normally have.

Your entitlement to 100% cover needs renewing every five years.

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