Changes to medical reimbursements on 1 January 08

[AnOther]

It is a tough call, especially for those less financially able to pay for a mutuelle, but you might want to reconsider your statement "I cannot imagine many operations that are not" (life threatening) [:'(]

I have a friend in UK who, whilst out riding his Harley, simply missed his footing at the road side when he stopped to let a car come the other way. The bike fell on his ankle shattering just about every bone in it to the extent that the doctors wanted to amputate it which he flatly refused. That was perhaps 7 or 8 years ago and I've now lost count of the operations he's had on it since, it's around 10 for sure, plus the post op physio etc., and I don't think they've finished yet.

Absolutely none of the above was life threatning and I wouldn't even want to contemplate 30% of the cost of that lot [:-))]

[cooperlola]

Yup, Ernie, I can relate to that!  I've never been "ill" enough to visit a doctor in all my adult life.  However, I have : Broken my wrist (fell of horse); broken my ankle (fell off stile going to feed horse) and broken my leg (kicked by horse) - notice a pattern here?  I would not care to think what that lot cost and not one of those things was life threatening.  But they sure needed treatment...

The moral of this story is of course : If you're going to risk not having a top-up, stay away from equines![:-))]

[Sprogster]

According to my sister and her husband who are both medical Doctors, broken bones are indeed life threatening, treated or otherwise. Apparently, the major risk arising from a broken bone are blood clots that break away and lead to a lung embolism during the healing process. Sadly, my wife's father died under exactly these circumstances some years ago.

Maybe this is information one would prefer not to know!

 

[Logan]

[quote user="ErnieY"]

Absolutely none of the above was life threatning and I wouldn't even want to contemplate 30% of the cost of that lot [:-))]

[/quote]

Actually Ermie given thoses set of circumstances the CMU would be likely to pay the full cost. It is impossible to judge. However life is full of risk and I personally dislike contributing to something where I don't get value. I have a feeling that Mutuelles in France are simply a method of taxation by another name. Similar to tax habitation/foncieres for which I personally actually receive nothing in return. If you live in France you contribute to the social system. That I can accept. However as I seem to be contributing more and more with every year that passes to the health system I am questioning if the state simply plays on our fears to extract even more. Since doubtless the state gets some form of revenue from them

I have another example. My wife needed a crown recently and she obtained an estimate of 560 euros from the dentist. I contacted the Mutuelle and asked what they would contribute. Back came the answer after waiting weeks and a complicated formula with the pricely sum of 60 euros! I could go on with other similar stories.

Mutuelles are simply a poor deal.

[AnOther]

[quote user="Sprogster"]broken bones are indeed life threatening, treated or otherwise[/quote]They of course mean can be not are, there is a distinction [:'(]

I won't argue that virtually every operation carries a risk, my friends mother died of a blod clot the day after a simple routine varicose vein op, but with mutuelles being such a key part of the French system I simply don't accept that they can get routinely away with claiming every operation was life threatning per se [:-))]

Also, if this were happening the nett gain for Sarkozy and French health system from clamping down on them would far exceed that realised from kicking a relative mere handful of Brits out of CMU and I don't think he is one to miss a trick like that.

 

[Caussenarde]

Logan,

Are you saying that you have the financial resources to self insure yourself, and presumably conjoint, for 30% of the cost of the worst scenario?

Imagine for example, a very serious road accident. I leave you to estimate the cost of this, hospital, ambulance, post accident treatment, home visits.....

If you are sure you have the liquid funds to cover 30% of the total  then fine, you can choose to self-insure.

If you do not, then who exactly do you imagine is going to pay your costs?

[Russethouse]

Logan,  I guess you have already researched that you have the best value mutuelle for your circumstances ?

[Logan]

[quote user="Caussenarde"]Logan,

Are you saying that you have the financial resources to self insure yourself, and presumably conjoint, for 30% of the cost of the worst scenario?

Imagine for example, a very serious road accident. I leave you to estimate the cost of this, hospital, ambulance, post accident treatment, home visits.....

If you are sure you have the liquid funds to cover 30% of the total  then fine, you can choose to self-insure.

If you do not, then who exactly do you imagine is going to pay your costs?


[/quote]

My point is the CMU in general pay for life threatening treatment in hospital. I have paid to be a part of CMU so I expect value in return. In the senario you describe I would expect the costs to be covered 100% by CMU. Not 100% of the tarif convention but the whole cost, apart from the daily forfait charge. I certainly do not expect anyone else to pay my costs. If I take a risk then it's my risk, period. I am suggesting here that the Mutuelles do not give value for money and you don't necessarily need to subcribe to one to live in France. There is another way.  For example a commercial insurer who will cover just hospital costs only which is far cheaper. However common sense tells me that apart from minor aliments anything that requires hospital treatment must be 'life threatening' in nature.

[Russethouse]

Logan, I often agree with you but I'm afraid our common sense take on this matter, is at odds. I hope you do not find yourself, perhaps in poor health and feeling nothing like doing it, having to fight this point.

 

[Caussenarde]

Logan,

When you leave hospital (after life threatening event or not) you get a 'ticket', ie a bill, which you have to pay.

It represents the amount outstanding after deducting the proportion of the cost covered by CMU in your case, typically this is a bill for 20% of the cost of  the hospital treatment.

A person with no Mutuelle or money could  present this unpaid bill as a problem  to their CMU Caisse as a basis for their need for CMU complementaire.

But a person with sufficient resources, who has apparently declined to insure against this possibility (even a probability) should expect, I suggest, short shrift.

I'll leave you to it now, but you can see the situation for yourself at

 http://www.hopital.fr/hopital/vos_demarches/l_hospitalisation/les_frais_d_hospitalisation_et_remboursement

Bon courage, and don't get sick.

[Ron Avery]

As far as I can see the whole basis of Logan's arguement for dropping  the Mutuelle is totally flawed.

As far as I can find out there is no differential tarif of charges for medicines its 0.50€ per carton/bottle etc (perhaps Clare can confirm this) there is a differential tariff for other medical "actes" like blood tests and X rays.

The deductions are done in the same way as they deduct 1€ from your reimbursement for a visit to the doctor ie  CPAM deducts this from your next reimbursement for doctors, prescription items etc   It is different as you don't pay the charge at the chemist at the time, so there is no immediate charge, so its deducted later which is where perhaps the confusion has occurred.

"En pratique, que se passe-t-il à la pharmacie quand j'achète des médicaments ? Le pharmacien me fait-il payer plus cher la boîte ?
Non, vous payez le même prix que d'habitude.  Le montant de la franchise, 50 centimes, est déduit du remboursement effectué par l'Assurance Maladie pour la boîte de médicaments que vous avez achetée.
Par exemple, si vous achetez une boîte de médicaments 10 euros, et que ce médicament est remboursé à 65 %, l'Assurance Maladie vous remboursera 6 euros au final (6,50 € - 0,50 € de franchise).

However, is not getting 0.50c back for a box of pills grounds for dropping your mutuelle?    I have had a reimbursement from my Groupama Mutuelle for everything on a prescription at the chemists that was covered by the CMU, but there has always been are a number of medicines and other items like elastic bandages that are not reimbursable by CPAM and that list is ever growing, more were added in January2008.  So is it CPAM not reimbursing you or your mutuelle?  If the latter, change your Mutuelle.

[Clair]

Ron is correct and as I posted in the OP, the franchises médicales are:

• €0.50 per box of prescribed medication (4 boxes  = €2.00)
• €0.50 per para-medical act (visit by a nurse for an injection + change of dressing + toilet of patient= €0.50 + €0.50 + €0.50) up to a maximum of €2.00 per day
• €2.00 per medical transport (non-urgent transport to hospital in a taxi-ambumlance = €2.00 each way) up to a maximum of €4.00 per day

• €50.00 annual ceiling per person

Source: http://www.ameli.fr/assures/soins-et-remboursements/.../la-franchise-medicale/

This is in addition to the €1.00 fee for participation forfaitaire which is charged on most medical acts.

Details here: http://www.ameli.fr/assures/soins-et-remboursements/.../la-participation-forfaitaire-de-1-euro

What Logan is proposing to do is to pay the ticket moderateur and any forfait hospitalier himself, rather than pay for a mutuelle.

Details here:

http://www.ameli.fr/assures/soins-et-remboursements/.../le-ticket-moderateur

http://www.ameli.fr/assures/soins-et-remboursements/.../le-forfait-hospitalier

This section shows what a patient is liable for. Most of the costs can be covered by a top-up (mutuelle).

http://www.ameli.fr/assures/soins-et-remboursements/ce-qui-est-a-votre-charge/index.php

[Logan]

[quote user="Ron Avery"]

As far as I can see the whole basis of Logan's arguement for dropping  the Mutuelle is totally flawed.

However, is not getting 0.50c back for a box of pills grounds for dropping your mutuelle?    [/quote]

There you go again Ron personalising my suggestions and getting it wrong.[:(]

I am not considering dropping my mutuelle simply for the reason you mention. It was only a catalist which made me re-examine the whole concept. The insurance industry feeds successfully from our personal fears and insecurities. Some is necessary, indeed complusory but most others have another solution. If you calculate how much all your insurance costs over 10 years then tot up the benefits received you will realise just what a poor concept it is. Of course if you are in poor health, accident prone or take part in dangerous pursuits then perhaps a mutuelle might be a good idea. However I am still not convinced. If my argument is flawed Ron you really should please suggest why.

It looks like CMU have overcharged me on the basis of this charge scale. I obtained 4 boxes of medication. 2 were charged at 0.50, one at 1.50 and one at 2 Euros. Very strange. [8-)]

[cooperlola]

Ultimately, it's a personal choice - either you let the insurance company take the risk, or you do so yourself.  If you believe, at whatever age you have reached, that if you put the "saved" premiums in a safe place (and perhaps make a bit of interest or profit on it in the meantime), then you'd have enough to cover any problems, then that's up to you - nobody else.  I wouldn't do it, but Logan may certainly do so.

[Ron Avery]

[quote user="Logan"][quote user="Ron Avery"]

As far as I can see the whole basis of Logan's arguement for dropping  the Mutuelle is totally flawed.

However, is not getting 0.50c back for a box of pills grounds for dropping your mutuelle?    [/quote]

There you go again Ron personalising my suggestions and getting it wrong.[:(]

[/quote]

And once again you are right and everybody else is wrong....... and you of course did not write

" The franchises médicales charge is dependant on the type of drug that is prescribed by your doctor. Some are 0.50 Euros and some are 2 Euros and 1.50 Euros and so on. My last prescription was charged a total of 9 Euros. Since this charge is not recoverable from the mutuelle contract I am now beginning to wonder why I have one.

Logan, quite frankly  get on with it.  You know the risks of not having a Mutuelle, go ahead save yourself a few euros, don't insure your house and contents, save yourself a few extra euros, why have any insurance at all?  ........  but really take care out there and hope all around you equally as careful[:(]

[Caussenarde]

Mistake.

[Caussenarde]

Exactement Ron !!

But please Logan, don't expect others to pay your costs......

[Logan]

[quote user="Caussenarde"] But please Logan, don't expect others to pay your costs......
[/quote]

When on earth did I suggest that?[:'(]

[Helen]

(Slightly digressing from Logan's discussion)

It may be coincidental but many of my medicaments are now being dispensed in larger quantities.  Pills are are in  90s rather than 30s and testing strips in  boxes containing 100 rather than 50. If  the franchise is per box, then for some people, over the year, it would make a significant saving. I remember reading somewhere that the pharmacists were very anti the introduction of franchises perhaps they are trying to cut the charges to a minimum.(?)

 I'll still end up paying 50E but  I really don't mind , particularly  if the money is  ringfenced for Alzheimer's disease and cancer research .  I'm just very relieved to have health care

 

[Clair]

Following from Helen's post, my regular blood pressure med is available as a box of 90 tablets (= 3 months supply), but another daily med is only available as a box of 28.

I pay 1x €0.50 and 3x €0.50 respectively over 3 months, disregarding the unrecoverable charge for the doctor's visit (€0.50 + €1.00).