Diabetics

[billy10]

I am a type two diabetic and control my diabetis by diet, I do have to take other medication to keep my cholesterol and blood pressure down which in turn helps my diabetis control, will I be eligable to get any medication I need free of charge or does that only apply to type one isulin dependant diabetics. I intend to move to France shortly and I will be 3 months short of 60 years old when I go.

[Val_2]

Suggest you ring Newcastle to find out your rights as it is not automatic in France and you would probably need to take out a top up cover as well. Each CPAM has it's own rules and regs according to them regardless of a universal system.

[Sunday Driver]

Both type 1 and type 2 diabetes are classed as long term illnesses (affections de longue duree) and therefore qualify for 100% reimbursement of treatment costs.  This should include the cholesterol and blood pressure medication if it is part of the diabetes treatment.

When you arrive in France and register with your state healthcare insurance bureau (CPAM) you have to nominate your medecin traitante (GP).  He will arrange the necessary consultations and treatment for you and he will write to your CPAM recommending you be classed as an ALD.  

Your 100% reimbursements will only apply to the treatment of this specific condition, so if you need your piles sorting out, you'll only receive the normal 60-70% which means you'll still need to purchase top-up cover.

The CPAMs do not have their own rules and regulations.  Article D322-1 of the Code de la Securite Sociale defines thirty medical conditions which are classed as affections de longue duree.  You can find full details of these on the French healthcare [url=http://www.ameli.fr] website[/url].

[Owen]

Hello SD,

I think you have been harsh with Val 2 and her comments about CPAMs. What she means (I think!) is that CPAM offices can and do differ in their interpretation and implementation of laws. I would certainly agree with that.

You need to be careful when quoting the list of 30 serious conditions that can qualify for 100% cover. A case still has to be put up by the médicin traitiant to CPAM for approval. So even if a serious disease has been diagnosed it may not qualify for 100% cover if, for example, it is in its very early stages. And certainly in the case quoted, 100% cover for the cholesterol and blood pressure medication would need to to be judged on the clinical records of the individual patient even though this medication in turn helps treat the diabetes.

Regards

[email protected]

[Sunday Driver]

I felt it would be more helpful to offer Billy10 a brief explanation of the French system and point out that type two diabetes was listed as an ALD.  I did include the proviso that his medecin traitant would have make a recommendation in order to have his condition classified as such.  As you rightly point out, the clinical opinion needs to support this for the classification to be approved.  On that basis, it's not so much local rules/interpretation (eg, CPAM "A"doesn't cover diabetes but CPAM "B" does) but more adhering to the national clinical guidelines.

I also included a link to the official French healthcare site so that Billy10 could read about this further.

Val 2's brief response about ringing Newcastle for advice and her comment about each CPAM having their own rules regardless of the national regulations suggested to me that she might not be too familiar with the French setup.  If my response came across as being harsh, it wasn't intended that way and I apologise to her.

[Val_2]

It was meant in the context that each office interprets the rules itself and as for experience - 17 years enough? Apolgy accepted and as you know,it isn't easy to express things on a computer in the sense of how you would tell it verbally. Have a nice weekend and keep posting.

[Poppy]

I agree each CPAM interprets the rules itself. Latest from our local one is that you cant apply to renew the European Health Card until after it has expired. Would the fact that we asked at 11.55 am have anything to do with it. [blink]

[La Vette]

As someone with high cholesterol and bp I registered with a doctor fairly quickly.  His routine testing discovered I am also type 2 diabetic.  You do not automatically get everything related to the diabetes free, your doctor has to write to the CPAM and request their consideration of your condition.  Diabetes is definitely a Prise en charge 100% (100% free condition) and you will receive a letter to this effect.  Take this letter and your carte vitale into a pharmacy (or CPAM if you are near) and ask for mettre a jour (for them to update it).  After that anything to do with your diabetes is free ie annual eye test, annual cardiology examination and all your medication.  However, your bp and cholesterol tablets will still have to be paid for even if these conditions could impact on the diabetes, I take Simvastatin, Atenalol and a diuretic at a cost of 27 Euros each month.  If your diabetes is controlled by diet then the medication costs do not apply to you.

Dont waste your time with Newcastle, they do not understand the French system.  If you need more info call the english speaking CPAM line on 0820 904 212 (if you are in France) - someone gave that number to me on this site and it was a god send.

[Sunday Driver]

[quote user="Poppy"]I agree each CPAM iterprets the rules itself. Latest from our local one is that you cant apply to renew the European Health Card until after it has expired. Would the fact that we asked at 11.55 am have anything to do with it. [blink][/quote]

Sorry, local health insurance bureaus don't just make up rules to suit themselves.  You mention this latest rule from your local CPAM - but it quite clearly isn't a rule at all!  It's just an excuse made by one member of staff at your local office, fobbing you off because you suspect they wanted to knock off early for lunch.  You really can't attribute this individual's comments as being local CPAM policy.

The procedure, as published by the health insurance service, is quite straightforward. You should apply to your CPAM for your European Health Insurance Card at least two weeks before your departure, given the time it takes to manufacture and post out to you.  They also say if you cannot obtain it in good time, your CPAM will provide you with a provisional replacement certificate. There is no requirement to wait for the existing card to expire. 

By their very nature, large organisations like CPAM have very precise policies and procedures to follow.  If a particular member of staff misinterprets those procedures or provides misinformation in order to avoid doing their job, then it's a matter which should be reported to local management.

[Poppy]

Unfortunately  Sunday Driver we have found they do suit themselves, after 16 years in France I can tell you some stories. On the serious side unless you know better it is difficult to gauge whether you are being misinformed or not. In addition if you do make a report to management what happens on your next visit.

We find the best approach is to go with a suitcase full of all your papers including the pets death certificate [:D] hopefully have all your facts correct and stand your ground with the person interviewing you. Most of them are very helpful but as everywhere there are the exceptions.

The CPAM Helpline we have always found to be very efficient and polite.

[Sunday Driver]

Poppy, I think the point that you are making is that it is individual people who get things wrong - for whatever reason, ignorance, laziness etc.  I do take your point that most are good although there are the exceptions (as you found out recently!). The CPAM helpline is a good example of a helpful and accurate service.

What tends to confuse matters is when people interpret posts like this as inferring that the official rules change from CPAM to CPAM.  That's clearly not the case.

[Poppy]

Sunday Driver I totally agree with you that universal official rules don't change from CPAM to CPAM  but locally the interpretation does. Have you never been on the receiving end of the French shrug. I was trying to point out that you often need to be in full posession of all your facts and paperwork.

[Sunday Driver]

You're right.  And that's where this forum works really well in preparing people for those kind of situations. 

If someone posts a query asking for information about what appears to them to be a complex situation, they can receive a detailed explanation of what the requirements are, where they need to go, and which documents they need to take with them.  After the event, they often post back to say how easy it was after all.  In most people's experience, turning up somewhere with everything that's required usually gets a positive response. 

Yes, turning up with no idea and no papers, then not understanding what they're being told to go away and do, would more than likely get the "shrug" (I'm not meaning you, by the way).

 

[pigeonnier]

I would seem to be in a similar situation to Billy 10 as I have type 2 diabetes, hypertension too. Have an E121 as I'm 62 and my wife is over retirement age. My medication for the above plus uricaemia is totally 100% covered plus any inpatient treatment necessary (including day stay) is also 100% funded.

My wife pays the usual prescription charges but any in patient treatment is also covered at 100%. She has recently had two cataract operations for which the total cost to her was 14 euros (two eye patches!). All consultation fees were refundable as well.

HTH

Bob

[Will]

[quote user="Sunday Driver"]

The CPAM helpline is a good example of a helpful and accurate service.

[/quote]

Not necessarily, although many people have found the service very good, I have had some extremely unhelpful and inaccurate information from that source.

Officials do often give wrong or misleading advice, often due to them wanting to avoid work, or not to appear that they don't actually know the answer without looking it up, or just through dislike of non-French nationals for example. They are far less accountable than in Britain, best thing to do is just to ask again in another office or on another day if you get unhelpful advice. It's seldom any use complaining, as fonctionnaires will tend to stick together. The situation isn't helped by the myriad guidelines and directives that can be found to modify the rules, and can often be used to justify obstructive tactics or contradictory advice.

As to whether 100% refunds apply to any condition, this is, as SD says, not automatic, even when the condition appears on a list. The 100% has to be recommended by a doctor, and approved by the patient's caisse (which may not necessarily be CPAM, though for most forum users it is). It seems that being in possession of E121 form can, in practice, make 100% refunds more likely.