Médicine Traitant

[Lori]

Can anyone tell me if a Médicine Traitant has access to all your records on Ameli?  Meaning he/she can see all your doctor visits (who you saw), treatments (what you were diagnosed with), prescriptions, etc.?

Just curious how this works.

Thank you.

[NormanH]

The MT will usually have a copy of all the results of visits to specialists hospitals x-rays and other examinations etc. They are sent to the MT as well as to you.

The MT will keep a copy of prescriptions also.

That isn't from Ameli, which deals with the finances, it is between the MT and the various places you were sent to.

There is something else the DMP, (Dossier Medical Partagé) which SHOULD give access to all this  to any Doctor or Hospital but as yet it is only in a very rudimentary stage and not really working as intended.

Copy from another thread:

Re: carte vitale and ALD

I keep mine (reasonably up to date) on a USB Stick, but of course IF the Dossier Médical Partagé worked as it should it shouldn't be necessary. But it doesn't I have also made a 1 page of A4 summary with details (organised into different sections) of : 1) major illnesses with dates of signifcant events in reverse chronological order 2)Contact details of the relevent specialists I see 3) A list of my current medicines 4) Up to date results of coagulation and most recent cancer marqueurs I keep a copy in my wallet in case of an accident or emergency, and can always give a copy to Doctor I haven't seen before at the first appintment Of course I also have a much fuller 'dossier' I can give if needed, but this list has been very useful on many occasions, cutting out a lot of questions and answers

[Lori]

Thank you Norman.  So, if I understand correctly, if you walk into a lab/doctor office and do not give your carte vitale (pay in cash) - let's say you don't have one, no one gets a copy of whatever you had done?  Except, of course, the lab or doctor and I have no idea if they would actually keep these records under this type of circumstance.

[NormanH]

If the MT had given a prescription then a copy of the results would go back.

If there is no prescription as I think can happen for some Covid tests at the moment and also can happen in some AIDS testing centres then only you would have the results.

Remember that for some things you are supposed to pass by the MT

https://solidarites-sante.gouv.fr/IMG/pdf/parcours_de_soins_coordonne_a_l_hopital-2.pdf

and if you don't you might not be reimbursed or for a lesser amount

[Lori]

Yes, I understand that about the Parcours de soins and that a MT needs to send you to other doctors (with the exception of the GYN and the Dentist - and a couple more that we never see) or you may only get reimboursed 30% or not at all.

I'm really just trying to understand how the entire system works as it is quite different from anything we have had in our lives.  Hence some of my weird questions.

Thank you for helping me.

[mint]

Went to my new MT yesterday evening and not only was he new to me, he seems to have been new period.

No, medical details are not visible using your carte vitale.  He told me that only authorised people could see your medical details which are all on your DMP, as explained by Norman.

As I wasn't yet registered with him, he couldn't see anything and I had a very dreary time telling him about my illnesses and medications.

Because of my cancer, I do have a paper file given to me by the oncologue on which I fill in all the dates and notes of consultations and procedures.  Also, if I have had some treatment, surgery, rayons, etc I always ask for a copy of what they have done and I file that in this dossier.  My previous MT also gave me a copy of all the letters she had received regarding my treatment but they tell me nothing more than the reports from the specialists so I just stick those in a corner of the drawer designated for "medical" stuff.  Said drawer is getting awfully full and I will have to find another, bigger repository for my "life in illness".....yuck!!!!

If you consult anyone and you think the findings might be important, it's prudent to just make a note and write down brief details.

[NormanH]

Lori

Your questions are not at all 'weird' and it is very useful that you ask them as it can help others.

We 'oldies' in the system can forget what is it like for those just getting in to it..

[Lori]

Thank you Norman.  I'm sure I'll have more questions to come.  I've done a LOT of reading and yet some things are still not totally clear to me.

One thing I see is that Dental and Optical care are not really covered by l'assurance maladie or so little covered as to be what I'd say is 'not really covered.'  It is looking like the hearing aid coverage is also poor to nothing.  It is very similar in the USA.

Here, I am learning that even mutuelles don't cover these things very well either.  I suppose you could buy some sort of Mercedes Benz mutuelle, but I don't think I could afford such a plan anyway.  Not likely I'd use the money that way anyway.  So, the year when you need a crown, you simply set aside the cash to get it done.

[NormanH]

That is why I like the 'modular' Mutuelles where you can choose the level for each section rather than having a 'one size fits all' approach.

That said  there is a much better level of cover included in the basic Sécu for certain things:

"Depuis janvier 2020, le 100 % santé est mis en place et permet un meilleur remboursement grâce au respect du contrat responsable."

https://www.service-public.fr/particuliers/vosdroits/F33956

and

https://www.ameli.fr/herault/assure/remboursements/rembourse/soins-protheses-dentaires/soins-protheses-dentaires

[Lori]

Yes, I read about the 100% Santé.  I found it very vague with regards to exactly how much and to what detail things are covered.

[NormanH]

The second link showed some worked example but you might not be able to open it as it was for my departement

[NormanH]

https://www.ameli.fr/herault/assure/remboursements/rembourse/soins-protheses-dentaires/soins-protheses-dentaires

[Lori]

Yes, it is the same rates for us here.

But, for example:

The devis for my crown shows what the tarif de convention is, what my dentist charges, what's left for me and the R.O. which I presume is what CPAM reimburses.

                                    Charges       Tarif de convention     A charge       Montant R.O.

Depose old crown                   100,00                    38,70                  72,91              27,09

Temorary crown                      140,00                    10,00                 133,00               7,00

Inlay Core sous couronne

ceramique                                 340,00                    90,00                277,00              63,00

New crown & Pose                   790,00                  107,50                714,75              75,25

Sorry for the mish mash of languages.  I could not manage to copy this portion of the devis onto the thread. 

Honestly, this is not a lot different from prices in the U.S.  However, 'most' private health plans cover 50% of the costs.

Even when we lived in Provence many years back, the cost for a ceramic crown was 1000 euros.

If we had the mutuelle that costs 1800 per year, it would pay 250€ total for the above work.  There is also a 300 euro desinfection work on top of the above.  He says CPAM and mutuelle would cover that.  But, we don't have a mutuelle so we'll pay the price....

[Lori]

Sorry for the layout.  It doesn't look like that when I edit it, but I can't seem to correct the layout here.