Percentage coverage Carte Vitale

[frexpt]

Just wondering whether anybody knows (roughly) what percentage of the cost of a hip replacement operation in France is covered by the Carte Vitale?

[YCCMB]

Looking at an article published in Le Figaro, it appears that the cost over and above that covered by the sécu varies by region, so any answer you get from someone outside where you live might not be valid for you.

Le Figaro also published this simulator, if you are able to try it in French, which gives the supplementary fees for 150 common operations. It also seems to take into account where you live. I haven't checked if it works for a hip replacement but you can try!

http://leparticulier.lefigaro.fr/jcms/p1_1509864/simulateur-de-depassement-d-honoraires-en-chirurgie

[nomoss]

You can get the charges for any hospital, service, or doctor etc. on the ameli site - https://www.ameli.fr/

After selecting your "caisse", by entering your post code, you choose "annuaire santé" by hovering over the coloured list on the RHS and clicking the stethoscope image.

You can then use the search facility presented to find a professional or hospital, together with charges.

Sorry I can't give you this information in English.

[pomme]

You will not really get a useful percentage. The refunds are based on the standard tariffs available for your region on ameli.fr. But hospitals, surgeons, anaesthetists, etc. may all charge a higher amount and any refund will only be based on the standard tariff.

This page indicates 77.3% of hip operations were charged at more than the standard tariff with an average being 113% and a maximum of 300% (from 2016).

This page gives an indication of costs for one establishment: (Base remboursable 489€ à 732€, le complément

est à la charge du patient ou de sa mutuelle de 400 à 1000€ selon prise

en charge)

You will get a more realistic idea of costs by identifying where you want the operation to be done (hospital/private clinic, etc) and then get the surgeon of your choice to give you an indication of the hospital room, surgery/anaesthetist, after-care charges together with the corresponding Ameli refunds.

You might find this article useful: Chirurgie: quel reste à charge pour le patient. Je vais prochainement me faire opérer de la hanche.

[nomoss]

It might be worth noting the remark contained in pomme's third link:

"Un conseil: recherchez les tarifs pratiqués par l’établissement où vous projetez de vous faire opérer sur le site le l'Assurance maladie ameli.fr"

[frexpt]

Thanks for the replies.

I had a replacement done in France a few years back before we were resident, but that was paid for in its entirety by the NHS under the Article 56 provision.

Much cheaper than the cost of the op in the UK and one less person on the NHS waiting list. A very convenient arrangement for everyone.

I am now anticipating the other hip may need to be done somewhere down the line and looking for what might be the most cost effective option.

[pomme]

frexpt: If you are happy with the first replacement perhaps you should consider contacting the same surgeon/hospital. I'm not sure "most cost effective option" would be my highest priority.

[Judith]

I am still trying to work out how much I paid myself for my hip op last year, but as I took out a top up mutuelle entirely for that reason, its not entirely easy.  It wasn't a huge amount. My surgeon (I would highly recommend him to anyone in this region, and he speaks English pretty fluently, I'm sure he worked in the States, but it all went perfectlyt as planned ..), is certainly sector 2, but as far as I can see all the op costs were covered ... but I am not sure whether that was the state / CPAM / CV or whether it was the mutuelle.  But I suspect it was the CV. The mutuelle covered the surgeon's "extra" fee. Transport was certainly covered, plus the clinic after and the kine at home.  Only had to pay for the extra bed bit for the hospital and clinic, single room choice, and something else small but I cannot now remember what.  Maybe not what you wanted to hear, but certainly no reason why the CV would not cover the 65-70% as usual ...