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mutuelles revisited


mint

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Have been re-thinking my mutuelle requirements.  Admittedly also trying to save some money in case Brexit does send the pound plunging against the euro.  Forewarned is forearmed but only if one is prepared to do some preparation, don't you think?

I am tempted to opt for hospitalisation only as I now have an ALD and all my médicin traitant consultations are prise en charge and also consultations with all necessary specialists.  Admittedly I pay something for the fees not covered by the social security services but they amount to very small amounts and in any case my present policy does not cover those either.  I shall have to factor in the cost of medications not associated with my ALD and they are not frightening.

I know that some amongst us have pic-and-mix policies but I don't really need one of those.  A straightforward hospitalisation only policy would do me very well.

Can you please just give me some thoughts on this?  I'd like to hear your accounts and how you think these policies have worked out for you.  Any recommendations of companies that do this type of policy would also be good.

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I think that you might consider a little more than just hospitalisation.
Don't forget that technically your ALD only covers the specific problem, and   for example similar specialist consultations for something else would not necessarily be fully covered.

I went for hospitalization, medicine de Ville, and for things you get from the pharmacy

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Mint wrote : .. all my médecin traitant consultations are prise en charge ..

OH has a couple of ALDs but, even so, he pays his mt for each medical appt and then receives a reimbursement either at the normal rate or at 100% depending what category the problem came under.

If you are really healthy apart from your latest horrible experiences then you might well be ok with hospitalisation only but, if you are not, then Norman might well have a valid point.
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Thank you for your thoughts.

What is medicine de ville, Norman?

Sue, I don't pay for ANY consultations with my Médicin Traitant or her colleaque when she isn't there.  I have even been with OH and they would only take 25 euros for him and none for me.

Went to the hospital to see a specialist for something totally unrelated to my ALD and, when I asked for the bill, she said she was putting me on 100%.  Well, I didn't argue the toss!

I have noticed that some items, including some types of bandages, are now completely non reimbursable and some services such as my LPG kiné sessions require a contribution from me which I was told that neither the security services nor any mutuelle would pay.  I shall contact our mutuelle and see if the reduction in premiums make a change worthwhile.

Thank you again for your input.  It's always good to get another view.

 

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I suspect that living in the country you still benefit from the kind and somewhat lax attitude towards the use of the ALD system that used to prevail, but I am not convinced that this will last for long and I have already noticed the change of attitude here in town.

Technically you should have an ordonance bizone 

with the things relating to your ALD on the top part,

Quand

vous êtes « en ALD », le médecin que vous consultez utilise une

ordonnance particulière : « l'ordonnance bizone ». Elle lui permet de

distinguer les soins et traitements en rapport avec votre ALD et ceux

liés aux autres maladies. Elle se compose de deux parties :

  • Une partie haute, réservée aux soins et traitements en rapport avec votre ALD. Les

    soins et traitements prescrits dans cette partie sont pris en charge

    avec exonération du ticket modérateur : médicaments, examens biologiques

    et radiologiques, soins infirmiers et de kinésithérapie, dispositifs

    médicaux, etc.
  • Une partie basse, réservée aux soins et traitements liés aux autres maladies. Les soins et traitements prescrits dans cette partie sont pris en charge aux taux de remboursement habituels.

Important : afin que le médecin puisse utiliser

correctement l'ordonnance bizone et que vous soyez bien remboursé, il a

besoin de votre protocole de soins pour savoir ce qui est ou non pris

en charge au titre de cette ALD.

 

I know that I am a bit of a worrier, but with all the cuts that are being proposed by the Macron government I can only imagine but there will be a push to apply this more and more strictly as ALD treatments represent a huge part of the budget. Here in town I have already noticed it, and the person who takes me in a taxi to my appointments is finding that the social security are being  more and more difficult.

In so I think we should be prepared for the day when more and more is

pushed over to the Mutuelles to pay. Don't forget also that the ALD only lasts 5 years before it has to be re-newed.

As for Medecine de Ville it is all the " médecins généralistes et spécialistes, les

chirurgiens-dentistes, les pharmaciens, les sages-femmes, les

infirmiers, les masseurs-kinésithérapeutes, les pédicures-podologues…

Ces professionnels, libéraux ou salariés, exercent à titre individuel en cabinet, en groupe ou de manière coordonnée en maison ou centre de santé."

i.e all the non-hospital appointments

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The old barrel dweller is right about the bizone stuff and about renewal of ALD every five years. Have had both, but it is not a problem.

There are far too many ALD people so the government says, hence the need to reduce them. My guess is that it might become conditional where possible. For example, type 2 diabetes ALD might be conditional on weight loss.
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Hm......thank you for your further replies.  Yes, I guess it might be as well to cover all bases, so to speak!

Norman, yes, I get the bizone ordonnances.  But the consultations themselves are always prise en charge; I suppose it's difficult to disentangle what consultations are necessary for the ALD and what are for "other" illnesses[:)]  Human bodies come all of a piece....no cherry-picking as M. Barnier might say[:D]

Indeed, my doctors and specialists border on the indulgent; the other point you make in your post.  I quite often get things OK'ed and agreed with little fuss or even questions.

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Even having ALD cover only means refunds up to the 100% level. If a consultant charges more than the standard rate you would need to cover the extra.

There is a lot of pressure on the French social security budget and most hospitals are in deficit and there have been discussions to reduce costs including tightening up ALD rules, etc.
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Have found a competitive mutuelle.  The name is Smatis [:D]  Has anyone heard of/used these people?  Any info gratefully received.

Not vastly cheaper but by about 400 euros which is sufficiently interesting to me.  But, as they say, le diable est dans les détails so I am checking this out as best I can.

Thanks

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Check out ‘sole occupancy’ hospital (or clinic) cover.

It can (not everywhere of course) be as much as €45 / day and even more in Paris. We found to our horror that our mutuelle provided no cover, so when Mrs G was hospitalised for 6 months, we were faced with a hefty shortfall.

We cried “Foul” because the insurer had changed the terms somewhat surreptitiously - they agreed to cover it if we upped the policy. Not a big problem for a very short stay, but it would be for most of us for anything much longer than a fortnight.

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45€ a day is very modest..I don't know any that are that inexpensive round here..

en moyenne, une chambre particulière est facturée 45€ par jour mais

certaines cliniques peuvent faire grimper la note jusqu'à plus de 150€.

[:-))]

I was in the Millibnaire in Montpellier recently and it was 72€ for a room with a balcony covered in pigeon droppings...there was even an egg...

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My room was 55€ a day and I was told on admission that my mutuelle did not cover that and asked if I still wanted it.  I said yes as it was only for 4 days.  When it was time to leave, there was in fact no fee.  I took it that the mutuelle paid up but it could be that the surgeon said that I had to have a single room (so medical reason).

Then, I had to stay one day for day surgery and I again requested a single room.  The hospital mixed up my booking and, by the time they checked with me on the day before admission, all the single rooms had gone.  So nothing to pay again and I didn't mind as it was a simple op under local anaesthetic and I was neither frightened nor incapacitated and spent a pleasant half a day with my room companion.

Gardian I remember you telling us about that episode of the hospital and I am glad to see that the new proposed mutuelle will pay for a chambre particuliere.

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Personally I'm not bothered at all about a single room so I wouldn't bother to insure for that. I have an ALD for an autoimmune disease and here they are quite strict about only reimbursing things related to that.. All other medication I pay the difference for myself..so my influenza vaccination was only reimbursed partially so I think it cost me around 12 euros plus a small fee to the nurse to give the vaccination. (If I was brave I could have done it myself). So all in all, at the moment the extra costs I pay for medication are way less than any contribution for a mutuelle. When I went to see a specialist I did end up paying a little extra, as not all the charges were conventionee , but it only added up to about an additional 20 euros.. I do plan to get a hospital only policy to cover the basics for any unexpected hospital admissions as I'm getting older, but I'm not convinced yet by anything more comprehensive.
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Well reasoned and I was also thinking along those lines myself.  They give me all sorts of things including a bon de transport when I request it.  I do not abuse that and OH runs me in if the RVs are not too close together.  Trouble he is really getting on now and I myself have not driven since last year so do not have the confidence to shoot off to Périgueux.

I do have asthma and the monthly cost of those drugs amount to 25€ plus a month (the mutuelle's contribution) so I have definitely decided on the same cover as I have had for 11 years or so.  Besides, after last year's bronchitis which went on for several months and necessitated numerous visits to the MT, I think I shall have less worry just paying up.  The new mutuelle being some 400€ cheaper has definitely sweetened the pill.

Thank you, everyone, for your continuing good advice, thoughts and suggestions.  If anyone should know Smatis, please do say something?[:)]

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[quote user="You can call me Betty"]Gosh. Whatever its perceived faults and flaws, the NHS is a lot less complicated![/quote]

Yes, it is, in many ways.  OTOH, I like the choice I have here in France.  This is something I have only been convinced about since my illness last year.  Before that, I never had much chance to "sample" the French system and, from an outsider's viewpoint, I was totally unconvinced of its efficiency.  Now I have (literally!) bought into the system!

What is horrific is the American system.  I have recently joined a forum dedicated my type of rare and very vicious cancer and I have nothing but utter compassion for people who have to ask on a forum for recommendations for cancer specialists, to reflect before committing to this or that cancer centre on the basis of cost, to choose to have chemo, radiotherapy and other therapies also on the basis of affordability and all sorts of services to which we have for so long taken for granted.

Then there is even the more specific but potentially life-saving timings of when to start, receive and stop treatment.  People on the forum are asking for optimum times for starting say, radiotherapy, and would it be OK to delay it for a few months until they could get the money together.

And talk about distances.....hell's bells, it was, well I could fly into town x to see someone in hospital y so could someone recommend somewhere to stay? 

Not to mention all the different studies that conclude that this and that type of test, treatment and drug have been shown to work and very ill people being expected to discuss these findings with their doctors.  It's enough to do your head in, if you were in full health and the sheer fear and helplessness of some of the posters could only be inferred from their board messages.

This forum, by contrast, is a veritable calm lake with the mere whisperings of the occasional ripple[:)]

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So true, mint. I'm just grateful that, warts and all, I'm never going to have to decide if I can afford healthcare. At least, unless that changes in my remaining lifetime, which I accept is not outwith the realms of possibility. And if I were to feel thus inclined right now, I could pay for private insurance and have the same choices enjoyed by those in other countries at ( it seems) somewhat less cost...both to my pocket and to my brain!

Good luck with your research and of course I wish you the best of health.

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So I am told, Nimt, so I am told.

By the way, when you start choosing a new mutuelle, beware of them offering stuff you might never need, such a opticians fees, dental fees and others. These often seem to put the premiums up.

Something around €60/70 per month might cover just about everything but you need to go through it with a fine tooth comb.

Some might want you to wait up to 6 months before any claim.

Remember that they do not have the right to know any preexisting conditions.

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