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Mutuelle - Check your Cover


Gardian

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Mrs G has been in hospital for a month and has just been transferred to a Rehabilitation Centre and will probably be there for a further lengthy period.

The purpose of this thread is not to regale you with our woes, but to extend a warning to do what the thread title suggests.

Whilst in hospital, there was no problem - most of the time, she was in Intensive Care, which by definition is single room. However, on transfer to Rehab, I was told by their Administration that our Mutuelle wouldn't pay for a private room. I checked all my paperwork and found to my horror that two years ago, they had 'moved the goalposts'. The Formule was changed, removing completely the private room benefit. They had the cheek to say that "Your benefits remain virtually unchanged". Oh no, they weren't.

I cried "Foul" and they have agreed to allow me to upgrade immediately in order to get what we need. I shan't bore you with the details of the numbers, but suffice to say its a minute fraction of what we would have been faced with. A cynic might suggest that they're the winners because I'll probably stick with the upgrade for ever, but I couldn't possibly comment!

OK, I should have been more careful and carry some of the blame, but I've more or less got away with it lightly. Please take the advice and assume nothing.

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Thanks for the warning, Gardian.

Our mutuelle is the basic one, no frills , so I don't expect a lot from them.

But I was pleasantly surprised when they reimbursed my husband for most of the cost of his new specs - we thought they weren't covered?

Wishing your wife a speedy recovery x.

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You are quite right to raise the issue.

I was caught out in 2011 with my previous Mutuelle who refused to pay for 2 months in a private room in the convalescent clinic.

They argued they only covered this in the actual surgical word in Hospital, but not in the follow-up (known as 'réaducation et soins de suite', this despite the care being directly related to the operation (a stoma bag amongst other things).

It came down to hair-splitting over nomenclature, but I ended up paying over 3000€  at a time when I was feeling very low.

Obviously I changed my Mutuelle, but as you say they 'change the Formule' each year and it can be hard to keep track.

On a single room I believe if you can wangle it that they decide to give you one unasked (which seems to happen surprisingly often) or your Doctor   decides it is needed for medical reasons you aren't charged.

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Thank you Gardian for alerting us to this, especially as you're obviously under pressure yourself. Wishing Mrs G well and hoping that she makes a good recovery. I've come to the conclusion that as one gets older we must savour each and every day as nobody knows what's around the corner. Look after yourself too.....
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I remember NH mentioning this. Our mutuelle was via work, so what what it was, fortunately it wasn't too dear either.

Just wondering, how much are you all paying per month? If we had stayed in France, ours would have been 160 Euros a month!

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At last renewal our combined mutuelle was about 1880 euros per annum. I must admit that we don't pay for private room automatically. Each time either of us has been in hospital for a few days I pay the extra for a private room but other half prefers the company so goes for shared room.
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I'm quite sure that quoting numbers of euros / month for one's Mutuelle is a futile exercise.

You'd have to do a 'Which Guide' exercise to ensure that you were comparing apples with apples.

What matters (which was the point of the thread) is that you're covered for what you believe you might need, at a price that you're comfortable-ish with.

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Guardian,

Useful reminder.  Also useful to find one in which you can change your cover as required.  For example, this year I went for the highest I could, as I have had a hip replacement, (all went well) and knew there would be lots of extra expense.  Another year, I might not go for the highest cover, and hope I don't need it.  Until this year, I did not have a mutuelle at all, and paid the difference, which was not bank-breaking for us.  But hip ops don't come cheap, so decided to be sensible, and I am already sure that it has paid off for me.  I was prepared to pay for the single room on top, but on the whole, it seems to have been covered, though I did not think it was.  So nice surprise there.

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I am sorry that your cover was not initially for convalescence Gardien, and pleased that you could change it.

Money does count though, and something often forgotten in budgets for those living in France. I was told by someone from work that the retraites, got a good deal at 160€'s month, and it would be dearer elsewhere.......

Years ago I would bang on, on here about cover and the importance of 300% cover for medical things,  and in spite of that, that cover was very hard to understand.

I know this, as in all my years, I never understood our cover. OK it was sorted out via work, but every year they renegociated contracts, and sometimes for such as dental or optical, it was a % and sometimes it looked like a sum was involved and sometimes both,  often, but not always, including the Social Security baremes, as if any of us all those years ago could easily find out what they were in the dark ages.

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