Jump to content
Complete France Forum

Reimbursement of charges - Tiers Payant


Daft Doctor

Recommended Posts

Hi, currently waiting for Carte Vitale but have attestation from CPAM.  Also now have mutuelle cover with 'attestation de tiers payant santé'.  Just wondered what the mechanism of reimbursement would be for me at the prior to getting my carte vitale if I needed to see a Dr?  I assume I pay over the cost directly (say 23 euros for a GP).  For the part reimbursed by CPAM I send off the feuille de soins to CPAM and they pay me (? by cheque or direct to bank).   Regarding the amount covered by the mutuelle, how does that work, do I send a copy of the feuille de soins to them also?   How does the tiers payant thing work and how does reimbursement differ once a carte vitale is received?  Any insight much appreciated, I'm struggling to get my head round this a little!   
Link to comment
Share on other sites

The way the tiers payant works is explained here in French, so you have the official version

http://vosdroits.service-public.fr/F167.xhtml

In practice it avoids paying out in advance in certain situations, such as while you are in hospital or in a work accident  but not in others such as visits to a GP or an X ray.

In my case (I am covered at 100% for my regular medicines) I don't have to pay any thing when I go to the Pharmacy either

this is explained more fully

http://www.ameli.fr/professionnels-de-sante/medecins/exercer-au-quotidien/feuilles-de-soins/la-pratique-du-tiers-payant.php

For example normally you pay the Doctor, and give your carte vitale to be swiped through a reader.

After that reimbursements follow automatically and relatively rapidly, as the CPAM and Mutuelle are in contact.

If you have given the CPAM a RIB it is sent direct to your bank account.

As has been said before the carte is just a piece of plastic which speeds thing up in this electronic way.

Until you get it you need to send off the feuille de soins.

It would be advisable to send a copy to your Mutualle but it shouldn't be necessary in theory.

The carte vitale just is a sort of e-communication, it doesn't change the basic process.

Link to comment
Share on other sites

You never send a feuille de soins to the mutualist. You would send them the statement from the CPAM which shows clearling, what was spent, and how much it was reimbursed.

You need to ask your mutualist if they have been in contact with the CPAM and have you linked up with them. Or send the CPAM a copy of your mutualist contract?

At your pharmacie, I think that you would have to show them a copy of your mutualist contract too, even with the carte vitale, IF they will accept it, as our pharmacie didn't take all mutualists. And some people would have to pay the difference between the carte vitale and actual cost, they would then send the CPAM statement to their mutualist.

 

Also as I mentioned some time ago. If you have a prescription and you are having to do things manually, as you will be at the moment, you must take the vignettes from the prescription and stick them onto the feuille. Some pharmacies do this, others don't. And if you don't, and no longer have them, then no one will reimburse you, as if the CPAM doesn't, then neither will the mutualist.

 

You may have some teething problems. What I will say is, and it is a general rule, keep photo copies of everything before sending it off.  AND look after that CPAM attestation.

Link to comment
Share on other sites

It's worth shopping round the pharmacies to find one who will take your mutualiste, because it makes everything easier in future as you'll only pay any excesses (stuff not covered by CPAM or the top-up). In France it's expected that you stick with a pharmacy - when my husband was taken to hospital I was asked which was our pharmacy and which nurse we used (none until then!)
Link to comment
Share on other sites

[quote user="Daft Doctor"]Thanks again Norman, that's pretty clear.  If I don't send off a feuilee de soins to the mutuelle, how will they know I've been to the doc?  Cheers[/quote]

If you gave your Social Security number to the Mutuelle when you took it out what happens is that you go to the Doc, pay him and send off the feuille de soins, or once  you have the piece  of plastic that happens automatically, then the CPAM sends a message to your Mutuelle by 'téletransmission'  which activates that part of the process.

It is all fairly automatic.

Link to comment
Share on other sites

Remember too that you won't get back all your 23€

When you pay out to the Doctor this is one of the rare times you actually pay out, so the CPAM takes out of the repayment all the little charges that you have to pay, but which you don't actually pay for at the time, such as the 50 cm  franchise médicale per box of medicine, or the forfait of 1€ on consultations, blood tests or X rays.

So suppose you go to the Doctor with a cough, and you are sent for an X ray, a blood test, and prescribed 4 boxes of tablets (easy with Doliprane 500mg being packed in 16 a box)

Of the 23€ you paid you would be reimbursed 16.10 but

minus 1€ for the consultation, 1€ for the bloood test, 1€ for the X ray and 2€ for the boxes of tablets, so your  final amount paid back is only 11.10€

There are certain limits to how many of these charges can be made at once

La franchise médicale s'applique pour chaque acte mais elle est

plafonnée à 2 euros par jour pour un même professionnel de santé et pour

un même patient.

Par exemple, si la même infirmière passe le matin

et le soir pour effectuer trois actes pour le même patient, la franchise

médicale ne pourra pas excéder 2 euros pour la journée même si ce sont 6

actes qui ont été réalisés.

http://www.ameli.fr/assures/soins-et-remboursements/ce-qui-est-a-votre-charge/la-franchise-medicale/la-franchise-medicale-sur-les-actes-paramedicaux.php

The Mutuelle cant pay these charges although it will top up the 16.10 to 22, but that still leaves he 'hole' in the payment you et back from the CPAM.

Your account can be seen online

https://assure.ameli.fr/PortailAS/appmanager/PortailAS/assure?_somtc=true

where you can follow this each month.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...