woolybanana Posted March 4, 2012 Share Posted March 4, 2012 A question for the wise, svp.Where one has an ALD, are medical visits and lab tests reimbursed at 100% by CPAM, as with medication? Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 Yes Link to comment Share on other sites More sharing options...
woolybanana Posted March 4, 2012 Author Share Posted March 4, 2012 Thank you, Norman. I wonder why my last visit to the doc was only reimbursed at €10.60, then? It may have been that the ALD paperwork was still in the pipeline, even though the doctor handed the requisite authorization from CPAM over to me in the surgery and the card was updated immediately.Am I also right in thinking that the ALD rights are backdated until the time of application? Link to comment Share on other sites More sharing options...
CBC65 Posted March 4, 2012 Share Posted March 4, 2012 Hello WoolyPerhaps you had some non- or pre-ALD 'forfaits partipaires' and/or 'franchises' that they needed to recoup from you.Question to you (or Norman) - do I have to have an appt with my GP to collect my 'volet' from the ALD confirmation she has received? I know she has it and yesterday I received my letter of confirmation. Are there things relating to it that need explaining face to face?Thanks.CBC65 Link to comment Share on other sites More sharing options...
woolybanana Posted March 4, 2012 Author Share Posted March 4, 2012 Thank you CBC.This was the first time I have used the Carte Vitale so I wonder what they have targetted? Next time I am anywhere near their offices, I'll pop in and ask, as they seem very willing to help. Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 It could be how he has presented the consultation.Obviously if you went to him with a sprained ankle you wouldn't be covered at 100%, since only the things on the protocol de soins are covered.My Doctor always distinguishes between the 2 parts of the prescription for the ALD-related and non ALD related medicines.On the other hand he always passes my consultations as being ALD-related, even though at the last one he also syringed my ears..This makes me think that there must be a way for the Doctor to distinguish between the two types of visit, so perhaps yours slipped up.It could also be that the card needs to go through the 'bourne' again at the Pharmacy...Edit:If it was the first time you have used it it is even more likely that it needs updating... Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 [quote user="CBC65"]Hello WoolyPerhaps you had some non- or pre-ALD 'forfaits partipaires' and/or 'franchises' that they needed to recoup from you.Question to you (or Norman) - do I have to have an appt with my GP to collect my 'volet' from the ALD confirmation she has received? I know she has it and yesterday I received my letter of confirmation. Are there things relating to it that need explaining face to face?Thanks.CBC65[/quote]Not really explaining, but I seem to remember him signing something.In any case it is re-imbursed, and a visit is a courtesy Link to comment Share on other sites More sharing options...
Val_2 Posted March 4, 2012 Share Posted March 4, 2012 Yes, but we found for any extra blood test work outside the fixed three monthly ones, we had to pay for those and they were not cheap either. Having an ALD attestation does not entitle the holder to everything 100% covered even if it is part of the ongoing medical problem. Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 That's strange Val.I have blood tests every 10 days, and all my other tests have always been paid at 100%, as long as related to the problem concerned.Pour ces affections, l'Assurance Maladie rembourse à 100 % (du tarif de la Sécurité Sociale) les dépenses liées aux soins et traitements nécessaires.Perhaps (as often) the a regional question, depending on the interpretation your local CPAM? Although it shouldn't be... Link to comment Share on other sites More sharing options...
cooperlola Posted March 4, 2012 Share Posted March 4, 2012 Sorry to interupt but 10.60 sounds like an unregistered doc' to me, not just an ALD problem. Have you done the registration paperwork selecting your doc' yet, Woolyb?Edit : THIS ONE Link to comment Share on other sites More sharing options...
Benjamin Posted March 4, 2012 Share Posted March 4, 2012 [quote user="woolybanana"]A question for the wise, svp.Where one has an ALD, are medical visits and lab tests reimbursed at 100% by CPAM, as with medication?[/quote]http://www.completefrance.com/cs/forums/2/2677964/ShowPost.aspx#2677964Do try and keep up wooly. [:P] Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 Do you mean this Coops? Pénalités financières pour l'assuré hors parcours de soins Il convient de rappeler que le patient reste libre de choisir le médecin ou la spécialité de son choix, que ce soit dans le parcours de soins coordonnés ou en dehors. Cependant, toute personne qui n'a pas déclaré de médecin traitant ou qui ne respecte pas le parcours de soins coordonnés doit assumer une majoration de sa participation aux frais d'assurance maladie (ticket modérateur) de 40 %.other useful linkshttp://vosdroits.service-public.fr/particuliers/F10870.xhtml#N10157http://vosdroits.service-public.fr/particuliers/F1069.xhtmlhttp://www.ameli.fr/professionnels-de-sante/medecins/votre-convention/tarifs/tarifs-conventionnels-des-medecins-generalistes/tarifs-des-medecins-generalistes-en-metropole.php Link to comment Share on other sites More sharing options...
cooperlola Posted March 4, 2012 Share Posted March 4, 2012 [quote user="NormanH"]Do you mean this Coops?Pénalités financières pour l'assuré hors parcours de soins Il convient de rappeler que le patient reste libre de choisir le médecin ou la spécialité de son choix, que ce soit dans le parcours de soins coordonnés ou en dehors.Cependant, toute personne qui n'a pas déclaré de médecin traitant ou qui ne respecte pas le parcours de soins coordonnés doit assumer une majoration de sa participation aux frais d'assurance maladie (ticket modérateur) de 40 %.other useful linkshttp://vosdroits.service-public.fr/particuliers/F10870.xhtml#N10157http://vosdroits.service-public.fr/particuliers/F1069.xhtmlhttp://www.ameli.fr/professionnels-de-sante/medecins/votre-convention/tarifs/tarifs-conventionnels-des-medecins-generalistes/tarifs-des-medecins-generalistes-en-metropole.php[/quote]Yes, Norman. It's just that10.60 doesn't sound like even the usual 70% to me although arithmetic is certainly not my strong point (to put it mildly.) Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 Here is the detail of my last consultation with my GP.It was at home as I had twisted my backThe first part shows that I got the standard 70% (16,10)The 1€ you have to payThe third line shows that the CPAM also paid the part normally paid by the Mutuelle (Compl à 100%) as I get 100% for the ALDThe extra 10€ for a home visit was also paid at 7€ and 3€Date de l'acteNature de la prestationMontant payéBase de remboursementTauxMontant versé25/01/2012VISITE 23,00 euros23,00 euros70 %16,10 eurosparticipation forfaitaire à retenir(1) (PFT)-1,00 euro25/01/2012COMPL. A 100% 23,00 euros30 %6,90 euros25/01/2012MAJ. DEPLACEMENT 10,00 euros10,00 euros70 %7,00 euros25/01/2012COMPL. A 100% 10,00 euros30 %3,00 eurosThe best way to see this detail is to go to the site at https://assure.ameli.fr/PortailAS/appmanager/PortailAS/assure?_somtc=trueand look up your own details Link to comment Share on other sites More sharing options...
cooperlola Posted March 4, 2012 Share Posted March 4, 2012 Yes, so the fact that Wooly was reimbursed just 10.60 for a consultation is odd, isn't it? Nowt to do with ALD - it sounds as if he was paid the unregistered rate. But until he comes back, I'm just guessing. Link to comment Share on other sites More sharing options...
woolybanana Posted March 4, 2012 Author Share Posted March 4, 2012 Well, I am fully registered, took the paperwork in myself, and have the ALD ststus confirmed as well. Link to comment Share on other sites More sharing options...
NormanH Posted March 4, 2012 Share Posted March 4, 2012 Then it sounds as if the system hasn't caught up yet.Keep an eye on the site I linked to above and see what it says in a couple of weeks (it tends to be a bit behind) Link to comment Share on other sites More sharing options...
Pommier Posted March 5, 2012 Share Posted March 5, 2012 I think it's got to be the €1's and 50c's added together from previous prescriptions, doctors visits etc. It's easiest to register on the Amelie site and then you can see what you actually owe in the way of these franchises and it all becomes more simple. Link to comment Share on other sites More sharing options...
idun Posted March 5, 2012 Share Posted March 5, 2012 Yes, I was wondering if it was the odds and sods of those €1's and cents. Link to comment Share on other sites More sharing options...
NormanH Posted March 5, 2012 Share Posted March 5, 2012 I thought he said it was the first time he used it, but perhaps there is a back-log from befire. Link to comment Share on other sites More sharing options...
cooperlola Posted March 5, 2012 Share Posted March 5, 2012 [quote user="NormanH"]he said it was the first time he used it, [/quote]at a doc's but maybe not at the pharmacy? Link to comment Share on other sites More sharing options...
woolybanana Posted March 5, 2012 Author Share Posted March 5, 2012 At the pharmacy too, but I did get some blood tests done under ALD whilst the thing was going through, so I wonder if they registered correctly.I have asked for a provisional code from Amelie but it takes up to 10 days to come through, apparently. Then I can check the account and see what has been going on. Link to comment Share on other sites More sharing options...
NormanH Posted March 5, 2012 Share Posted March 5, 2012 Don't forget they take the 1€ or 50 centimes off even if it is for an ALD..So they may have been playing 'catch-up' as has been postulated ... Link to comment Share on other sites More sharing options...
AnOther Posted March 5, 2012 Share Posted March 5, 2012 With all these Kafkaesque calculations, 100% of this, 70% of that, it kinda makes you homesick for the 'free at point of delivery' NHS doesn't it ? Link to comment Share on other sites More sharing options...
cooperlola Posted March 6, 2012 Share Posted March 6, 2012 [quote user="AnOther"]With all these Kafkaesque calculations, 100% of this, 70% of that, it kinda makes you homesick for the 'free at point of delivery' NHS doesn't it ?[/quote]Frequently. Not to mention all the daft bits of paper and endless back and forth in the post. For example. I have blood transfusion during op. A month later I get a prescription (two copies of one, letter of explanation from doc, plus further bit of paper from transufsion service) for a blood test. I go to nurse who takes blood and send it to the lab. Lab sends copies of results to me, the surgeon, my gp and the transfusion bods. Lab sends to me (in separate envelope) a bill for 4.20. I write cheque and send it to lab. They send me a receipt. I send receipt to my top up insurer who then reimburses me (finally - somebody is in this century) direct to my bank account.Phew, [:-))][:-))][:-))] Link to comment Share on other sites More sharing options...
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