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Carte Vitale


woolybanana

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Well, there we are, Carte Vitale through in about six weeks which includes Xmas and NY. Not bad. Not had medical cover of any type for xxxxx years!

Then to register with the doctor on Monday, but a couple of questions which wiser minds than mine may be able to deal with, svp:

Firstly, I know that one needs a private top up to cover such eventualities as hospital room and bawd, but in the case of having treatment stemming from a long term illness, such as diabetes, is that also the case, even though medication in such cases is free?

Secondly, the EHIC is issued through UK, but in the event of needing it, does it offer the level of cover of the issuing country, the country of residence or the country where the treatment happens to take place?

Within Europe, does the EHIC card replace what we used to call holiday insurance within the EU?

Thanks in advance, guys.

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If your treatment is related to an ALD signed off by your doc' then the state covers your costs (including daily charges iirc but not a single room.)

The EHIC covers you up to the level of a national of the country you visit (eg 100% in the UK, 70% here)so you need to be aware of the local system.  It doesn't replace travel insurance 'cos you won't get paid for trips cancelled due to illness, repartration, lost luggage etc etc, only direct medical costs.

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The GP with whom you are registered, (médicin traitant)  not the specialist treating the disease has to write to the CRAM and apply for you to be covered for an ALD.

You then get a form called a 'protocole de soins' which specifies which things you are covered for at 100%, and an Attestation, normally valid for 5 years but renewable.

You may sometimes have to produce these. Only the illnesses specified on there are covered at 100%

In understanding the importance of going though your GP this is useful:

http://www.ameli.fr/assures/soins-et-remboursements/comment-etre-rembourse/le-parcours-de-soins-coordonnes/choisir-et-declarer-votre-medecin-traitant.php

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Hi Cooperlola.After 6 years, don't ask, have finally got Mrs W's CV however they missed me off the CV, let's hope they do't take another 6 years to sort it. We are both of retirement age.

We have never had any sort of mutuelle and have been looking at them on the i/net........all a bit confusing.

What are the sort of things to look for when buying a mutuelle. We are both in good health, touch wood, especially Mrs W. I have had a stent put in 10 years ago and have had check ups in France and all is good. The thing I don't really understand is this 200% 300% etc. Be obliged for any sort of run down as to what we should look out to be buying, and from whom

Thanks

Wi;ko

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[quote user="woolybanana"]...

Within Europe, does the EHIC card replace what we used to call holiday insurance within the EU?

[/quote]

As Coops so swiftly said, the EHIC does not cover any part of your holiday insurance except for medical treatment.

However, look closely at your bank account description, as often holiday insurance is included with that for repatriation, emergency trip home etc.  It allegedly is with my UK one - though I do not entirely trust it.   And some French friends found that they were covered by their French one when tragedy struck their family during a holiday in the UK.

As regards theft or breakage of personal belongings while abroad, my UK household insurance covers that kind of thing - and I have had cause to claim once or twice.

Angela

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[quote user="Wilko"]One thing i forgot to ask is that we have not specified a doctor, will do so in next couple of weeks

"n'a pas declare un medecin traitant. Does this make a difference to our reimbousements ?

W[/quote]

Yes. On the link I gave:

, si vous n'avez pas déclaré de médecin traitant ou si vous ne

respectez pas le parcours de soins coordonnés, vous serez moins bien

remboursé par l'Assurance Maladie lors d'une consultation.

Par

exemple, une consultation chez un médecin généraliste conventionné

exerçant en secteur 1 coûte 23 € (tarif applicable au 1er janvier 2011) :

  • S'il s'agit de votre médecin traitant déclaré,

    vous êtes dans le parcours de soins coordonnés. L'Assurance Maladie

    vous rembourse alors 70 % du tarif de la consultation, moins 1 € au

    titre de la participation forfaitaire, soit un remboursement de 15,10 €.

  • Si vous n'avez pas de médecin traitant déclaré,

    vous êtes hors du parcours de soins coordonnés. L'Assurance Maladie ne

    vous rembourse alors que 30 % du tarif de la consultation, moins 1 € au

    titre de la participation forfaitaire, soit un remboursement de 5,90 €.

In brief you would only get 5,90 € back for a consultation costing 23€ if you haven't got a médicin traitant, or don't go through him instead of 15,10 normally. And that is only an example of a low cost consultation.

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 Just picking up on the ALD 100% point.....please would someone just clarify one or two things for me.

 My husband recently, early Dec , got his ALD documents through because of Horton's Disease and Diabetes( latter has become more complicated by the treatment for  the former) .

 Does the 23euro consultation  fee which he pays to our Medicin traitant fall into the 100% category, likewise the cost of pretty frequent blood tests, all related to either or both of the relevant illnesses?

I ask because firstly he continues to pay the doctor the 23euros  which is then reimbursed 16.10 euros by CPAM and 6.90 euros by our Mutuelle.

I notice on the monthly reimbursement statement that we had today from the Mutuelle that this is still the case even since the ALD notice and the same CPAM and Mutuelle reimbursement is going on for the blood tests. I had assumed that at least the blood tests , necessary to monitor and to prescribe treatment for  the two conditions, would fall into the ALD category, be covered 100ù and be referred to our Mutuelle. Perhaps I'm wrong . 

Any thoughts anybody?   My husband has an appointment with the Medicin Traitant on Monday and it would be as well to know before then- we can ofcourse ask him himself but as he seemed to drag his heels a lot over the initial application and was a little discouraging about it , it'd be interesting to know where we stand.

I'd appreciate some advice please.

Sue

 

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If the doctor has given you a prescription written on the part of the Form intended for 100% then they should be re-imbursed.

As for consultations with him it depends on him to some extent.

For example I need my ears syringed, and at the same time I will have my monthly  check up for blood pressure and he will give me a prescription for my fortnightly blood tests.

The latter two are certainly covered in my case by 100% as I have had a stroke and am on anti-coagulants, but obviously the ear wax shouldn't be covered by my ALDs.

In practice he usually makes no distinction, and I think your husband should be getting 22€ back from the CPAM and nothing from the Mutuelle for these diseases (you have to pay1€yourself)

There will also be strange amounts kept back for medicines and blood tests that aren't taken off when you go in the the lab or Pharmacie.  Each 'acte' has a small amount you have to pay that isn't covered either by the Sécu or by your Mutuelle

Have you updated your Carte Vitale since you had the ALD documents through?

 You can do this in Pharmacies stc.  It may be that it still automatically sends the old details.

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Thank you Norman.  My husband's appointments and blood tests  have been for only the two ALD conditions, so that is fairly clearcut.

The card has been 'mise à jour' now but you may have hit on a possible  reason particularly regarding the lab blood tests there. We thought it had been done at the Pharmacie early on and it was only when he had another hospital appointment that they found it wasn't going through and they put it through the machine thing again to validate it.

The doc and his 23 euro fee in cash is perhaps another issue..

I'll keep an eye on all of it , perhaps it'll right itself by next month.

Thanks for your quick response.

Sue

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My blood tests relating to the ALD are all marked on the prescription so I pay nothing to the nurse or the lab - the latter's invoice always comes back as 0 and the odd 50cs and euros which the government takes get sorted out from time to time.  Thus I think you need to clarify this with your gp so that it goes through 100%.  If it continues then you can always talk to your top-up insurer because it is in their interests not to pay for something which should be free!  Hit somebody in the wallet and it's amazing how helpful they can be.[:)]

Wilco, I find the 100%, 200% etc thing very hard to explain easily but it's about what the government deams each treatment should cost and what doctors and other medical professionals actually charge you.  I've rarely been charged more than the standard (100% in insurance terms) by anybody except my dentist and opticians (so for the latter I go privately in the UK now as it's a lot cheaper) but in some regions (I suspect especialy around Paris etc) the charges can be a lot higher than the government agreed charges and that's when you need more cover. 

Important things to consider are single rooms (does this matter to you? Are you happy to share?), convalescent care, follow up treatments like physio etc - it's all in the small print!  I'm sure lots of people have different priorities and a lot depends upon what you can afford, of course.

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I missed the question about

Mutuelles.

Basically any consultation or medical 'acte' is given a

tariff de base  ( a basic price) by the Sécu, who pay 70% of that in the case of a

consultation, with the rest to be found by the patient

A 100%

reimbursement is 100% of that price, in other words the mutuelle will

pay the extra30%

However that may not be the actual

price charged by the Doctor or the service you see.

A Doctor

'conventionné secteur 1'   charges the Sécu

price

http://sante-medecine.commentcamarche.net/faq/493-comprendre-le-fonctionnement-du-secteur-1-et-secteur-2

but

even in this secteur they can charge more for such things as a call

out at night.

In Secteur2 the Doctor is free to charge what

they like
(the word 'libre' means free in this sense, not that

they are free)

All the same the Sécu only reimburses

their standard price, and the rest has to be paid either by the

patient or the Mutuelle

If the Mutuelle pays 100% it is as

explained above, 100% of the Sécu tariff, not 100% of the Doctor's

price.

To work a couple of examples:

Assuming you go to see your médecin

traitant, the consultation secteur 1 costs 23€

You pay the first

1€

The Sécu reimburse 70% (around 16€)

The rest ( around 6€) is for

the patient to pay, or the Mutuelle will pay this if you have one

which reimburses you at 100%

Result you pay only the 1E which no

other organisation is allowed to pay for you.

If you see a Doctor in Secteur 2

however you may be charged say 50€

But the Sécu will still only give you

the 16€, so now you have

to find
34€

If your mutuelle

covers you at 200% they will pay up to twice the tariff de base, i.e.

46€
of the 50, and so you would only pay 5€ if you

have a 300% cover they will pay up to 69€ so you would only pay the

1E

So why see a

Doctor secteur 2 I hear you ask.

The answer is that

in many clinics there are no secteur 1 Doctors, and many specialists

are secteur 2

There can even be

the situation where both the Surgeon and the anesthetist are

charging their own prices so you get a double whammy

On top of this

there is what is called 'dépassement des horaires' supposedly

overtime but often added automatically

The

final bill for the services can easily come to 2 or 3 times the

tariff de base

Hence the need

for cover at more than 100%

I have previously posted on what to look out for when choosing a Mutuelle.

I have just changed to Swisslife because I liked the fact that they have 5 modules and you can choose you own menu of cover from each section, so for example you may want level 5 for Hospitals but only level 3 for the dentist or vice versa.

I confirmed this with a couple of word of mouth recommendations, so I will see.

They have a good guide (in French) here

e/Dossiers/Guide-pratique-pour-Bien-comprendre-et-bien-choisir-votre-complementaire-sante

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Not just the Drs and hosptials.

 

Dental cost, eyes, hearing, etc etc all need to be taken into account. Dentistry and it's associated things has specific tarifs associated with them and the base tarifs for somethings can be very low. And so I would recommend good cover for these things too, so seeing what you would actually get back is important.

 

ie ask, if I need a hearing aid, how much do I pay and get back.

 

if I need false teeth, how much and how much would I get back, same with crowns.

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Thanks, but I still can't find it. I was replying to a question from Wooly about what to look out for in a Mutuelle.

Here goes briefly:

1) Read the small print and be sure to look out for exclusions. My last mutuelle for example paid for a single room in a Hospital, but not in the Nursing home that followed, and despite advertising that it paid the 18€ a day charge, had a nasty little clause saying that this was only in surgical wards...and they interpreted the nursing home (which was looking after me after a surgical procedure) as not being 'surgical'.

I ended up paying over 3000€ even with their cover!

2) Get one you can tailor to your expected needs.  My new one has a 'modular' structure with 7 levels of cover, but you don't need to take the same level for each section.

The sort of areas of cover to consider are: 

Hospitalisation
are all the fees (surgeon/anaesthetist)  covered? Do you want a single room? Will the 18€ frais de séjour be covered and for how longWill you be in a private clinique or a CHU, and will the extra in the former be covered?  Bonuses might be help towards paying for  a bed for your other half or for the TV

Teeth and Eyes   are poorly reimbursed so if you have problems here you might want to opt for a high cover

General Medicine  (GP, X rays, blood tests etc) I have largely explained this above.I went for a 200% cover, and also get back 40€ for consultations with a chiropractor who are not covered by the Sécu

Pharmacy Most Mutuelles will top up to 100% o the tariff, but may demand that you accept generics.  A higher level of cover might see some non-reimbursable items covered, such as homéopathics

Medical Aids  hearing aids, breathing apparatus, wheelchairs etc

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Right, carte vitale in the bag, doctor chosen and long-term illness forms completed. So, could I just check that I have got it right about the EHIC, svp, ie that the French will process both copies of the S1 and send one back to the UK who will then issue me with a form to fill in to get the EHIC which they issue, which process may take a little while?
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[quote user="woolybanana"]Right, carte vitale in the bag, doctor chosen and long-term illness forms completed. So, could I just check that I have got it right about the EHIC, svp, ie that the French will process both copies of the S1 and send one back to the UK who will then issue me with a form to fill in to get the EHIC which they issue, which process may take a little while?[/quote]

Absolutely correct!  The "getting the form for the EHIC from the UK" bit, is still ongoing in our case from last September. Interim advice from the DWP is as follows:

"If you have to travel to another EU Member State before you get your
EHIC you will still be covered for necessary state healthcare.

If you require treatment you can apply for the Provisional Replacement
Certificate (PRC). The PRC can be faxed to the facility providing you
with treatment and is accepted in place of the EHIC.

Of course this may not be practical under all circumstances. If you
are charged for state healthcare you can apply for a refund.

To apply for the PRC or a refund you must ring 0044 191 21 81999"

 

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