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Health Reimbursement


Bertiebe

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Hope someone can answer this query for me:  I have just received the 125 Euro reimbursement for my wig (during chemo) from my Caisse (Ram Gamex), however at the same time they have deducted 50 Euros in various charges.  These are all small amounts marked, FR récupérée and PF récupérée, all on different dates and deducted from my reimbursement.

If anyone can shed any light on these charges I would be grateful as all my recent treatment has been for an ALD (Affection Longue Duree), and I thought that these Dr's/Hospital appointments were covered 100%?

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There are a number of charges 'forfait' which are taken off your reimbursements even if you have an ALD. This applies to each consultation and 'acte médicale'

La participation forfaitaire de 1 euro

http://www.ameli.fr/assures/soins-et-remboursements/ce-qui-est-a-votre-charge/la-participation-forfaitaire-de-1-euro.php

This will probably be the pf

and 50 centimes for each box of medicines called a 'franchise' probably the fr

There is also a small charge towards transport (Two euros I think, for each direction, so 4€ for a round trip  but might be wrong on the exact sum)

All of these are taken off your payment periodically

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Bertiebe,

On the positive side (if there is such a thing here), there is a daily 4€ ceiling (i.e. 4 medical acts like X-ray, doctor or specialist appointments, blood test in a single day) and annual ceiling of 50€  for the Participation Forfaitaire and an annual ceiling of 50€ for the Franchise Médicale.

Details in French HERE.

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Ask your Mutuelle if they will contribute to the wig also.  Mine forked out double the state amount on top thus I could afford a really good wig - lightweight and very easy to wear.  It's well worth asking them.

Oh, and pick a hair dresser/wig fitter who knows what they're doing.  Their professional advice and knowledge are worth their weight in gold during a depressing business.[:)]

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Thanks for the advice Coops.  I did choose my wig from a professional fitter in Toulouse and she was extremely helpful and a totally personal service.  However, my Mutuelle, Groupama, only offered me the huge sum of 37.50 Euros.  Again this was a bit of a surprise as when we took out the Assurance we were led to believe that this was a fairly good level of cover, but recently have found that while they cover all the basics but none of the niceties.

I assume now that I have an ALD it is not so easy or cheap to change Assurance providers.

However, on the positive front I did get a very modern "red" wig, which I am still waiting to utilise as the hair is currently going through the "looking dead" stage, but still hanging in there!!
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[quote user="Bertiebe"]Thank you for the info Sunday Driver, I hadn't thought about this, but I suppose it is too their advantage if you have an ALD.  Glad to see someone is happy about it, ha ha. 

[/quote]

Don't hold your breath. Not every insurer sees it like Sunday Driver's. From memory AXA and MAAF didn't want to know about a reduction.

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