Cost Question.

[powerdesal]

The whole funding - who pays what to whom is very confusing to me as a simple engineer.

The last bill total seemed to indicate E800 ish with us being required to pay E500 ish. Our assumption at the time was that a French resident would have to pay the 500 and claim it back from their mutuelle, or in the case of a tourist, from their travel insurance.

From the info given in this thread I now assume that the balance of E300 (ish) would be billed directly to the UK.

[cooperlola]

I think you have that backwards, Steve.  You pay the smaller portion, normally, but are liable for 100% of the daily "hotel" rate (ie that dreaded food!).

EDIT : Yes, imo, the bit that a French person would have paid for by the state should be billed direct to the UK, or you'll pay it and get a feuille de soin/or some sort of receipt equivalent which you can take to a CPAM and get the money back for, as Chancer had described.

[idun]

If your bill was 800€ then I would say that you would get back approx 500€ and the rest was down to you or your holiday insurance.

Chancer mentioned emergency care being 'a charge', but the only time I was in les urgences, there was nothing instantly taken on by the government, but they may well do that for certain medical problems.

I would click on that link that coops gave you. Find the CPAM office that dealt with the area the hospital was in. Send them every last receipt, but before you do, KEEP a copy of every thing you send off. That is a good rule to follow when you move to France.

[powerdesal]

I'm not sure about the 'backwards' bit Coops, We certainly were presented with a bill and asked if we wanted to pay it then or did we want it posted to us.

The total, including all costs (food, treatment etc) was some E800 and then there was a reduction to result in E500 ish. We paid and got a receipt of course. Unfortunately I can't quote the bill breakdown now as its in UK.

The attendance at Les Urgences was due to ventricular arrhythmia and was not an ambulance presentation as I drove there. As it was an emergency cardiac admission I think its probably one of the more serious types of emergency.

I am not sure of the idea of sending receipts to the local CPAM office because we are not French residents, we have no social security number and are tourists covered by a UK issued EHIC.

No doubt we will sort it all out in the end and possibly the Hospital Administration will be able to advise as,being a popular tourist area, they probably have experienced British tourists getting ill / having accidents in the past.

[cooperlola]

I'd certainly be inclined to take stuff to CPAM rather than post!

Anyway, as you say, the important thing is to get her well.  Money is nice but there's always more where it came from.  There's only one Mrs PD.[:)]

[idun]

Sorry I didn't quite understand what was what earlier in the thread. I would say that this last bit is down to yourselves. If the bill was 800 and they reduced it by 500 then using your EHIC I think that the hospital will have claimed that back from the CPAM themselves. The rest is for your holiday insurance company or from your savings.

I feel sure that for full time french residents that the 300€ would have gone off to the mutualist for reimbursement.

[powerdesal]

[quote user="idun"]

Sorry I didn't quite understand what was what earlier in the thread. I would say that this last bit is down to yourselves. If the bill was 800 and they reduced it by 500 then using your EHIC I think that the hospital will have claimed that back from the CPAM themselves. The rest is for your holiday insurance company or from your savings.

I feel sure that for full time french residents that the 300€ would have gone off to the mutualist for reimbursement.

[/quote]

Idun, I think you may have misread, it was was not reduced BY 500, it was reduced TO 500.

I have no problem with the principle of paying, nor of the amount, my confusion relates to the system and its administration.

I / We will pay whatever it takes to get Mrs PD the necessary treatment whenever and wherever that may be. Its only money and you cant spend it if you'r dead.

[Chancer]

[quote user="powerdesal"] I am not sure of the idea of sending receipts to the local CPAM office because we are not French residents, we have no social security number and are tourists covered by a UK issued EHIC. [/quote]

Not wanting to take a trip into town to find the exact name of the building but it is a walk in type centre for all issues involving L'assurance maladie, I am pretty sure that it is called "centre de sécurité sociale" but may be wrong, basically it is there to deal with the issues of predominantly the unemployed etc who do not have the means to go to the CPAM at Amiens.

I am assuming that you have a French address and bank account, what you do is take all your avis de sommes à payer to them together with your EHIC and an RIB, perhaps a justicatif de domcile, I cant recall it was a long time ago. They will photocopy everything and get the ball rolling, the money will be paid into your account long before you get the statement, when you get it (the statement) check it carefully and you will find that they have issued you with a social security number starting with a 5, make a good note of this.

If your wife is hospitalised again give them your new social security number at admission, that way you will only be billed for the amount that remains at your charge, subsequent hospital stays and surgery related to the initial emergency will be 100% prise en charge, consultations, out patient appointments etc will be remboursed at 70%, you pay the forfait journalier of around €17, I wont get into the €1 contribution for each acte as it is de minimus in your case.

The biggy and that which is responsible for all the horror story bills is the frais de sejour which in my case was around €900 per day, I was never billed this as I quoted my social security number on admission and was treated as a French citizen (I believe), however on one of my admissions the paperwork was cocked up by the surgeon who refused point blank to revisit the dossier, for the 2 days I was billed €1915 which was 80% prise en charge (this number is significant) but bizzarrely the forfait journalier which one would normally pay was 100% prise en charge.The admin people at the hospital who were doing their best to convince the surgeon to correct her mistake told me that was only prise en charge for pregnant women! Anyway it was one of the few times that I gave up as it became apparent after the surgeon let rip with a volley of racist insults that I was never going to get anywhere so I happily paid the bill.

After further investigation I have come to the conclusion that if you are hospitalised with a social security number you will be treated as I described, 100%  prise en charge for emergencies and the dreaded frais de sejour, 70% for the outpatients, prescribed medication etc and you pay all of the forfait journalier.

If you are a foreigner with an EHIC then everything is chargeable including the frais de sejour at 80%, I think this is the French interpretation of the charges for treatment being the same as for French nationals [;-)].

Once you have your social security number you can then claim a remboursement for most of your future medical expenses, doctor, dentist, pharmacy etc, mostly at 65%, if you talk it through with the admin staff the hospital, ambulance companies etc then they will usually claim directly from CPAM and only bill you the amount that rests at your charge which can make things easier.

Good luck and I wish your wife well with the OP.

[idun]

OP isn't a french resident yet, and hasn't got a social security number, just an EHIC.

Sorry pd, I mis read yet again.

Isn't your bill clear as to what is what? and which bit has been paid. Wish my old ones were not still in boxes, or I would have looked at them just to see how they worded it all.

[powerdesal]

I'm pretty sure the bill is quite clear about the various bits but unfortunately the bill is in UK and we are not due to return to UK until next week.

[Sunday Driver]

Steve

This really is quite straightforward.

From what you say, the hospital have calculated the total cost of your wife's stay as 800€.  Your EHIC performs basically the same function as a carte vitale so the hospital have billed the state health insurance bureau (CPAM) for their contribution towards the cost and billed you for the remaining balance, ie the 500€.  That's the patient contribution (also known as a co-payment) which is down to you to pay.

You can submit the hospital bill to the UK Overseas Healthcare Team and ask them to reimburse you for your patient contribution.  I believe they will reimburse up to the equivalent cost had the treatment been provided by the NHS.

 

[powerdesal]

Thanks SD,

Clear and concise, as we all have come to expect from you. Please don't ever leave this forum.

[idun]

This is from the NHS web site.

 

Your European Health Insurance Card (EHIC) will enable you to access state provided healthcare at a reduced cost or sometimes free. It will cover you for treatment that is needed in order to allow you to continue your stay until your planned return. It also covers you for treatment of pre-existing medical conditions and for routine maternity care provided the reason for your visit is not specifically to give birth.

How to claim refunds

Reimbursements are claimed from the local CPAM office (Caisse Primaire D‘Assurance Maladie) in France. You will need to provide the treatment form (feuille de soins), copies of receipts and prescriptions, a copy of your EHIC, your address of residence and your bank details, including IBAN and BIC. Confirmation of your refund will be sent to your home address.

If you have had to pay for the cost of your care and have been unable to claim a refund during your stay in France you should contact the Overseas Healthcare Team (Newcastle) on 0191 218 1999 (Monday - Friday, 8am - 5pm) on your return to the UK. However, this process will take longer than claiming for a refund in France.

 

 

AND THIS

 

The European Health Insurance Card (EHIC) allows you to access state-provided healthcare in all European Economic Area (EEA) countries and Switzerland at a reduced cost or sometimes free of charge.

Everyone who is resident in the UK should have one and carry it with them when travelling abroad. Remember to check your EHIC is still valid before you travel. Applying for the card is free and it's valid for up to five years.

Presenting the EHIC entitles you to treatment that may become necessary during your trip, but doesn't allow you to go abroad specifically to receive medical care. However, maternity care, renal dialysis and managing the symptoms of pre-existing or chronic conditions that arise while abroad are all covered by the EHIC.

Your EHIC will allow you access to the same state-provided healthcare as a resident of the country you are visiting. However, many countries expect the patient to pay towards their treatment, and even with an EHIC, you might be expected to do the same. You may be able to seek reimbursement for this cost when you are back in the UK if you are not able to do so in the other country.

The EHIC is NOT an alternative to travel insurance. It will not cover any private medical healthcare or the cost of things such as mountain rescue in ski resorts, repatriation to the UK or lost or stolen property.

For these reasons and others, it is important to have both an EHIC and a valid private travel insurance policy. Some insurers now insist you hold an EHIC and many will waive the excess if you have one.

Applying for an EHIC is easy. Even if you don't have any plans to travel in the near future, it is always a good idea to get one.

 

 

They say 'may' be able to ask for the extra costs to be reimbursed, but they don't seem to guarantee that happening, hence travel insurance should be bought.

 

 If I were you I would try sending the bill to Newcastle or call them about it and see what happens. Let us know how you get on.

 

 

[Sunday Driver]

[quote user="idun"]

This is from the NHS web site.

<<snip>>

<<snip>>

<<snip>>

 If I were you I would try sending the bill to Newcastle or call them about it and see what happens. Let us know how you get on.

[/quote]

Which is wot I suggested three hours ago.......[Www]

 

[powerdesal]

Thank you one and all for the time and effort you have put in to help us in this situation, it is greatly appreciated.

When ?????? the full result is known I will post so that everyone will know.

[powerdesal]

[quote user="powerdesal"]Thank you one and all for the time and effort you have put in to help us in this situation, it is greatly appreciated.

When ?????? the full result is known I will post so that everyone will know.[/quote]

As promised, a result.

Claim made to Newcastle, money refunded and paid directly to bank account - in full.

The unfortunate bit ---------, we returned to France to continue our hols after treatment regime established in UK, 4 days later SWMBO again admitted to Avranche with a relapse, this time she was in for six days and a great number of tests, heparin injections etc. This bill was E 1000+.

We returned to UK (obviously) after her release.

That bill has been submitted to Newcastle and we are waiting to see if that will be reimbursed.

A new treatment regime has been established (which is not very nice) and an ablation is planned for September at the JR in Oxford.

The method of reimbursement is:-

Telephone Newcastle and explain what happened, in detail.

They send a claim form and you return it with all original documents (receipts) and your bank account details.

If allowed, the claim is met and the money sent directly to your account.

The claim is allocated a reference number which you should keep as any future claims will be referenced to that same number.

[NickP]

I'm not challenging your  experience in any way, it's just that I thought that in an emergency all treatment was free with your European health card.  A couple of years ago my wife was unfortunate enough to develop peritonitis while we were on our way to our house in France. She was taken into hospital immediately; treated wonderfully well, spent a week in hospital recovering and then had home visits after to make sure everything was OK. I must add that my wife is a retired SRN ( a real old fashioned one) Nurse Tutor and finished her career as a Practise Nurse. She said the care and treatment she received in France was superb. But to get back on track all we had to pay was 100 Euros, the rest was covered by our health card. Has something changed; as it would appear to me that your wifes situation was an emergency?

[powerdesal]

It would seem that something must have changed. My wife was admitted as an emergency on both occasions. Yes, the treatment was superb (the food less so !!!!!) but at the end we were given a bill (the second was actually sent by post to our UK address). The EHIC details were taken both times.

I can only speak as we found the situation, not paying the bills did not seem to be an option (although it would have been nice) and we have no complaints whatever.

[Sunday Driver]

Treatment (emergency or otherwise) is not free and the EHIC only covers you to the same extent as a French resident.

A important surgical intervention for something like peritonitis would be covered by the state apart from a fixed 18€ contribution from the patient whereas a serious of tests and injections would only qualify for the usual 80% reimbursement leaving the remaining 20% payable. Also bear in mind that the daily' forfait journalier' covering bed and board, consultant fee dépassements and extras like single room/TV/telephone are not covered by the state.

All of these patient contributions have to settled with the hospital and claims submitted back in the UK.

 

[Chancer]

Its interesting to note that the UK in this case at least reimburses 100%.

[NickP]

[quote user="Sunday Driver"]

Treatment (emergency or otherwise) is not free and the EHIC only covers you to the same extent as a French resident.

A important surgical intervention for something like peritonitis would be covered by the state apart from a fixed 18€ contribution from the patient whereas a serious of tests and injections would only qualify for the usual 80% reimbursement leaving the remaining 20% payable. Also bear in mind that the daily' forfait journalier' covering bed and board, consultant fee dépassements and extras like single room/TV/telephone are not covered by the state.

All of these patient contributions have to settled with the hospital and claims submitted back in the UK.

 

[/quote]

Well what ever, but all I know is the total paid by us was 100 Euro and I was very happy to pay that. The OP was talking about paying hundreds of Euros,  all I did was offer our example,  maybe I got away with something; I don't know, if so long may my luck continue. You say emergency treatment is not free, and then say an important surgical intervention like peritonitis would be covered by the state apart from a fixed 18 Euro contribution from the patient, in my book that's free. Also keep in mind that in the UK hospital you pay for the TV/telephone, that is not covered by the state, and if you don't want to eat the junk supplied  by the hospital as is often the case, that costs you extra in the UK; resident or not.  [:D]

[idun]

And you think that you don't pay for tv and phone in a french hospital,  ofcourse you do. AND the food, well I have had good and I have had muck served up that I wouldn't have fed to pigs. And no alternative but the cafe which only had croissants and the like, which is not proper food.

 

[NickP]

[quote user="idun"]

And you think that you don't pay for tv and phone in a french hospital,  ofcourse you do. AND the food, well I have had good and I have had muck served up that I wouldn't have fed to pigs. And no alternative but the cafe which only had croissants and the like, which is not proper food.

 

[/quote]

 I never claimed that TV and phone supplied in French hospitals are free, I merely stated "that in the UK these things are extra", as indeed they are in France as stated by Sunday driver when he wrote about the French System. Pay attention at the back please!!!