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EHIC and how is it funded


colinstone

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Morning All,

Does anyone know how the EHIC actually works.  Is there an exchange of dosh between countries for treatment given??  Eg France gathers up all the EHIC treatment bills and sends them off to Overseas Health in Newcastle or does France take the treatment hit and just bill the recipient 20% of the costs. 

If the former, there appears to an easy fraud.  I've had A&E teament under the EHIC and the hospital has billed me 20%.  If it is the former, then France effectively get paid 120% of the cost of the treatment.  If the latter, then I guess it is OK.

I have to say it appears to be pretty pricey - 5 hours in hosp A&E, 1 blood test, 1 Xray, 1 midrif CT scan and 1 antibiotic drip came to €799.  Or perhap just like insurance claims, the amount is bumped up and the 20% they know they'll get back actually reflects the total cost??

TVMIA

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I may be wrong but I understand that when treatment is covered by an EHIC, or its equivalent issued by other European countries, the issuing country is billed for the 'refundable' part of the cost, up to a certain maximum figure, which I believe corresponds to the highest figure for the equivalent treatment chargeable under the German health system.

That sounds complicated, but it has to be so. The various member states have widely different health systems, varying from the universal, residence-based, free-at-point-of-delivery NHS model, to those based almost entirely on private assurance, as in Germany, so a universal scale of reimbursements would be impossible to establish. France occupies a middle ground with its paid-for system involving a combination of private and public cover.

I am sure there is plenty of opportunity for, if not fraud, maximising the income; though if France has billed you 20% it can only reasonably expect to bill the UK for the remaining 80%, not 100%, and the UK civil servants will, I am certain, be wise to this.

I may be totally wrong, unfortunately I can't remember where I heard this and can't, on a quick search about reciprocal health arrangements, find any confirmation. If so I am sure somebody like Cooperlola will have the correct information, though her specialist area is E106 rather then EHIC (she has, of course, extensive first-hand experience of A&E in France).

Your treatment does sound expensive, but health care is not cheap in any of the major countries. French health care is generally reckoned to be of a very high standard, and excellence has to be paid for of course.

Interestingly, A&E treatment is generally provided free to anybody under the NHS, though after-care is, of course, subject to residence rules and/or reciprocal health agreements.

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As British politicians are so adept at skimming off money them selves from the state, I am sure that they wouldn't allow any one else to steal anything. After all if another country or person pinched it; there may not be enough left for them. As for the cost of French health care, yes it is high but so is the service and treatment. The only reason we don't know the true cost in Britain is because there is no direct billing system as in France, but I would guess it's no cheaper.
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"I have to say it appears to be pretty pricey - 5 hours in hosp A&E, 1

blood test, 1 Xray, 1 midrif CT scan and 1 antibiotic drip came to

€799.  Or perhap just like insurance claims, the amount is bumped up and

the 20% they know they'll get back actually reflects the total cost??

TVMIA"

 I had a CT scan recently in a private (UK) hospital the cost was £700 just for the CT scan never mind the rest of the treatment.

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I support what Cendrillon has said on here.  OH had a CT scan on his neck area after a stroke and it cost in excess of £600 and that was about 8 years ago.

So I do think that, in comparison, the French treatment sounds eminently reasonable![:-))]

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I was taken to hospital here in France by ambulance, 1 km to my house then approx 50km to the hospital, I had a consultation with a doctor, a IRM head scan, an anaesthetic then some stitches from a nurse.

The total before remboursement came to €134 for the ambulance and €56.25 for the hospital, the net amount that I had to pay was €64.85.

The CT scan was not billed as it was 100% prise en charge by l'assurance maladie, surgical operations etc following an accident are normally 100% prise en charge and hence we dont get to see the cost

The 80% prise en charge is only for etrangers as for those with a French social security number it varies between 35% and 70%.

An etranger will end up paying 20% of a charge that others will not get to see and may be unaware of., my IRM scans (I have had others) being an example.

Quite how charging other EU countries 80% of everything compared to 35 to 70% of some things is supposed to equal what a resident of that country would pay I am unsure.

Editted.

I should add that the IRM scan revealed a small fragment of brain lodged in my skull that was later successfully removed by surgery [;-)]

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Slightly off topic, I'm not sure if anyone has come across this but E121 (and other?) holders covered under the French system by reciprocal arrangements now apply to the UK for their EHIC cards. OH was sent an application form recently even though she has a current french-issued card.

Steve
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hi

slightly off the main topic but still about ehic.  I've (holiday home in france, uk resident)  had some treatment here recently and would like to claim back the refundable amount.  I'm not going back to uk until end of april.  I presume I get all the paperwork together and visit my local cpam (limoges or bellac).  Funny when I was going through paying for the various medicines/services nobody wanted to look at my uk ethic card, they just asked me to pay a certain amount.  Hope someone can provide some usefull comment, thanks.

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[quote user="Sc"]Slightly off topic, I'm not sure if anyone has come across this but E121 (and other?) holders covered under the French system by reciprocal arrangements now apply to the UK for their EHIC cards.

[/quote]

More information and discussion here

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