Choosing a Mutuelle

[Jamesdee]

We would like to thank many of you for the information you have provided through numerous threads, which we have trawled through to help us  to decide how we should proceed with regard to "Top up Insurance". We decided to adopt the cautionary approach, favoured by some of you and actually take up the insurance.

We then followed advice on one thread about finding a Mutuelle on the internet. But we were not ready for the huge number of providers all vying for our business. The procedure was not helped by the fact that I did not tick the box that says "Do not ring me". We were inundated by emails and telephone calls.

Gradually we whittled them down but before we make our final decision we wanted to see if anybody on the forum had any experience of the organisation we see as the strongest contender. Is it okay to say the name of the one we think is best for us?

[suein56]

[quote user="Jamesdee"]. Is it okay to say the name of the one we think is best for us?   [/quote]

Perhaps if you mask your choice with a link like this.

Sue

[Owen]

Hello Jamesdee,

Ask potential providers what criteria they apply in assessing premiums. There are several; age. sex etc but providers do not necessarily apply the same ones

Regards

Owen

pjowen@expathealthdirect.co.uk

[NormanH]

In any case I think you have made the right decision.

There is increasing privatisation in the French system, with some specialisms being only available in Private Clinics in some towns.I saw a recent documentary on this on M6, and for example there was a town shown where ALL the urologists worked in the Private: there were none available at the Public Hospital.

This can mean that you have a hefty bill for 'dépassement des horaires' . (Despite the word 'horaires' it is nothing to do with the time taken in the consultation, but a reflection of the added overheads the Doctor has to pay the Clinic for the space and facilities occupied)

Whether or not the Mutelles pick that up (something you could ask when choosing) , it is at least clear that it is best to have the top up cover so at least 100% of the normal charge is covered.

[Jamesdee]

Thank you suein56. I must say that if my grey cells were less grey I might have thought of that myself. This is the organisation we are looking at.

Thanks to the other responders for their advice. I shall take your comments on board. The policy we are looking at is for " seniors" and is very competitively priced with a 20% discount in the first year. I have to confess that one major factor in our interest in this policy is that the person we are speaking to speaks very good english. We are able to ask our questions and get the answers in plain english.

[KathyC]

[quote user="NormanH"]In any case I think you have made the right decision.
There is increasing privatisation in the French system, with some specialisms being only available in Private Clinics in some towns.I saw a recent documentary on this on M6, and for example there was a town shown where ALL the urologists worked in the Private: there were none available at the Public Hospital.
This can mean that you have a hefty bill for 'dépassement des horaires' . (Despite the word 'horaires' it is nothing to do with the time taken in the consultation, but a reflection of the added overheads the Doctor has to pay the Clinic for the space and facilities occupied)

Whether or not the Mutelles pick that up (something you could ask when choosing) , it is at least clear that it is best to have the top up cover so at least 100% of the normal charge is covered.
[/quote]

 

Just wanted to point out that not all specialists working in the private sector charge more.All the pulmonologists in our area, for example, are conventionne - you have to go as far as Bordeaux to find one who's not.

In case anyone's missed it, the sticky at the top of the board links to a site where you can see who charges what in your area; a very useful read before deciding what level of cover to go for.

[NormanH]

"Just wanted to point out that not all specialists working in the private sector charge more"

Perhaps not for the moment. I think one can see which way the wind is blowing though.

In the same film a  department in a clinic was shown which seeks out all the possible little things to add on to the bill, going into the patient's medical history to 'justify' it.

This is because the Sécu pay, and so it is regarded as a 'vache à lait' by the private providers.

After all they exist to make  a profit, unlike the public Hospital.

 With moves towards 'franchises' and 'contrôles'on things like hospital transport just the first steps in tightening up the Health Budget I prefer to have a Mutuelle which at least pays some of the cost on top of what I expect to be a diminishing part paid by the State.

[KathyC]

[quote user="NormanH"]"Just wanted to point out that not all specialists working in the private sector charge more"
Perhaps not for the moment. I think one can see which way the wind is blowing though.
In the same film a  department in a clinic was shown which seeks out all the possible little things to add on to the bill, going into the patient's medical history to 'justify' it.
This is because the Sécu pay, and so it is regarded as a 'vache à lait' by the private providers.
After all they exist to make  a profit, unlike the public Hospital.
 With moves towards 'franchises' and 'contrôles'on things like hospital transport just the first steps in tightening up the Health Budget I prefer to have a Mutuelle which at least pays some of the cost on top of what I expect to be a diminishing part paid by the State.

[/quote]

You may well be right for the future but that would seem to me to be the time to upgrade one's cover, rather than before it's necessary. I thought that the franchises and controles weren't able to be covered by a mutuelle anyway.

[Jamesdee]

Thanks KathyC for your comments. Showing my inexperience again, exactly where is the "sticky at the top of the board"? Thank you.

[NormanH]

KathyC: You are completely correct that the Mutuelle won't pay the  "franchises". In fact I believe they are not allowed to.

My point is that they, like the increasing 'contrôles' are a symptom of a tightening up.

In that climate I want to have the 70% topped up to 100%, (rather than saying I will pay the 30% if I ever have to)  knowing that there will be in any case more and more non-reimbursed either by the State or the Mutuelle .

 A crucial point for me is which things the Mutuelle will pay, rather than just the cost.

For example look carefully at the Optical/Dental options, and what they do about care at home.

[Âme]

[quote user="Jamesdee"] ...where is the "sticky at the top of the board"? [/quote]

At the top of this page you will see:

Health

Topic has 9 replies.

France Forum » Living » Health » Choosing a Mutuelle

Click on Health

Then in "Announcements and FAQs" (locked threads, referred to as stickies) click on "Looking for a GP, a specialist or a physio?"

[Owen]

Hello,

A bit of clarification is appropriate here. 

One has to be careful using the term "private" in respect of healthcare matters in France particularly with so many viewers, who are UK Nationals and are familiar with the difference between private and NHS treatment. To compare private healthcare in France to that in the UK is almost like comparing apples with oranges. The vast majority of doctors, specialists, hospitals and clinics are conventionné; some of which charge dépassements". However, a GP or Specialist with his own "cabinet" will be very probably "conventionné", but by some UK measures he/she would be regarded as being in private practise.

Private healthcare in the UK is quicker than the NHS for certain procedures, possibly of higher quality and definitely very much more expensive than a private clinic (conventionné) in France. There are private non-profit making clinics in France just as there are in other countries such as the Netherlands.

Even the profit making clinics can have some advantage in costs over such establishments as the CHUs, which also have a teaching function. Sure, a surgeon performing an operation in a private clinic (conventionné) will charge a "dépassement'" but the general costs of a stay there - the "frais de séjour" will be picked up by the CPAM.

I certainly agree that more of the healthcare costs are likely to be transferred to the insurers and the choice of provider will become even more important.

Regards

Owen

pjowen@expathealthdirect.co.uk

[Clair]

HERE

enter the doctor's name if you know it,

select the profession and confirm

skip to the postcode and enter the 5 digits

click rechercher to start the search

[NormanH]

I am not comparing private care in France and the UK. I have never mentioned the UK, and is has no relevance to choosing a Mutuelle in France, nor to anybody living permanently here.

Private health care in France is a business which exists to make a profit, and which milks off funds from the CPAM, looking for any pretext to perform money-making procedures which are just possibly necessary, in addition to the essential

This gives the patient a feeling of being well looked-after, so everybody is happy.

On the other hand the system cannot go on paying, hence the alarm bells

The CPAM pays the treatment

You or the Mutuelle  (possibly) pay any 'dépassement des horaires'

As to some of the 'Frais de séjour' , these may be met by the Mutuelle depending on the terms of your contract:

TARIFS AU 1ER JANVIER 2007 :

Supplément chambre particulière	51 €
Forfait journalier	16 €
Ces suppléments peuvent éventuellement être pris en charge par votre mutuelle. Si votre prise en charge n’est pas parvenue à la clinique le jour de votre départ, vous devrez régler ces suppléments.

This is why the choice of a Mutuelle is important.

A final point: it can pay to have a Mutuelle recognised by the clinic you are likely to go to, ( possibly a local one  as you then won't have to advance any money

[KathyC]

[quote user="NormanH"]KathyC: You are completely correct that the Mutuelle won't pay the  "franchises". In fact I believe they are not allowed to.
My point is that they, like the increasing 'contrôles' are a symptom of a tightening up.

In that climate I want to have the 70% topped up to 100%, (rather than saying I will pay the 30% if I ever have to)  knowing that there will be in any case more and more non-reimbursed either by the State or the Mutuelle .

 A crucial point for me is which things the Mutuelle will pay, rather than just the cost.
For example look carefully at the Optical/Dental options, and what they do about care at home.

[/quote]

 

We seem to have been talking at cross purposes. I too have a 100% top up although I know it won't cover fees that are non conventionne. As all our MTs and specialists are conventionne I haven't taken out a mutuelle for 150%/200%/300% although I'll be prepared to if more of them locally start being non con.

[Owen]

Hello Norman,

I was not suggesting that you were comparing UK with France. I really had in mind those who have not yet moved to France and may associate a private hospital such as a BUPA establishment in the UK being the same as a private clinic in France most of which are still conventionné.

The frais de séjour are the overall costs of a hospital stay eg; operating theatre costs and will be picked up by the CPAM in conventionné establishments. You are quoting the private room benefit which is never picked up by the Sécu and the hotel charges (forfait journalier) very rarely so. A provider will usually separate these 3 items in the table of benefits related to the policy.

But if you live in an area where these "dépassements" are more commonly and more heavily applied eg; the Cote d'Azur then this can affect your choice of insurer or a particular plan within that provider's stable.

Regards

Owen

pjowen@expathealthdirect.co.uk