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Reimbursements from CPAM


tuppence

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Hello.

Can anyone shed any light on the fact that my reimbursements from CPAM seem to be getting smaller?Thankfully I only have to see my doctor every 3 months for a prescription (unless on the rare occasion when something else crops up). I pay the doc 22€ each time and I get the 30% back from my mutuelle but the CPAM only pays 8.50€ and this month I only got 6.40€. Am I missing something here? Help someone please.[6]

tuppence

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I am not sure what this 'franchise payments' is all about. I am over 60 and do not pay for prescriptions by showing my carte vitale, but I was expecting to get a fll refund fo a visit to a doctor. All my other ex-pats locally seem to get the full reimbursement. Why not me?

tuppence

 

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[quote user="tuppence"]I am not sure what this 'franchise payments' is all about. I am over 60 and do not pay for prescriptions by showing my carte vitale, but I was expecting to get a fll refund fo a visit to a doctor. All my other ex-pats locally seem to get the full reimbursement. Why not me?tuppence[/quote]

I don't think you're being singled out [:D]

Franchise payments:

[quote]

Qu’est-ce que la franchise médicale ?

La

franchise est une somme qui est déduite des remboursements effectués

par votre caisse d'Assurance Maladie sur les médicaments, les actes

paramédicaux et les transports sanitaires.

La franchise : quels montants ?

Le montant de la franchise est de :

  • 50 centimes d'euro par boîte de médicaments (ou toute autre unité de conditionnement : flacon par exemple) ;
  • 50 centimes d'euro par acte paramédical ;
  • 2 euros par transport sanitaire.

La franchise est plafonnée

Un plafond annuel

Le montant de la franchise est plafonné à 50 euros par an pour l'ensemble des actes ou prestations concernés.

Un plafond journalier

Un plafond journalier a été mis en place pour les actes paramédicaux et les transports sanitaires.

On ne peut pas déduire :

  • plus de 2 euros par jour sur les actes paramédicaux ;
  • plus de 4 euros par jour pour les transports sanitaires.

Qui est concerné ?

Toutes les personnes sont concernées par la franchise sauf :

  • les enfants et les jeunes de moins de 18 ans ;
  • les bénéficiaires de la couverture maladie universelle (C.M.U.) complémentaire ;
  • les

    femmes prises en charge dans le cadre de la maternité (les examens

    obligatoires et la période d'exonération du 1er jour du 6ème mois de

    grossesse au 12ème jour après l'accouchement).
http://www.ameli.fr/assures/[/quote]

in google English here.

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Hi Jotty,

Yes this was mentioned to me when I first noticed the shortfall in reimbursements. It turned out that although I had seen the same doctor I had NOT actually registered with her. However I have since done that and the forms were duly signed and sent off, but I am still getting less than I expected to get. In fact I am getting even less now. It does seem to me that the 'franchise' thing doesn't mention visits to the doctor in their criteria for not having to reimburse the patient.

tuppence

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Here are the official reimbursement rates for a visit to the doctors.

If the doctor is registered as your medecin traitant:

Cost - 22€

Reimbursement @ 70% = 15,40€ minus the 1€ 'forfait' = 14,40€

If the doctor is not registered as your medecin traitant:

Cost - 22€

Reimbursement @  50% = 11,00€ minus the 1€ 'forfait' = 10,00€

(Source: www.ameli.fr)

Sounds like you need to visit your local CPAM permanence and query things.

 

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Thanks SD,

I have never ever received a double figure reimbursement from the CPAM. From the mutuelle I get 6.60€ but the 14.40€ has never been forthcoming. The most I have ever got is 8.50€ and as I said in my previous post, todays refund was a measly 6.40€. Most annoying but I will visit CPAM and try to get it sorted. [:(]

thanks

tuppence

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Don't forget that franchise payments are sometimes 'lumped together'. That is you may find that the franchise for each box of medicine has to be deducted from the reinbursements you get for the Doctor's fee, especially as you don't pay anything over the counter at the Pharmecie.

If you have several boxes the franchises are added together, then deducted from your reimbursement.

Otherwise they couldn't collect them.

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Hi Tuppence

I don't know if you are already aware but you can go to www.ameli.fr  to set up an account.   You will be able to view your reimbursements with all the details from CPAM on line.  You need to have your SS number and the six digit number from your last statement of reimbursements.

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Jotty,

You were spot on with your reply to my original post. I have just logged on to the www.ameli.fr site and sussed it all out. During July- September I had to have 2 blood tests plus 3 visits to the pharmacy resulting in the 'franchise forfaitaires' being deducted in a lump as you said. Total to be refunded was 14.40€ minus 8€ for the franchise, et voila 6.40€ into bank. Very easy to see once you get onto the website. Many thanks for pointing me in that direction and others who have posted also.[:)]

tuppence

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[quote user="Clair"]Click on the "Soins et Remboursements" tab, then "Consultez vos remboursements" on the right-hand side.
This should bring this page.
[/quote]

Thanks Clair but the site keeps turning me in circles, every time i click on "create your account" it takes me to the log in page assuming that I have already created one, there is a lovely animated description of how to do it but the link again goes to the same page as does following the instructions of where to find "create your account".

Maybe its a man thing and I am missing something obvious, can you help again?

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Do you already have your confidential code number then JR?  If you have never been given one you can't get onto the system, but you can request one (by filling in your SS number, surname, DOB and postcode) https://login.assure.ameli.fr/assuresso/default.do

Your number will then be posted to you (by snail mail) and you then use it to access the system.

EDIT, Just noticed that the code can also be "Votre n° Allosécu à 6 chiffres, envoyé avec vos relevés de remboursement " so I guess if that's what you were using  then the problem is something else.

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Funnily enough, I have next to me a page from them with my name, SS number and code, but the system doesn't seem to want to know me and I have been locked out!

I have tried requesting a new code, but my name is not being recognised... [8-)]

I have used the system before, but not for a while, not with this laptop and not with Firefox 3, which I know has problems with other websites where identification is required.

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  • 5 weeks later...
Hi Tuppence,

I too have a problem with my Reimbursement from CPAM. I visited the dr this month for the first time since February and my reimbursement from CPAM was 4.90€ and 6.60€ from Ascore. Is this because I am a dependant on my OH's E121. He is in receipt of 100% Maladie Long Duree. Perhaps wonderful SD can help. We completed the Medecin Traitent form when we arrived in 2006.

Suey
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[quote user="sueyh"]I visited the dr this month for the first time since February and my reimbursement from CPAM was 4.90€ and 6.60€ from Ascore. Suey[/quote]

If you were prescribed medicines by the Doctor in February then it is probably the 'franchises' - so much deducted from your repayment for each medecine prescribed - which are taken retrospectively, which are causing the difference in your reimbursements.

See http://www.completefrance.com/cs/forums/1179671/ShowPost.aspx which is what Cat suggested might be the answer on page 1 of this thread.

Sue

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Hi Clair - I've also had difficulties setting up the Ameli account - mainly I think because it asks for a 13 figure SS no. ("sans cle"). Our no. is 15 figure, but still isn't accepted by deleting either the first or last 2 digits.

Did you get anywhere with it?

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[quote user="seb47"] Our no. is 15 figure, but still isn't accepted by deleting either the first or last 2 digits[/quote]

[quote]Le numéro de sécurité sociale est un nombre composé de 13 chiffres

et d'une clé de 2 chiffres qui nous suit et nous identifie toute notre

vie.

Une petite explication sur un exemple

1 59 10 75 118 104 key

A B C D E F

A : sexe (1 pour un homme, 2 pour une femme)

B : année de naissance

C : mois de naissance

D : département de naissance

E : code de la commune de naissance

F : rang de naissance dans le mois dans la commune

The social security number is a number composed of 13 figures and key figures of 2 which we read and we identify all our lives.

A little explanation on an example

1 59 10 75 118 104 key

A B C D E F

A: gender (1 for a man, 2 for a woman)

B: year of birth

C: Month of Birth

D: Department of birth

E: code of the town of birth

F: birth order in the month in the town register
[/quote]

Mr Clair's number is something like 1 xx xx 99 xxx xxx key, where the x represent numbers. As Mr Clair was not born in France, his dept number is 99.

Does your number fit it with this explanation?

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Thanks for the quick reply Clair!

Sadly the formula doesn't seem to fit us. We both have the same SS number under my husband's name and apparently we are sex no. 7!

 99 doesn't figure anywhere though we were born in UK. They seem to have a poor opinion of us!

Not to worry though - we keep saying "we'll get there in the end ....."

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If your number starts with a 7 (or an 8 for a woman), it is a temporary one.

Temporary in this instance can mean long-term.

This happens when a CPAM has to issue a number without having sight of the usual documents they require, like a full birth certificate.

This is also the case for foreign students and its was also the case for Mr Clair until he started working and contributing in his own name.

Edited for further details.

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