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Why not 70 percent?


Fleur

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I noticed yesterday - very slack I know - that when visiting the doctor, my husband gets 70 percent allowance against the 22 euros. Whilst I, on the other hand,  having started out at 70 percent, it went to 60 and now I'm only getting 50!

I've called the English speaking helpline and they can't - as yet - explain it but are being kind and looking into it.

I just thought it might be useful to remind others to check theirs.

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The most likely explanation is that you have not filled in the medecin traitant form for yourself.  Unless this doc' is your nominated one, you will get a lower percentage back.  Is that it?

EDIT : HERE is a copy of the form, in case that is your problem.  Fill it in, get your doctor to sign it, and take it to your CPAM.

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[quote user="cooperlola"]

The most likely explanation is that you have not filled in the medecin traitant form for yourself.  Unless this doc' is your nominated one, you will get a lower percentage back.  Is that it?

EDIT : HERE is a copy of the form, in case that is your problem.  Fill it in, get your doctor to sign it, and take it to your CPAM.

[/quote]

I fear that life is not that simple.

On 1/10/07 I visited my doc, paid 22€ then RAM reimbursed 10€ (50% - 1€)

On 18/1/08 I visted doc, paid my 22€ then RAM reimbursed 14,40€ (70% -1€)

Between those 2 dates I have not filled in (if you are American or young replace "in" with "out") any forms BUT my doc now has a shiny new gizmo that means automatic reimbursement without my sending off a brown feuille.

I'm not really concerned just confused.

John

not

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Another possibility which happened to us (and got me very confused at the time) - for certain things there is a "forfait" that you have to pay (like the 1 euro for the doc).

BUT if you don't pay for it at the time then they take the forfait off the next time you get a remboursement for something else.  Oh dear I'm not sure that makes sense!

Our example: husband had a test at the laboratoire, presented carte vitale and top-up thingy - nothing to pay.  Turns out there's a "forfait" of 3 euros for this test, but of course CPAM can't deduct from the remboursement because there wasn't one, so next time he went to the doctors and paid, only 10 euros something back from CPAM because they also took off the 3 euros owing from the previous time.  I did contact them and got it explained but of course once the list of remboursements came through it was clear what they'd done.

On another note, CPAM managed to "lose" our medecin traitant forms when we were transferred onto permanent carte vitales (previously on an E106 on temporary numbers) which only became clear when we didn't get the full remboursement after a visit to the doc.

Lou

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Yes you are right: they catch up on things you have to pay for by deducting them from other re-imbursments.

This happens with the 50 centimes per box of medicine even  if you are at 100%.

Obviously you haven't paid anything out at the pharmacie, so it has to come from one of the payments you have made..to your Doctor , for example.

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[quote user="Jura"]It is not unknown for GP's to charge us women more than the men.[/quote]

This is incorrect.

Doctors are either conventionné de secteur 1, in which case their fee is set (currently €22 for a GP and €25 for a specialist) or conventionné de secteur 2, in which case they set their own fee.

More details here: http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-remboursé

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Okay, so when hubby and I both see the same doc for sore throats why does he get charged 22 and I get charged 25? Same for our two kids...the 3 year old we pay 25 for and for our 5 year old we pay 22?...both always go in for the same thing as I only ever take them when needed...!

The prices most certainly are not fixed we have found.

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[quote user="Jura"]Okay, so when hubby and I both see the same doc for sore throats why does he get charged 22 and I get charged 25? Same for our two kids...the 3 year old we pay 25 for and for our 5 year old we pay 22?...both always go in for the same thing as I only ever take them when needed...![/quote]

If this is the case, have you asked your GP?

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