Why do I have to pay extra to my doctor?

39 Replies

When I visit my docto,rdespite having a carte vitale and top up mutuelle, I still have to pay 7 euros. I don't visit very often at all, but I thought the cost was 23 euros, not 30 euros. Any ideas why this happens? Steve

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Replies

shepherdscrook 1454926488

It all depends what the Dr does - if he gives you an injection or takes blood or a complete medical some Dr's charge for this and that is the extra cost.


However if you are going just to renew a prescription etc then it should be just the 23 euros. I would ask what the extra 7 euros is for.

Iguana Rock 1454926627

You should have completed a 'Medecin Traitant' which your doctor would have signed. If you see another doctor (your choice as you can go where you like) the charge will be different.


This link will explain everything (I hope) but you will need to translate if your French isn't great!


http://www.ameli.fr/assures/soins-et-remboursements/comment-etre-rembourse/le-parcours-de-soins-coordonnes/choisir-et-declarer-votre-medecin-traitant.php

steve the painter 1454929855

He checks blood pressure and a couple of other things, but no blood taken or injections. He is my medecin traitant and has been for over 8 years now, and is recorded on my carte vitale as such. When I queried the cost, he said that it would be reimbursed through my mutuelle. Ths is not the case, so still unsure as to why I have to pay extra?

tigre-979768 1454930970

How many times has your doctor charged you 30 euros? I would query this with cpam, especially if you have paid him cash. It would be interesting to go and see him and  see if he would except a cheque from you!

malcolm1-10066606 1454934438

My doctor takes 25€ and I only get 4.95€ back from the CPAM!

countrydweller 1454935149

A doctor can charge what ever he/she wants.The reimbursement is decided on the scale laid down by CPAM and the level of cover that you have paid for by your mutuelle.You can check which health professional charges what on the ameli website.


malcolm1 You have not declared this doctor as your  Medecin traitant with CPAM which is why you only get a small amount back.Again you can check whether you have nominated anyone by checking your Ameli account

tigre-979768 1454938443

The standard charge for a GP is 23euros. Steve, do you know anyone else that uses this GP? If yes ask them what they are charged. Also the GP is obliged to make his charges known to his patients, I take it there isn't a list of his/her charges in the surgery? Is there more than one doctor in the practice you go to if so is there a receptionist? Ask her for a list of the charges. 

countrydweller 1454939358

There is no "standard" charge for anything in the French Health system.CPAM produces a tariff at which they base their reimbursements but no doctor hospital or specialist is obliged to follow this but they should declare it on the ameli website and every health professional should display a list of their charges so patients can see.

tigre-979768 1454940843

It seems that a GP can fall in to two categories, conventionne 1 or conventionne 2. If no1 then they have to adhere to the national agreement (standard) rate of 23euros for a consultation, if no2 then they can charge what they want. If you Google his/her name and area in France you may find the info, It may be quicker than using the ameli.fr site.

malcolm1-10066606 1455100921

Countrydweller he has been my doctor for 27 years and named since the system started !

MrsOverallagain 1455106976

My doctor's category 'conventionné' is stated on her prescription heading. Have a look at your last prescription. 

tigre-979768 1455190030

Steve, have you managed to find out if your doctor is conventionne 1 or 2 ?  It would be good for you to persue it as it may help others that are possibly being over charged.

Kanak 1455191326

saw an item on tv news yesterday how some GP's (who haven't seen tariffs rise for x? years) are randomly charging extra according to length of time, or anti-social hours of the consultation... apparently within their gambit even if conventionné, so why not ask the receptionnist?

countrydweller 1455213168

Malcolm1 Have you checked your Ameli account just in case he isnt

steve the painter 1455228021

My wife, who has the same doctor, is not asked for an extra 7 euros, and is always reimbursed 22 euros 3 or 4 days later by CPAM;  I only have to give him 7 euros,  which is never reimbursed. by RAM. I don't understand the difference. I have asked the receptionist who just says that it is 'Tiers Payante' .


Steve

tigre-979768 1455229659

Steve, you say you only give him 7 euros, don't you mean you give him 30 and get back 23 from cpam and your top up? Not quite sure who RAM is either. I'm only going from what you say in your original post.

steve the painter 1455229975

Nope, I only give him 7 euros, not 30 euros. And RAM is my medical provider through RSI.


Steve

tigre-979768 1455230780

So RAM is your top up insurance? Your doctor puts your carte vitale in the machine and then charges you 7 euros and this you don't get back from RAM or CPAM?

tigre-979768 1455231578

I can only think that between RAM and CPAM your doctor is paid directly but only 16euros hence him asking you for the 7 euros. Do you have any statements from either company saying what they have paid him directly? It seems odd that you are not reimbursed this amount. Failing that he's ripping you off, or your top up isn't adequate. 

jjp47 1455269569

Hi Steve, I am with RSI. I received an attestation recently for the right to 'tiers payant'. Previously we had CMU -c so didn't pay anything at the Dr, but we no longer qualify. I asked the Dr what 'tiers payant' was when I went yesterday. He said you just pay 7 Euros instead of 23, which makes it less onerous for me, and the Dr still gets 16. He said it was my choice if I wanted to pay the 7 instead of the 23. He didn't mention that I wouldn't get it back! Or maybe I missed that bit.

steve the painter 1455272722

Tigre - I am not with CPAM, my wife is, and she has her own carte vitale. I have AXA for top up insurance, with RAM being my main health provider through RSI, which most artisans pay in to.  My top up is more than adequate, but it seems that if you don't know who RAM or RSI are, then you don't really understand the system and therefore can't really offer any explanation.

steve the painter 1455273161

JJP47 - yes, that would make sense, I am also with RSI, but the doctor defifnately said I would get it back from RSI/ RAM. I have checked on LARAM.fr website but no 7 euros charges have ever been paid back yet, unless we only get it back once a year as it's such a small sum? Will be interested to know if you get your 7 euros back!!!!


Steve

jjp47 1455274927

I will be interested too, its the first time I have used this system. I will let you know, and I think I will be ringing RSI if I don't get a refund as it doesn't seem right!

tigre-979768 1455277750

You are correct Steve, I don't know how RAM and RSI work, but it seems you don't either after 8yrs with them. If you look at your original post it states nothing about Ram, CPAM or RSI,  it may save wasting a lot of other members time if you had made more of an effort to explain more in the first place. It seems jjp47 found out by asking his GP, an obvious place to start I would have thought.

steve the painter 1455279763

Yes, you are absolsutely right in that I never mentioned CPAM or Ram in my original post, but I just wanted to know if anyone had to pay a 7 euro charge to the doctor, regardless of what social health regime they had.


And I do understand the system very well (RAM and RSI and CPAM) but this was the first time I have visited my doctor in over a year and I did not understand why I had to give my carte vitale, plus 7 euros. My wife gives her carte vitale, pays 23 euros and gets the normal 22 euros reimbursed from the doctor. I don't get the 7 euros reimbursed at all, and with many more visits scheduled to both my doctor and a vascular surgeon, I was getting a bit worried that nothing would be reimbursed. I pay fairly hefty cotisations to the Regime Social Independants (RSI) and my health cover comes under this regime;  it's called RAM. Most self employed people are under this health care regime, and if often does not work too well, to say the least. That was my concern. However, I did mention that I was with RSI ad RAM before your last 2 comments.

tigre-979768 1455292627

Steve, I did ask you in one of my posts how many times you had been to the doctors and paid the 7 euros, this you didn't answer. If this is the first time you have been charged how do you know you don't get it reimbursed? If not and you have been charged this before surely you would have found out why by contacting RAM and possibly AXA before now?

lottie13-403657 1455309469

http://www.directmutuelle.fr/fiche_mutuelle_08.htm


 

tigre-979768 1455310473

Hello Lottie, would you be good enough to let me know what the link you have posted means in english in relation to this discussion. Thanks.

paul & nadine 1455355527

Hi,


I dont want to pry, but are you on any regular medication? If you are your reimbursement will be reduced by 50 centimes per box, which goes to Alzheimers research. 2 boxes per month for six months would account for your discrepancy.


Paul R

SG-404468 1455367088

I too think you are being charged 23 euros not 30, and that the 7 euros is the ‘top-up’ part of the charge. When we changed mutuelle provider a few years back, we found that we weren’t automatically receiving reimbursements and we have to email our RSI statements through to the insurance company in order to effect payment of the ‘top-up’ part. It may be that you need to do the same thing?

chrissyxx 1455462397

Hi, Just reading thro this posting, I have noticed that no one has mentioned that when you pay 23 e. to the doctor , only 16 e is actually refunded by CPAM. 6e. is reimbursed by your mutual assurance. . and 1 e. is paid by theyourself.. It looks as if you are being charged the 7 e that CPAM does not refund the doctor.Your doc is probably reimbursed 16e from your health company (if not CPAM) but you might have to claim your refund of 7e. from your mutual yourself. as CPAM automatically informs the mutual .Maybe this will help.

tigre-979768 1455464507

Chrissy, read the posts again, Steve is not with CPAM but RAM, he pays his doctor 7euros so it appears that the doctor is paid directly by RAM 16euros  then Steve's 7 euros makes up his fee. It seems more likely that jjp47 has come up with the answer and Steve has to claim back through AXA his top up insurance, of course we won't know iunless Steve let's us know if this is the case, he claims that he knows the system very well ( RAM, RSI & CPAM) so should be able to sort it out. It would be nice to know the outcome of his query as several members have been good enough to respond to his original request.

chrissyxx 1455466536

Yep! I think that's what I said. Except that I didn't actually mention RAM. but hey ho !! seems to work the same way as CPAM except for the reimbursement from the mutual. Think this is quite obvious!


 

tigre-979768 1455467669

Yes you did, as I did and jjp47 in previous posts in so many words. It's just unusual for a top up insurance not to pay back automatically, but  you would have thought Steve would know if his mutuelle doesn't do this as he has been in the system for some years now and wouldn't have had to ask on this forum, but if this isn't the case it may not be obvious as you suggest.

steve the painter 1455470874

As this was the first time I had to pay the doctor the 7 euros, I really did not know how to claim it back, or whether I would get it back at all. One lives and learns, even if you know the sytem well. Now that I have been advised to go onto my personal space on RSI, I see that the doctor has in fact been re-imbursed his 16 euros, and therefore I will send this attestation to AXA for re-imbursement from them. This is completely new to me - and in all other cases when I have presented my CV, it is re-imbursed automatically. Now I know, thanks to Chrissyxx, JJP and SG for their very  helpful comments. Sorry I did not get back quick enough for some people but I am often busy.


Steve

tigre-979768 1455475889

Yes, well done you three for steering Steve in the right direction. Steve, first point of contact should always be your insurance provider, let's face it you pay them enough, may be you are held back with the lack of the French language that's all I can think as to why you didn't contact them in the first place!

steve the painter 1455476109

No, I'm quite fluent, actually. I just didn't think to ask AXA, as it had always been automatic in the past. I changed my Mutuelle in October, and I've not had to do this before.


But thanks to everyone for their help.

jjp47 1455479573

No problem, glad you got it sorted! Looks like I know what to do now too.

tigre-979768 1455481084

Really pleased you now have it sorted Steve. You know what they say about insurance companies, always read the small print, a lesson to us all, mind you your doctor did give you a hint by saying it would be reimbursed by your mutuelle.

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