Categories
Health Mental health

Expat blues

When you first know that you’re gonna be an expat, you may have some mixed feelings. On the one hand, the thrill of the adventure, a new country, a different culture. You’re on a path to actually get out of your comfort zone as so many signals in our culture urge you to and that’s when the expat blues may hit you.

On the other hand, you may have heard stories about expats having trouble to fit in their adoptive country. Of course, migrating to a new country can be a big shock, it’s a new culture, new food, new ways of handling your daily life. Going to the doctor is not the same, you won’t find the same things in supermarkets, the language, weather, vibe of the country, everything can radically shift from what you’re used to. It’s like being born again.

We, Juliette and Amaury, have had experiences in several countries, like Qatar, England and France when Juliette first came to the country and we’re gonna be the first to acknowledge that … it’s true. It can be so hard to find your place. You never know what to expect, what to do and how to react. Especially in Qatar, it was a true culture shock for me.

What to do to prevent it

Before you leave

  • Get to know the culture (movies, books, politics, radio, newspaper
  • Try to find your place, at least narrow it down (link housing)
  • Check with your company if you’re being transferred, what they can do to help
  • List the admin procedure you’ll need to do (link to the 30 days articles) and create a step program (link)
  • Learn the language (link to learning french)
  • Friend everyone you know in the city you’re gonna go, to get out of your place.

Once you’re in the country

  • Sleep
  • Exercise (link sport, and running)
  • Don’t abuse alcohol
  • Join groups to connect (link to social events)
  • Talk with measure to your friends and family back home (it’s better to not talk everyday, but do things, discover the city, do things in order to have a lot to talk about)
  • Explore the town
  • Minimise social media
  • Remind yourself why you’re there
  • Cook the meals you like

Recognise the symptoms

  • Lack of motivation and productivity
  • Poor sleeping schedule and exhaustion
  • Bad diet and upset stomach
  • Mood swings and emotional outbursts
  • Sudden social anxiety and withdrawal
  • Changes in energy levels

Deal with the symptoms of

expat blues

On your own

  • Let people around you know they can help
  • Ask for advice to your expats connections, to your colleagues

Seeking the help of a professional

  • Seek professional help
Categories
Health Physical health

Emergencies

I hope that if you read that article you do not find yourself in dire need of assistance, but if you do, I sincerely hope that the following will answer your questions.

Who are you gonna call ?

In France, there is no unified emergency number like 911 in the US or 991 in the UK. But here are the main one you need to know : 

15 – calls the SAMU which is a first responder for medical emergencies

17 – calls the police

18 – calls the firemen

112 – European emergency number, if you’re a victim or a witness of an accident in any EU country.

We strongly recommend making a note of these numbers or adding them to your contacts.

Where are you gonna go ?

Here is the reference website if you find yourself in an unknown city and you’re looking for a hospital. It’s in french but quite easy to navigate.

When you’re in the hospital, look for the “Urgences” département. That’s our french emergencies and where you’ll be taken care of.

Little tip : the wait can be quite long, based on the condition you have, the number of staff etc, so take a book !

Tips and tricks 

  • Add the numbers above to your phone
Categories
Health Physical health

Getting reimbursed

Like everything in France, getting reimbursed can be quite complex. This article does not aim at explaining thoroughly the way it works.

I’ll give you an overview of the main aspects and provide you with some tips that should make you able to navigate and understand 90% of the situations !

Saving money when you go to the

doctor in France 

Parcours de soin and médecin traitant

Before going to the doctor in France, there are two concepts that you need to know : 

  • Parcours de soin (health pathway) : a couple of steps to follow in order to not have a huge medical bill
  • Médecin traitant (your assigned GP) : a practitioner that you chose and you’ll always see as your GP.

Parcours de soin – What is it ?

You may have heard that France has a generous health care system, and it’s true. Most french people don’t realise it and won’t stop complaining about “La Sécu”, the social security. This generosity implies that a lot of money is spent in our social system (around 700 billions € a year).

In order to regulate the spendings, the state implemented a system of “Parcours de soin” (health pathway).

Parcours de soin – What does it entail ?

It’s very simple. It means you have to see a GP before going to a specialist. If you’re not referred to a specialist by a GP, the fees may be topped up.

When I say a specialist, I cover all the doctors that you hope to never see in your life (gastroenterologists, …).

Dentists and ophthalmologists are not specialists, you can go and see them as you please.

Does any GP work as a reference ?

Theoretically no. In order to go and see a specialist, you should first make a stop at your “médecin traitant”. 

But it is not frowned upon to see any GP to get the reference, even if he is not your own.

What is a médecin traitant ?

The médecine traitant can be a GP but not always.  It could be your homeopath, your gynaecologist etc. Basically, it’s a health professional that know you a bit more than the others.

How do you select your médecin traitant ?

  1. Go online on your “assurance maladie” personal space. 

TIPS :

  • In order to log in, you’ll need your social security number (here is how to get one)
  • The French government set up a system that helps you connect to different bodies of the administration like the Impôts (Taxes), the health system etc. It’s France Connect and it’s awesome.
  1. After logging in, click on “Mes informations” category in the top-right-hand corner and fill in the info.

Or you just ask the doctor to be your “médecin traitant” during your consultation and they’ll do the thing for you.

The timeline

Let’s take a look at what it will look like with my friend Napoleon. He’s been having a stomach ache for some time now and he is a busy guy, a lot of countries to conquer etc. He hasn’t had time to look at what to do yet.

What ? There are different types

of reimbursement ?

Yep, there are ! The amount you will get as a reimbursement from your medical expenses will depend on : 

  • The types of doctor you go and see and if he is secteur 1 or secteur 2
  • The nature of the procedure
  • The coverage you have from a possible private insurance (a mutuelle / assurance complémentaire)

What are the different types of doctors ?

There are two types of doctors in France :

  • Conventionné ou Secteur 1 : it means that you’ll get reimbursed with the Social security barema. That ‘s the case for most GPs and their Doctolib profile mentions it. In short, it means you won’t have to pay too much because Social security covers most of it.
  • Non-conventionné ou Secteur 2 : it means the reimbursement barema from Social security won’t apply to the whole cost and you may pay more (dépassement d’honoraire).

The payment to a doctor is an “honoraire” and the secteur 2 doctors go above the normal honoraire, hence the “dépassement d’honoraire” (extra fee). For some treatments and actions, secteur 1 can also add some extra fees.

How does the reimbursement for medical

expenses work in France ?

We’ll not go into much details, but there are two concepts to remember to get reimbursed : 

  • La base de remboursement : what amount does the Social security cover
  • Le taux de remboursement (rate) : the fraction of the covered amount that you will get back

Also, as the Social security does not cover all of the medical costs, you can take, personally or through your work a mutuelle or complémentaire santé, which are private health insurances.

Let’s take a couple of examples with the help of our friend Napoleon. He doesn’t feel very good and needs to go and see a specialist. But first, he checks with his “médecin traitant”, in order to get a referral…

Going to the GP without additional fee

He goes to the GP and pays 25€. Social security covers up to 25€, meaning he is fully covered.

However, the rate is only 70%. So, he’ll get back 70% of the amount he paid (minus a deductible of 1€).

The remaining 30% is called “ticket modérateur” in France and is what you have to pay to reach 25€. Your private insurance can pay some of it, depending on the contract you have.

In that example, the doctor belongs to secteur 1 (no extra fee, no dépassement d’honoraires).

Going to a specialist

Let’s say now, that my friend Napoleon needs to go and see a specialist. The specialist is secteur 1 but requires a medical work that will trigger an extra fee (dépassement d’honoraires).

Napoleon pays 500€ for the procedure. Social security covers up to 400€ and the rate is 50%. So, he’ll get back 200€ (minus the 50€ of deductible).

Then remains 300€ : 200€ of copayment and 100€ of extra fee, that the pricate insurance can cover, depending on the contract.

This is a fictional example, the figures used do not reflect in any way the costs you may find during a procedure.

How do I get reimbursed ?

There are two ways to get your money back after a visit to the doctor.

If I have a Carte Vitale

This is the easiest process. You have nothing to do. You’ll just hand in your Carte Vitale to the professional and you’ll just wait and relax to get your funds back. The money you’ll get covers the Social security + mutuelle reimbursement, if you have a mutuelle.

The process can take up to 3 weeks.

Here is an article about the Carte vitale that explains how to get one.

If I don’t have a Carte Vitale

The process to get reimbursed gets a bit tricky. The doctor (and the pharmacist if you need medicine) will give you a form (feuille de soin) that you’ll need to fill with : 

  • Your name
  • Social security number

Then, you’ll need to send it to the CPAM (Caisse Primaire d’Assurance Maladie), the body of government that handles certain healthcare actions. To know the address where to send, it’s very simple, just click there.

If you’re in Paris, kudos, that’s the address displayed underneath. Otherwise, just click on “Changer” and type in your zip code.

Categories
Health Physical health

Dentist in France

Going to the dentist in France is like going at any health professional : fairly easy and most of the time reimbursed by social security.

A couple of tips before going

You don’t need a referral to go to the dentist

You may have heard about the “parcours de soin” and the “médecin traitant”. If you didn’t, please look at this article, it’ll help you lower your fees for your next visits to the doctor. In short, the parcours de soin (healthpath) is a set of steps that patients have to follow to go and see a specialist.

Good news, you don’t have to follow the steps to go and see a dentist. You can merely book an appointment, and off you go.

Is it expensive ?

France likes seeing people in good general health and doesn’t like that you have to pay a lot of money to get your care. So for most dental works, the cost, even if it may seem high (up to 50 to 100€) will be totally or partially covered. This means that you’ll get reimbursed.

However, it does not mean that every dental work is covered. Here are a couple of tips to avoid having to mortgage your house for your teeth : 

  • Opt for a dentist within secteur 1 or conventionné
  • Check the cost and reimbursements options with the dentist first
  • Make sure you have a “mutuelle” (private health insurance) that covers the extra fees.

What about kids ?

Children are entitled to a free dental check every three years from 6 to 18. The administration will usually remind you that the time for the check-up has come.

Most treatment for children is free but not all – for instance braces are not covered.

What does a visit look like ?

Book an appointment

How do I find a dentist ?

The preferred option is to use a booking platform. There are to main in France : 

Personally, I use Doctolib. It’s very user friendly and you’ve got a lot of info, especially if the dentist speaks another language.

Where can I find an english speaking dentist ?

Both Doctolib (in French) and Maiia (in French) offer the option to search their directories by language spoken. 

You can also skim through some expat groups on Facebook where people share their recommendations.

Before going 

What documents should you take ?

  • Your carte vitale (here is how to get one)
  • Your previous prescriptions if you consult for the same reason

That’s it.

Upon Arrival

There is this myth going around that doctors are always late and that you can arrive with a 15 to 30m delay. Let’s not kid ourselves, it’s true most of the time but not all the time. And usually, if the doctor is late, it’s because they take the time to treat every patient with the care and attention they deserve.

Most doctors don’t have a staff or a secretary. Upon arrival, you just ring at the “interphone” and they buzz you in. Don’t forget to check the floor before you go.

You’ll have to look for the waiting room “ Salle d’attente”. It’s fairly common to greet the people that are already there with a “Bonjour”. This is just in order to not get weird looks.

What happens after ?

How do I get my medicine ?

At the end of the session, if need be, the doctor will give you a prescription (ordonnance) to get your medicine. Most of the time, it will be written in an ​​indecipherable penmanship but don’t worry.

You’ll just need to take your prescription and your carte vitale and go to the closest pharmacy. The person behind the counter will; like magic, be able to read said prescription and give you what you need !

Categories
Health Physical health

Pharmacies

This a sign that you’ll find often in France, the green flickering cross of the pharmacy. Here are a couple of things you should know about pharmacies in France.  

What is it ?

Don’t worry there won’t be big reveals, pharmacies are places to buy medicine, but a couple elements differ from what you may know in your country.

What is sold in a pharmacy ?

In France, a pharmacy ONLY sells medicine. Compared to some countries where pharmacies also sell everyday products, you won’t find any TP or last minute grocery in a pharmacy in France.

What is a parapharmacie ?

Parapharmacie is a category of product found in pharmacies and supermarkets linked to health and beauty. It’s not medicine. It’ll be more skincare, dietary supplements etc.

Can I find medicinal products outside

of a pharmacy ?

Answer is simple no. From Ibuprofen to the very specific medicine you might need for a condition like asthma, it’s always in a pharmacy, never in a supermarket. 

What about emergency situations ?

In France, pharmacies like any other shops have classic opening hours from like 10 am to 7 or 8 pm.

However, for emergency situations, the pharmacies of a city or a neighbourhood organise opening shifts. These are the “pharmacie de garde”. You’ll find there the closest pharmacie de garde to your location.

How does it work to get my

medicine ?

Do I always need a prescription to get

medicine ?

No, some of the meds are available without any prescription. For minor conditions like a cold, a little fever etc, you don’t have to go to the doctor to get a prescription. Just go to the pharmacy and explain your situation, they’ll give you the product you need.

However, some meds require a prescription. Giving you an exact list of the meds available with or without a prescription would be too long and boring. You may just go to the closest pharmacy and ask if you can get the product.

How can I get a prescription ? 

Pharmacists are not allowed to prescribe medicine. Doctors only can.

Thus, if you need a specific medicine, get to the GP first. Here is the article about going to the doctor.

Tips : 

  • Pharmacists only sell medicine and don’t prescribe, only the doctors can.
  • Don’t forget your Carte Vitale, it’ll help you have your meds reimbursed.
  • For minor conditions, pharmacists can just sell you some products if they are available without a prescription.
Categories
Health Physical health

Going to the doctor

This article will explain a bit more about going to the doctor in France.

We’ll cover the ways : 

  • To book an appointment
  • To get reimbursed

We won’t cover : 

  • The ways to handle emergencies (There are specific services in french hospitals – Les Urgences)

Which one to choose ?

Parcours de soin and médecin traitant ?

Before going to the doctor in France, there are two concepts that you need to know : 

  • Parcours de soin (health pathway) : a couple of steps to follow in order to not have a huge medical bill
  • Médecin traitant (your assigned GP) : a practitioner that you chose and you’ll always see as your GP.

Parcours de soin – What is it ?

You may have heard that France has a generous health care system, and it’s true. Most french people don’t realise it and won’t stop complaining about “La Sécu”, the social security. This generosity implies that a lot of money is spent in our social system (around 700 billions € a year).

In order to regulate the spendings, a system of “Parcours de soin” (health pathway) has been implemented.

Parcours de soin – What does it entail ?

It’s very simple. It means you have to see a GP before going to a specialist. If you’re not referred to a specialist by a GP, the fees may be topped up.

When I say a specialist, I cover all the doctors that you hope to never see in your life (gastroenterologists, …).

Dentists and ophthalmologists are not specialists, you can go and see them as you please.

Does any doctor work as a reference ?

Theoretically no. In order to go and see a specialist, you should first make a stop at your “médecin traitant”. 

But it is not frowned upon to see any GP to get the reference, even if he is not your own.

What is a médecin traitant ?

The médecine traitant can be a GP but not always.  It could be your homeopath, your gynaecologist etc. Basically, it’s a health professional that know you a bit more than the others.

How do you select your médecin traitant ?

  1. Go online on your “assurance maladie” personal space. 

TIPS :

  • In order to log in, you’ll need your social security number (here is how to get one)
  • The French government set up a system that helps you connect to different bodies of the administration like the Impôts (Taxes), the health system etc. It’s called France Connect and it’s awesome.
  1. After logging in, click on “Mes informations” category in the top-right-hand corner and fill in the info.

Or you just ask the doctor to be your “médecin traitant” during your consultation and they’ll do the thing for you.

The timeline

Let’s take a look at what it will look like with my friend Napoleon. He’s been having a stomach ache for some time now and he is a busy guy, a lot of countries to conquer etc. He hasn’t had time to look at what to do yet.

What does a visit look like ?

Should I book an appointment or just walk-in ?

You can do both, provided the doctor you want to see offers both options.

How do I find a doctor ?

Usually, when you look for a doctor, you’ll type “médecin” or “généraliste” in google map and that will show you all the GP within your area. Typing on their name will show you if they do walk-ins or appointments.

Another way, that is the preferred option, is to use a booking platform. There are to main in France : 

Personally, I use Doctolib. It’s very user friendly and you’ve got a lot of info, especially if the doctor speaks another language.

Where can I find an english speaking doctor ?

Both Doctolib (in French) and Maiia (in French) offer the option to search their directories by language spoken. 

You can also skim through some expat groups on Facebook where people share their recommendations.

Before going 

What documents should you take ?

  • Your carte vitale
  • Your previous prescriptions if you consult for the same reason

That’s it.

Upon Arrival

There is this myth going around that doctors are always late and that you can arrive with a 15 to 30m delay. Let’s not kid ourselves, it’s true most of the time but not all the time. And usually, if the doctor is late, it’s because they take the time to treat every patient with the care and attention they deserve.

Most doctors don’t have a staff or a secretary. Upon arrival, you just ring at the “interphone” and they buzz you in. Don’t forget to check the floor before you go.

You’ll have to look for the waiting room “ Salle d’attente”. It’s fairly common to greet the people that are already there with a “Bonjour”. This is just in order to not get weird looks.

What happens after ?

How am I going to be reimbursed

and how much ?

There are several options and this is where things may get a little complex.

There are two types of doctors in France :

  • Conventionné ou Secteur 1 : it means that you’ll be reimbursed with the Social security barema. That ‘s the case for most GPs and it’s mentioned on their Doctolib profile. In short, it means you won’t have to pay too much.
  • Non-conventionné ou Secteur 2 : it means the reimbursement barema from Social security won’t apply and you may pay more (dépassement d’honoraire).

The payment to a doctor is an “honoraire” and the secteur 2 doctors go above the normal honoraire, hence the “dépassement d’honoraire” (extra fee). For some treatment and actions, secteur 1 can also add some extra fees.

How does reimbursement work ?

You’ll pay for an act, let’s say 25€ for a consultation with a “médecin traitant” (which is a standard rate for every secteur 1 GPs).

To that amount, is applied a rate called “taux de remboursement” (reimbursement rate). This is how much the healthcare system is going to reimburse you. For a consultation with your “médecin traitant”, it’s 70%. It’s only 30% if didn’t declare a “médecin traitant”

So, you pay 25€ and you’ll get 17,50€ back, that seems correct.

But you’ll see that you only get 16,50€. This is because there is a special 1€ fee.

Basically, this is way to calculate :

How much was the consultation (honoraires) ?What is the taux de remboursement ?Are there any additional fees ?My final pay back will be : 
25€70%Yes – 1€16,50€

The cost of the “honoraires” and the reimbursement rate vary depending on the type of doctor and the type of act they perform.

For more info, please check the dedicated article.

How do I get my medicine ?

At the end of the session, if need be, the doctor will give you a prescription (ordonnance) to get your medicine. Most of the time, it will be written in an ​​indecipherable penmanship but don’t worry.

You’ll just need to take your prescription and your carte vitale and go to the closest pharmacy. The person behind the counter will; like magic, be able to read said prescription and give you what you need !

Tips and tricks 

  • Make sure you respect the “parcours de soin” in order to lift some costs.
  • Check the prices of the doctor before going. If nothing is written, then, it’s the social security rate that applies.
  • The French government set up a system that helps you connect to different bodies of the administration like the Impôts (Taxes), the health system etc. It’s on France Connect and it’s awesome.
Categories
Health Health Insurance

Your carte vitale

Getting a carte vitale is paramount. You’ll need it to go to the GP, pharmacy, hospital … here is a quick and easy way to get one. Some people think it’s complicated. It is if you look closely at all the institutions and types of allocations that you can get. However, it’s friggin easy if you just follow these steps.

What is it ?

How do you use it ?

  1. The Carte Vitale will help you navigate the french health system. You’ll have to present it when you go to the doctor, when you go to the pharmacy.
  2. This will facilitate the reimbursements whenever you have a doctor’s visit because you always have to pay upfront and then get your reimbursement (60% to 70% of the amount). When you have your carte vitale, it is done automatically and the funds are automatically wired back on your bank account. Otherwise, it’ll be a pain for you, because you’ll need to mail in some papers to the french public insurance, the sécurité sociale. 
  3. Lastly, it stores information about all the doctors you have seen and medicine you have ordered. This will be a great help to follow through on your treatments whenever you go and see another specialist.

What does it look like ?

It’s like a credit card for health and it fits perfectly in your wallet for you to carry around at all time.

Carte vitale design

On it, you’ll find your social security which is quite useful.  Because it’s a long number and nobody remembers it by heart. There is also mentioned the name of the person(s) covered by the insurance. Indeed, if you have kids under 16, they are registered and get health insurance via their parents.

Is it mandatory ?

It is mandatory to have health insurance provided by the state (yep and nobody will ever reverse that, wink to our American friends). Whatever your situation, if you’re an employee, unemployed, your own boss or a student, you’ll need to have health insurance.

Is it free ?

To get it, yep. But some costs may apply, especially to translate some documents into french.

How long does it last ?

All your life in France.

How can I get a carte vitale ?

The conditions to apply

To apply for a Carte vitale you need to : 

  • Have spent more than three months in the country
  • Be over 16
  • Own a bank account in France
  • Have your numéro de sécurité sociale, When you get you Social Security Number, you’ll get a paper form to request a Carte Vitale. You can toss the paper if you follow the online process.

What documents do I need ?

  • A copy of your passport
  • Your picture 
  • Proof you have lived in France more than three months. This is a “justificatif de domicile”. It can be an electricity bill, a copy of your lease etc… Any proof 
  • Your relevé d’identité bancaire (RIB) so you can get reimbursed. 

How to apply ?

The whole process can be done online.

The go-to website for your national health insurance is called ameli.fr (you might know that freaky movie of that Parisian girl with the short black hair called Amélie, but that website simply stands for “Assurance Maladie En LIgne” –  health insurance online. Creative!). 

You can also do it on the dedicated app on your phone.

That’s when the trouble may begin, because the whole process is in french but I’ll help you to navigate through all the steps.

Step 1 : Create your account on Ameli.fr

Fill everything with your personal info etc.

Step 2 : Begin the process

Get on the website and look for the procedure to request a Carte Vitale.

It’s either in the frequent process in the middle of the page or, if you don’t find it click on :

 

  1. “Remboursement, prestations et soins” => Reimbursement
  2. “Être bien remboursé” => Getting reimbursed
  3. Carte vitale
  4. Finally click on “Commander une carte vitale” => Order a Carte Vitale

You can also find it in your personal space, there is an item “Mes démarches” and on the left a section “Carte Vitale”, click on it.

Tip : the french government set up a system that helps you connect to different bodies of the administration like the Impôts (Taxes), the health system etc. It’s called France Connect and it’s awesome.

Step 3 : Fill in and check the info

Select the person for which you want to order a carte vitale. Some info should be displayed. Just check it’s the right one, correct if you need and then upload the copy of your ID and you picture.

You’ll just need to validate your order in the end. That’s it.

You’ll receive your card within 2 weeks and in the meantime you can follow your order on ameli.fr. 

Do I need to update my carte vitale ?

You have two ways to update your carte vitale : 

  1. Classic refreshment

You’ll need to do that about once every year. It’s very easy. You can do it in every pharmacy or when you have a doctor’s visit.

  1. Update the beneficiary of the carte vitale

This happens when you have a child covered on your own carte vitale until he or she is 16. To do so, just go 

What if I lose my Carte Vitale ?

No worries, just go to ameli.fr, in your personal space, you can declare the loss or theft of your carte vitale.

Tips and tricks 

  • Please don’t call the vital card
  • You can do the whole process either on the app or the website of AMELI, don’t register or give any information on any other platform.
  • The France connect thingy
  • Update your carte vitale every year. You can do so in a pharmacy or during a doctor’s visit
  • Never send the original documents, always copies.
  • When you get you Social Security Number, you’ll get a paper form to request a Carte Vitale. You can toss the paper if you follow the online process.
EN