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 ?
- Go online on your “assurance maladie” personal space.
- 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.
- 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.
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.
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