typhoo

I have asked many friends if they can understand how the reimbursement system works, none can #-o In fact one said they had asked a French neighbour to explain it, but he couldn't.

For example, both of us went to the MD last month, paid our 23.00 euros, and 2 days later OH got 4.10 put back into our a/c, I got 9.60!! There were deductions for pharmacies from 2 months previously.

We went to the CPAM office yesterday to ask for an explanation - any time we've been before we used the English speaking lady, she's not there now and no-one speaks English :? I asked her if she could shed any light (in my limited French), then she just rattled on in French, so I had no clue what she said.

We only have hospitalisation cover, but I didn't get the impression that made any difference. Should we not get 16 euros back? That's what anyone else I've spoken to get refunded.

Many thanks if anyone can shed any light.

jsbach

I'm afraid I can't help you but might I gently say that your phrase "she just rattled on in French", coupled with "in my limited French" might form part of a solution?

typhoo

The CPAM situation is now obviously irrelvant. Just asking folks out there what they normally get refunded and are pharmacie deductions usually involved even tho they are paid by us at the time of receipt..............

Tweedpipe

Just checked on last months statement. Whenever we visit our doctor (23€ per visit) we are both subsequently reimbursed 22€ by CPAM - they list 1€ forfaitaire.
Note: A short while back at different times due to illness we we both listed as 100%. Looks like we still are - well almost!

dennerlymum

Is your doc your named doc? If not this is why they are withholding the 1€ ; if you dont name your GP now they take if off

catsanddogs

cpam send statements listing all your transactions, I find a doctors visit usually triggers off a statement, it will show, doctors payments, prescriptions and payments to the chemist, there seems to be a deduction of 50 centimes for each prescription item and a euro for doctors, it also lists repayments back into your bank after the deductions have been made.

graham.miln

typhoo, you will get 70% back if you register a médecin traitant with CPAM; your médecin traitant is your preferred general doctor.

Without a declared médecin traitant, you will only get back about 30%.

This government web page goes through the fine details, Choisir et déclarer votre médecin traitant.

typhoo

Thank you for your replies, but

"For example, both of us went to the MT last month, paid our 23.00 euros, and 2 days later OH got 4.10 put back into our a/c, I got 9.60!! There were deductions for pharmacies from 2 months previously."

this is my main question, Is it normal only to have 4.10 and 9.60 paid back on adoctor's visit, and have pharmacie deductions added on (adding these together makes up the shortfall) which we pay for when we go to the pharmacie

typhoo

Thank you, but we have been registered since we came 5 years ago. I'm confused.....................

graham.miln

typhoo, are you registered with an online Ameli.fr account? You can see your account status and check details such as your registered doctor are correct.

I believe you can also ask written questions through the account; we have found this useful for when relying on spoken French is challenging.

typhoo

Thanks Graham, yes I'm registered. We did tell CPAM when we first arrived here who our MT was, but that part on their website is down just now (wanted to cofirm they deffo have his name against us). Had a quick look and can't quite see where you can send them a note tho

Garonne

Dennerleymum, even if you are registered with your medecin traitain they still take 1 euro off unless you're on CMU-C.

Typhoo - yes - quite simply it's the accummulation of 50 cents per item distributed by the pharamacy - it soon adds up. But still, if you've paid up front for your medication you should still be reimbursed minus the 50 c per item as well as your doctor's visits. Didn't you just give your carte vitale at the pharmacy? If you paid up front why did you and if you did, have you sent your feuilles de soin off?

typhoo

Yes, gave our carte vitale......and it's not 50 cents quoted. e.g. on 1 reimburesment it quotes 23.00 - 1.00 70% then 16.10 (which is what I assume should be credited to our a/c), but then it has 2 deductions for pharmacies of 4.50 and 5.50 and 2 x 50cents for kine) and 4.10 put into our account.

Garonne

But earlier in the thread you said you paid the pharmacy???

4.50 may be for 9 packets of medicaments (it's 50 per unit not 50 per prescription, ie if you have 4 packets of iboprufen that's 2 euros not 50c). As I said, it soon adds up and if you gave your carte vitale you can't have paid up front??

typhoo

Yes, did pay for them, we don't have top up