Mutuelles

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martyn94
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Mutuelles

Post by martyn94 » Tue 26 Jan 2016 14:20

This is inspired by a recent comment from someone who says they have done without one.

My contacts with insurers in my working life has led me to believe that they always add very high overheads to the services that they offer, and are often as dishonest as they can get away with. But clearly they are indicated if there is a significant risk of what would otherwise be catastrophe. I can't easily see how that could arise in the French system, but happily I have minimal experience to guide me - in particular how far specialists round here exceed the "conventionée" rates to the extent that they do in Paris or PACA.

So does anyone here think that they are conspicuously good or bad value, or bitterly regret not having had one?

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Post by montgolfiere » Tue 26 Jan 2016 16:27

I use Via Sante. just under 100€ a month for me, now over 60 = a higher premium, Her Indoors in her 40's and a21 year Daughter and 11 year old Son. I am happy to have it as we have had various Broken Limbs, Hospital Visits and stays over the years.... so have had some value for money.....

1200€ a year.......but it gives some peace of mind and allieviates the worry of something major and prollonged befalling one of us.......

BTW, anyone with a 'Proper Job' has their own Mutual paid for by the Employer. Obligatory since 1/1/16....

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Post by Allan » Tue 26 Jan 2016 23:34

When I took out health insurance, my broker checked on the rates charged by local consultants and advised against a higher level of cover as most in this area are conventionnée.

I also asked him, that since your health is not taken into account when setting the premiums, why don't people wait until they are sick before taking out cover. He replied that a lot do.

All of my insurances are handled by Allianz and I find it interesting that every time they make a mistake, they rectify it by knocking something off the health insurance premium.

Last year they sent me a voucher for 100€ off my next pair of glasses. When I tried to redeem it they told me I wasn't eligible. I complained and they responded by permanently reducing my health premium by 18€ a month. I can only think that they must have been charging too much to start with.

When I can be bothered, I'll shop around and then haggle with them.

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Post by tia » Wed 27 Jan 2016 11:42

we have not had a mutuelle for years and do not regret it. When i did have one and worked out over a year how much it cost me to how much i actually claimed back on it i cancelled the next day. If ever a person finds themselves in hospital for a long stay it is possible to take out a mutuelle and be covered there and then. I have had plenty of hospital stays and have paid the fees out of my Pocket, still never comes to over a thousand euros a year.
For the new law it is not as simple as said. The employer does not pay it in whole , he is only obliged to pay 50%, it is from a certain amount of employees in the company and all that is paid is taxable, they also only have to pay for the employee and not for the rest of the family . My husbands company has taken out one of the most expensive ones and so far we have managed to get out of being in it because it is only obligatory for the employees that join the company after a certain date.

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Post by martyn94 » Wed 27 Jan 2016 15:10

Thanks for all this: it's helpful. For the moment, I think that I will cross my fingers and do without: experience suggests that I am a chronic under-claimer on the insurance I already have.
It seems bizarre that you can wait until you're ill before signing up, but I believe that there is a waiting period (typically 3 months?) before cover for pre-existing conditions kicks in. Or 10 months for pregnancy - God knows where they got that idea from.

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Post by tia » Wed 27 Jan 2016 20:50

there is no waiting period, i signed up for one when i had been diagnosed with cancer, was admitted to hospital a week later and they paid for everything cpam did not cover there. Only took out a minimum one and got first 3 months for free! There was actually a documentary on french tv a while back about hospitals and mutuelles and the social worker was showing how she would go round to see patients who are hospitalised to sort out taking out a mutuelle. One lady had serious cancer and she was allowed cover straight away. In the general hospital in Perpignan there is an excellent social worker , she helped me so much at a time that i really needed it,

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Kate
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Post by Kate » Thu 28 Jan 2016 12:41

We have mutuelles with the Roussillonnaise, in theory a cooperative or certainly started out like that) and dont regret it.
I personally would recommend it - tho certainly worth shopping around.
We pay around 120 for three of us - though the older we get, the more it goes up!!

Slightly off topic but I visited my doc yesterday. She charged me 25 euros. I said 'I thought it was 23' and she replied 'Yes, because the government wouldn't give us a rise so some doctors have got together and put the prices up'!
Beware when you go to the docs that you dont come across the small group of 'some doctors' who have started dictating their own prices. Is it legal? Dunno - and it's only a couple of euros I know - but it's the principal innit!
Last edited by Kate on Sun 31 Jan 2016 22:23, edited 1 time in total.

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Post by martyn94 » Fri 29 Jan 2016 10:46

Kate wrote:
Slightly off topic but I visited my doc yesterday. She charged me 25 euros. I said 'I thought it was 23' and she replied 'Yes, because the government wouldn't give us a rise so some doctors have got together and put the prices up'!
Before when you go to the docs that you dont come across the small group of 'some doctors' who have started dictating their own prices. Is it legal? Dunno - and it's only a couple of euros I know - but it's the principal innit!
You will probably wish that you hadn't asked. There are three "secteurs" for doctors to adhere to. Secteur 1 charges the sécu rates (most doctors in most parts of France): in exchange they get some perks in the form of lower social security contributions. So if your toubib is sector 1 they seem to be breaking the rules. I imagine that they probably are Sector 1 round here: it's often on their nameplate.
Sector 2 can charge more than the sécu rates but only within limits (in theory, with "tact et mesure") and their patients are re-imbursed to the extent of the sécu rates. Sector 3 are outside the sécu and charge what they like: you don't get reimbursed.
Whether it would be worth disrupting an otherwise-satisfactory relationship for the sake of the odd 2 euros is a whole other question.

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Post by Allan » Fri 29 Jan 2016 16:00

Out of interest, do the doctors get any salary from the state? Based on the length of time our doctor spends with my wife and I, he is raking in about half of what a plumber would get paid.

It seems weird handing over cash to a doctor at the end of an appointment but back in the UK we had to wait ages for an appointment and then it was limited to ten minutes. The system here may not be perfect but it seems to work.

The NHS seems totally bogged down with anti-privatisation dogma to the point that it really struggles. It used to frustrate me that to get decent treatment when and where I wanted it, I had to pay a fortune for private health insurance.

At least here the insurance is complementary to the state system so I don't feel I am paying twice for the same thing.

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Post by tia » Fri 29 Jan 2016 18:43

How do you find we are not paying twice. As workers we pay a fortune in charges from our wages which goes towards various things including healthcare, we then have to pay a second time to receive health care and if we do not have a mutuelle we lose part of what we pay. To see a doctor is easy, to see a specialist is another story. One specialist ihad too book had a 9 month waiting list.

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Post by Allan » Fri 29 Jan 2016 18:54

tia wrote:How do you find we are not paying twice. As workers we pay a fortune in charges from our wages which goes towards various things including healthcare, we then have to pay a second time to receive health care and if we do not have a mutuelle we lose part of what we pay. To see a doctor is easy, to see a specialist is another story. One specialist ihad too book had a 9 month waiting list.
I'm comparing it with the UK, I had a private operation there and was charged for everything, including prescriptions,had any of the facilities been NHS ones I would have had to pay to use them even though I have paid substantial taxes and NI.

Here part of the cost is reimbursed, if I choose to have a private room in a hospital or a more expensive consultant then a part of it is still reimbursed.

You may have more experience of the health system here than I do, but it seems to me that my insurance really is a 'Top-Up' to the health system, rather than a parallel system

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Post by tia » Fri 29 Jan 2016 20:00

Have no idea how private insurance works in the UK as only used the NHS for the few years I was living there. I was lucky as had managed to get on the books of a good dentist, doctor was a bit useless there though ( went with my then 7year old son once with his eye completely swollen and bloke didn't even lift his head and asked why I was there). That was a long time ago so might have changed now.
In France Private rooms are only reimbursed if you have a mutuelle and it covers it, if not then it is for the patient to pay in full unless they have been allocated one because there were no other rooms . The daily bill of 18 euros is also payable and only paid if you have a mutuelle. Glasses and things like crowns are considered as luxury so CPAM reimbursed just about nothing, same for hearing aids . If you work you are billed for health, have to pay for a mutuelle and still often have to pay out of your pocket. I would guess that this is a bit like in the UK where you pay NI and then would take out private insurance as well
Either way there is good and bad so with both systems, I had Cancer at the same time ime as a friend and in the UK , we wrote every day and compared what each of us was getting in treatment and it was pretty much the same. Only difference was that my friend had to get to the Chemo herself whereas I was entitled to a taxi service for 2 euros each way.

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Post by Pearsonb » Sat 30 Jan 2016 13:35

I keep hesitating about taking out a mutuelle. I have been on ALD for 25 years and never seen the need. But now I am falling over quite a lot. Luckily I landed on my face last time but I am worried about breaking an arm or leg. I get put off by all the hard sell when I research this.

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Post by Allan » Sat 30 Jan 2016 14:12

tia wrote:How do you find we are not paying twice. As workers we pay a fortune in charges from our wages which goes towards various things including healthcare, we then have to pay a second time to receive health care and if we do not have a mutuelle we lose part of what we pay. To see a doctor is easy, to see a specialist is another story. One specialist ihad too book had a 9 month waiting list.
It is worrying that Tia had to wait 9 months to see a specialist. In England if there is a long wait, you always have the option to go privately and certainly with private health care I have never had any appreciable delays.

Does such an option exist here? If you opt for a more expensive consultant then can you normally get to see them quicker?

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Post by martyn94 » Sat 30 Jan 2016 15:25

Allan wrote:Out of interest, do the doctors get any salary from the state? Based on the length of time our doctor spends with my wife and I, he is raking in about half of what a plumber would get paid.

It seems weird handing over cash to a doctor at the end of an appointment but back in the UK we had to wait ages for an appointment and then it was limited to ten minutes. The system here may not be perfect but it seems to work.

The NHS seems totally bogged down with anti-privatisation dogma to the point that it really struggles. It used to frustrate me that to get decent treatment when and where I wanted it, I had to pay a fortune for private health insurance.

At least here the insurance is complementary to the state system so I don't feel I am paying twice for the same thing.
As in the UK, medecins libéraux are self-employed independent contractors. I think there are feeble schemes to subsidise practioners in the many (and increasing) medical "deserts". But basically you set up where you like and charge what you like, albeit that almost all GPs (and most specialists outside Paris and PACA) find it expedient to be conventionnée. I agree that their basic fee seems cheap compared to plumbers, but I guess that plumbers would be cheaper if everyone took their leaky taps round to a plumber's surgery.

I have had no problems either in the UK or over here in recent years, though that is just dumb luck. My old GP practice in Greenwich was far more slick and capable than any of the one-man-bands I have come across here, but maybe that's not a fair comparison.

It's notable that both systems have found it necessary to let their better-regarded practitioners make serious amounts of extra money on the side. The difference is that you get the same doctor but quicker in the UK, but a different, more expensive, one here. I don't have the experience to judge which might be preferable.

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Post by tia » Sun 31 Jan 2016 09:28

The only way to get a fast appointment is by going throuygh your doctor or specialist who rings directly, if not then it is just a matter of waiting. my specialist was non conventionne and yet had a 9 month waiting list. For my cataract op there was a 5 month waitng list to have it done at the fee that cpam pays back but i could have had it done in 2 weeks if i coughed up a couple of hundred euros extra. gynecologist appointments are also with big waiting lists, i got one in a month because my oncologue rang ( all at main hospital so know each other), if i had asked for one elsewhere then there is normally a 6 month waitting list,/only way to get a quicker one is to say you are pregnant.

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Post by Smiley G » Wed 17 Feb 2016 12:11

Kate wrote:We have mutuelles with the Roussillonnaise, in theory a cooperative or certainly started out like that) and dont regret it.
I personally would recommend it - tho certainly worth shopping around.
We pay around 120 for three of us - though the older we get, the more it goes up!!

Slightly off topic but I visited my doc yesterday. She charged me 25 euros. I said 'I thought it was 23' and she replied 'Yes, because the government wouldn't give us a rise so some doctors have got together and put the prices up'!
Beware when you go to the docs that you dont come across the small group of 'some doctors' who have started dictating their own prices. Is it legal? Dunno - and it's only a couple of euros I know - but it's the principal innit!
I was charged 25€ last week but only 23€ went through the ameli.fr account. I don't begrudge the additional 2€ as the 23€ tariff has been in place since January 2011.
I too, am not sure whether or not it's legal but someone is bound to contact CPAM saying "You've only refunded 70% of 23€ and I paid 25€ etc. etc." That's when the fun could begin.................
Tinker Tailor Soldier Spy.

martyn94
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Post by martyn94 » Wed 17 Feb 2016 15:43

Smiley G wrote:
Kate wrote:We have mutuelles with the Roussillonnaise, in theory a cooperative or certainly started out like that) and dont regret it.
I personally would recommend it - tho certainly worth shopping around.
We pay around 120 for three of us - though the older we get, the more it goes up!!

Slightly off topic but I visited my doc yesterday. She charged me 25 euros. I said 'I thought it was 23' and she replied 'Yes, because the government wouldn't give us a rise so some doctors have got together and put the prices up'!
Beware when you go to the docs that you dont come across the small group of 'some doctors' who have started dictating their own prices. Is it legal? Dunno - and it's only a couple of euros I know - but it's the principal innit!
I was charged 25€ last week but only 23€ went through the ameli.fr account. I don't begrudge the additional 2€ as the 23€ tariff has been in place since January 2011.
I too, am not sure whether or not it's legal but someone is bound to contact CPAM saying "You've only refunded 70% of 23€ and I paid 25€ etc. etc." That's when the fun could begin.................
I was curious enough to do a Google search on "consultations a 25 euros". It seems that one of the GP trade unions has incited its members in recent months to charge €25 as an act of "désobéissence tarifaire". The Assurance Maladie has said that it's very naughty, but I can't imagine that they'll do much: revised rates are due in the middle of the year.

See eg here
http://www.francetvinfo.fr/sante/la-tar ... 17315.html

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