My Belgian and German friends didn't know anything about this, so I thought I'd do a public service announcement about the different categories of doctors.
So, imagine you need to see a doctor: general practitioner, specialist, whatever. How do you find one? You could ask your friends, you could look in the phone book, you could even call the numbers on the plaques of buildings you walk by. But these three methods won't tell you some of the most important information about the doctor:
What category are they in? 1 or 2?
Doctors in France have to decide how they do their billing; either they are in 'secteur 1' or 'secteur 2'.
Secteur 1 doctors accept the government billing guidelines. This means a general practitioner will only charge 23€. For your reimbursement, you subtract one euro for "participation", then the Sécu reiumburses 70%, and the last 30% of 22€ is either left to you or reimbursed by your private 'complément de santé'.
Secteur 2 doctors can charge what they like. This makes your reimbursement tricky. Imagine you see a GP in secteur 2 and she charges 30€. The sécu is still only going to reimburse 70% of 22€ because they ignore any charges above and beyond the official billing guidelines. (It gets even more complicated for direct access specialists like gynecologists and ophthalmologists because the Sécu reimburses 70% of an amount lower than the government guideline) These extra charges are known as "dépassements d'honoraires". After the Sécu reimburses you, the amount your private insurance pays you depends on the package you pay for. The most basic packages don't reimburse extra charges (so you get back the same amount as if you had seen a secteur 1 doctor), and often have to pay more each month in order to get reimbursed for seeing secteur 2 doctors.
The equivalent for dentists is "conventionné" or "conventionné avec droit permanent à dépassement".
Why go to a doctor is secteur 2? You might find the person a really great doctor and be willing to pay a bit extra. They also might have a shorter wait to get an appointment since fewer people are knocking on their door. They also might be the only doctor in your area specialized in your particular needs. Looking at gynecologists in Toulouse is seems that 90% of them are secteur 2, so sometimes you might not have a choice.
How do you know what secteur they're in? Easy, just go to Ameli-Direct and type in your doctor's name. You can also use this website to search for a doctor in your area, and then choose one based on the info you see. Click on the doctor's name to see examples of their prices, plus the amount the Sécu will use to calcuate your reimbursement. This website also indicates whether or not they have a machine for the Carte Vitale (if not you'll get the fiche de soins). I think by law doctors are also supposed to display in their waiting rooms their prices if they are secteur 2 so patients know how much they will be charged. You can also ask when you call to make an appointment ("Pratiquez vous des dépassements d'honoraires?")
Keep in mind that the price you pay also depends on whether you're seeing your "médecin traitant" or a specialist your GP has approved you to see. This page has the current prices of consultations. To keep your health care costs low, always see your médecin traitant first (usually your GP) to get a referral before seeing a dermatologist, cardiologist, or other specialist. Don't worry though, you can get glasses and birth control without asking your GP first. Between the ages of 16 and 25 you can also consult a psychiatrist without a referral.
If you have to have something important done, like getting a crown on a tooth, shoulder or knee surgery, or a bone spur removed, don't hesitate to ask for a quote (un devis). I was worried about how much my wisdom teeth removal was going to cost, so I asked for a quote explaining that I was unemployed and needed to budget my part. The dental surgeon reassured me that I didn't have anything to worry about and in the end I didn't pay a dime the day I showed up at the private hospital. Just asking for a quote and explaining your situation might convince a secteur 2 doctor to skip their extra charges and go with the government billing guidelines for you.
Hope that helps!
2 comments:
Thanks Laura! That was really interesting and you explained it a lot more clearly than Max has!
I'm off to the ostheopath this morning which is not reimbursed at all because I didn't get a referral, but our mutuelle gives us 2 free sessions per year, so I'm taking advantage of that!
Good post! I learned most of this the hard way -- a day before giving birth and wondering what percentage of my stay would be covered by secu and by the mutuelle. In the end I think after 8 days in the hospital we were responsible for something like 40€. I didn't know about being able to check it on the website though, so thanks for sharing!
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