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05/03/2008, 18:57 Sprogster Joined on 23/08/2004 Var & C.I. Posts 359 Re: Changes to medical reimbursements on 1 January 08 According to my sister and her husband who are both medical Doctors, broken bones are indeed life threatening, treated or otherwise. Apparently, the major risk arising from a broken bone are blood clots that break away and lead to a lung embolism during the healing process. Sadly, my wife's father died under exactly these circumstances some years ago. Maybe this is information one would prefer not to know!      Report

05/03/2008, 20:14 Logan Joined on 23/08/2004 Posts 773 Re: Changes to medical reimbursements on 1 January 08  ErnieY wrote: Absolutely none of the above was life threatning and I wouldn't even want to contemplate 30% of the cost of that lot Actually Ermie given thoses set of circumstances the CMU would be likely to pay the full cost. It is impossible to judge. However life is full of risk and I personally dislike contributing to something where I don't get value. I have a feeling that Mutuelles in France are simply a method of taxation by another name. Similar to tax habitation/foncieres for which I personally actually receive nothing in return. If you live in France you contribute to the social system. That I can accept. However as I seem to be contributing more and more with every year that passes to the health system I am questioning if the state simply plays on our fears to extract even more. Since doubtless the state gets some form of revenue from them I have another example. My wife needed a crown recently and she obtained an estimate of 560 euros from the dentist. I contacted the Mutuelle and asked what they would contribute. Back came the answer after waiting weeks and a complicated formula with the pricely sum of 60 euros! I could go on with other similar stories. Mutuelles are simply a poor deal. Dulce et decorum est Pro patria mori. (Horace).    Report

05/03/2008, 20:32 ErnieY Joined on 05/12/2006 W of Cahors (46) Posts 4,156 Re: Changes to medical reimbursements on 1 January 08  Sprogster wrote: broken bones are indeed life threatening, treated or otherwise They of course mean can be not are, there is a distinction  I won't argue that virtually every operation carries a risk, my friends mother died of a blod clot the day after a simple routine varicose vein op, but with mutuelles being such a key part of the French system I simply don't accept that they can get routinely away with claiming every operation was life threatning per se Also, if this were happening the nett gain for Sarkozy and French health system from clamping down on them would far exceed that realised from kicking a relative mere handful of Brits out of CMU and I don't think he is one to miss a trick like that.   My doctor said one drink per day, I can live with that !    Report

05/03/2008, 21:09 Caussenarde Joined on 10/11/2007 Posts 69 Re: Changes to medical reimbursements on 1 January 08 Logan, Are you saying that you have the financial resources to self insure yourself, and presumably conjoint, for 30% of the cost of the worst scenario? Imagine for example, a very serious road accident. I leave you to estimate the cost of this, hospital, ambulance, post accident treatment, home visits..... If you are sure you have the liquid funds to cover 30% of the total  then fine, you can choose to self-insure. If you do not, then who exactly do you imagine is going to pay your costs?    Report

05/03/2008, 21:13 Russethouse Joined on 23/08/2004 Forum Moderator Posts 10,144 Re: Changes to medical reimbursements on 1 January 08 Logan,  I guess you have already researched that you have the best value mutuelle for your circumstances ? www.quimperclub.org 99    Report

06/03/2008, 8:58 Logan Joined on 23/08/2004 Posts 773 Re: Changes to medical reimbursements on 1 January 08  Caussenarde wrote: Logan, Are you saying that you have the financial resources to self insure yourself, and presumably conjoint, for 30% of the cost of the worst scenario? Imagine for example, a very serious road accident. I leave you to estimate the cost of this, hospital, ambulance, post accident treatment, home visits..... If you are sure you have the liquid funds to cover 30% of the total  then fine, you can choose to self-insure. If you do not, then who exactly do you imagine is going to pay your costs? My point is the CMU in general pay for life threatening treatment in hospital. I have paid to be a part of CMU so I expect value in return. In the senario you describe I would expect the costs to be covered 100% by CMU. Not 100% of the tarif convention but the whole cost, apart from the daily forfait charge. I certainly do not expect anyone else to pay my costs. If I take a risk then it's my risk, period. I am suggesting here that the Mutuelles do not give value for money and you don't necessarily need to subcribe to one to live in France. There is another way.  For example a commercial insurer who will cover just hospital costs only which is far cheaper. However common sense tells me that apart from minor aliments anything that requires hospital treatment must be 'life threatening' in nature. Dulce et decorum est Pro patria mori. (Horace).    Report

06/03/2008, 9:16 Russethouse Joined on 23/08/2004 Forum Moderator Posts 10,144 Re: Changes to medical reimbursements on 1 January 08 Logan, I often agree with you but I'm afraid our common sense take on this matter, is at odds. I hope you do not find yourself, perhaps in poor health and feeling nothing like doing it, having to fight this point.   www.quimperclub.org 99    Report

06/03/2008, 10:25 Caussenarde Joined on 10/11/2007 Posts 69 Re: Changes to medical reimbursements on 1 January 08 Logan, When you leave hospital (after life threatening event or not) you get a 'ticket', ie a bill, which you have to pay. It represents the amount outstanding after deducting the proportion of the cost covered by CMU in your case, typically this is a bill for 20% of the cost of  the hospital treatment. A person with no Mutuelle or money could  present this unpaid bill as a problem  to their CMU Caisse as a basis for their need for CMU complementaire. But a person with sufficient resources, who has apparently declined to insure against this possibility (even a probability) should expect, I suggest, short shrift. I'll leave you to it now, but you can see the situation for yourself at  http://www.hopital.fr/hopital/vos_demarches/l_hospitalisation/les_frais_d_hospitalisation_et_remboursement Bon courage, and don't get sick.    Report

06/03/2008, 10:26 Ron Avery Joined on 29/11/2004 Aveyron 12 Posts 3,393 Re: Changes to medical reimbursements on 1 January 08 As far as I can see the whole basis of Logan's arguement for dropping  the Mutuelle is totally flawed. As far as I can find out there is no differential tarif of charges for medicines its 0.50€ per carton/bottle etc (perhaps Clare can confirm this) there is a differential tariff for other medical "actes" like blood tests and X rays. The deductions are done in the same way as they deduct 1€ from your reimbursement for a visit to the doctor ie  CPAM deducts this from your next reimbursement for doctors, prescription items etc   It is different as you don't pay the charge at the chemist at the time, so there is no immediate charge, so its deducted later which is where perhaps the confusion has occurred. "En pratique, que se passe-t-il à la pharmacie quand j'achète des médicaments ? Le pharmacien me fait-il payer plus cher la boîte ? Non, vous payez le même prix que d'habitude.  Le montant de la franchise, 50 centimes, est déduit du remboursement effectué par l'Assurance Maladie pour la boîte de médicaments que vous avez achetée. Par exemple, si vous achetez une boîte de médicaments 10 euros, et que ce médicament est remboursé à 65 %, l'Assurance Maladie vous remboursera 6 euros au final (6,50 € - 0,50 € de franchise). However, is not getting 0.50c back for a box of pills grounds for dropping your mutuelle?    I have had a reimbursement from my Groupama Mutuelle for everything on a prescription at the chemists that was covered by the CMU, but there has always been are a number of medicines and other items like elastic bandages that are not reimbursable by CPAM and that list is ever growing, more were added in January2008.  So is it CPAM not reimbursing you or your mutuelle?  If the latter, change your Mutuelle. Why not post a sensible answer, people will appreciate it more    Report

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