What happens if you move to France with a pre-existing medical condition, or are diagnosed with a life-threatening illness once you’re there? Becky Slack explains the healthcare options
Being diagnosed with a life-threatening or terminal illness is difficult enough. Add to this the challenges of navigating an unfamiliar healthcare system in a foreign language and it can really take its toll. So how can you make sure you receive the best possible care for your needs should you have a serious condition while living in France?
Access to the system
“I know it’s a little like stating the obvious, but it’s essential that you are registered with a doctor and in the healthcare system, and that you’ve either got insurance or a substantial pot of money put to one side. Don’t put this off – make sure it’s one of the first jobs you do when you arrive and then if anything terrible should happen, you are covered,” says Elsa Skinner, a district nurse in Dordogne. “If you receive a diagnosis, initially the GP will orchestrate everything and then a specialist will be your point of reference. They will then ensure that you get whatever scans, tests, treatments etc that you need. Your GP will be sent the compte rendu – your health record – for future reference, although in some places there will be a dossier de soins partagé, which means everyone in the healthcare system can see your records if and when they need to,” she says. “Depending on what you have been diagnosed with, you may also be sent to different treatment centres. For example, if it’s really complicated and your local hospital isn’t able to give you the best help, you might get sent to a university hospital or to a specialist centre elsewhere in the country,” she adds.
Currently there are 30 pathological conditions that the French government considers to be life-threatening or life-limiting. As medicine advances and new and improved treatments are developed, the list changes, but it includes illnesses such as cancer, diabetes and heart disease. Illnesses on this list are called affection longue durée (ALD) and are treated for free. For this to be recognised by CPAM and the insurance company, notification must have been made by the patient’s doctor. However, they can be quite slow at filing the necessary paperwork and so the onus is on the patient to remind them.
“ALD will be registered on your carte vitale, which means that every time you visit the doctor, collect a prescription or go into hospital, you have nothing to pay, you are 100% covered – except for your hospital bed and food, which are never covered,” explains Evelyne Drouin from Axa Insurance. However, she warns that ALD does not mean that all of your medical costs are covered. “You are only covered 100% for the pathological problem you have been diagnosed with. It does not mean everything else is covered – so if you have a cold or break a leg or are in an accident, you still have to pay,” she says, adding how she has come across instances where people have incorrectly assumed they no longer need top-up insurance or can get cheaper cover because of their serious illness. In addition, there are some insurance companies which will increase their premiums upon a diagnosis of a life-threatening or terminal illness, or which will make you wait a number of months before you can claim.
Equally, it’s a mixed bag for those people who have received a diagnosis prior to moving to France: some insurance companies will insist on a medical beforehand and others don’t – again this is something that can impact on premiums. However, the good news is that if you have previously had cancer and have been in remission for 10 years or longer, the law states there is no reason to declare this when taking out insurance. “It means it doesn’t affect your ability to get a loan or to take out insurance,” says Evelyne.
If your treatment requires you to spend time in hospital, a VSL – voiture sanitaire légère – ambulance can be arranged to transport you to and from your appointments, meaning no uncomfortable bus journeys, expensive taxi fares or car parking charges. This should be organised through your doctor who needs to make an official request via un bon de transport.
Likewise, aftercare shouldn’t be an after-thought, reminds Elsa. “After being hospitalised, you may be referred to assistante sociale, which will organise all the extra care and support you may need. My advice is to say yes to everything that is offered to you, and then decline it further down the line. It’s much harder to get things after you have left the hospital.”
The aftercare on offer includes a district nurse, meals on wheels, home help, hygiene care etc. It may also be that you spend some time in a convalescent home for monitoring, injections or physiotherapy. When it comes to paying for this, your financial situation will be taken into account, and the fees are not always covered by the mutuelle so check your insurance to see what you are entitled to.
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Top tips for ensuring effective care
1. If you have a diagnosis prior to moving to France, it can be helpful to bring all your records with you and get them translated. This will speed up your access to any treatment or medical supplies, and ensure that the doctors don’t miss anything important or have to repeat tests you may have already had.
2. If arriving in France with a pre-diagnosed condition, bring adequate medical supplies with you as it can sometimes take several weeks for you to be properly registered.
3. Don’t be afraid to ask for help. The more you ask, the more you get. And remember to remind doctors and specialists of what has been promised as sometimes they can be a little slow on the uptake.
4. Learn French, or if your language skills aren’t quite up to scratch, enlist the support of a French-speaking friend to help you. It is possible to have these friends acknowledged as an ‘ami de confiance’ who can attend appointments and receive information on your behalf, all of which can make a scary and stressful time of life a little easier.
5. No two insurance policies are the same. Always check your document for the exact details of what you are covered for.