7. Non-Reimbursable Health Charges in France
In earlier pages we stated that the French social security system only reimburses a percentage of charges, with most of the balance being reimbursed by your voluntary 'top-up' insurance policy.
However, there are a certain surcharges for which there may be no reimbursement at all, either through the social security system, or through your voluntary insurance policy.
7.1. Consultant Fees - Dépassements
Although the government sets the official tariffs that can be charged by health professionals, there are a growing number who have been granted the right to charge fees in excess of the official rate, which are not reimbursed by the social security system.
These excess charges are called dépassements and they are mainly charged by consultants.
The excess charges may be reimbursed by your voluntary health 'top-up' insurer, but it will depend on the terms of your contract and the option for full reimbursement is not always available.
Thus, if you go direct to a consultant without passing through your doctor the excess charge will not be met by your voluntary insurer. You will also receive a substantially lower level of reimbursement from the social security system.
Even if they are not reimbursed you will find that, as a general rule, the excess charge is not substantial for routine consultations – expect to pay between €5 and €30 over the official rate. However, beyond a routine consultation the charges for subsequent treatment can become a lot higher than the official rate.
Doctors and specialists who charge only the official rate operate as fully integrated health service professionals in what is called Secteur 1. Around 80% of GPs operate on this basis, but these percentages are going down and the percentage of specialists in this group is far lower. In some areas of France the majority of consultants actually operate outside of Secteur 1.
Those doctors who do not operate as fully integrated professionals operate in what is known as Secteur 2. These health professionals are part of the health service but have been given the right to impose their own ‘reasonable’ charges.
Some specialists have agreed to operate the official rates on condition that the patient is referred to them by their doctor; where the patient is not referred then an excess charge will normally be applied.
Those who operate on a completely private basis (and there are only a very small minority) are called non-conventionnés. Medical professionals in this sector are completely free to set their own charges.
Doctors and specialists are required by law to display their charges and charging policy. If you are not clear, ask them.
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