French News

Health in France

Appealing Refusal of French Health Cover

Tuesday 05 March 2013

A British expatriate couple recount their recent experience of successfully challenging the French authorities over refusal of access to the French health system.

"We are early retirees to Burgundy, becoming permanently resident in December 2009. We speak only basic French.

For the first two years of living in France we were covered for health by our E106 certificates from the United Kingdom.

When the certificates expired we were given what appeared to be a certificate by the local CPAM (health authority) granting us continuing cover with no expiry date. We assumed that we had been accepted into the health system!

However, it soon became clear this was not the case as reimbursement for medical treatment we had received did not appear in our bank accounts.

When we visited our CPAM we were informed that we had no cover since the end of December 2011! Officials quoted the 5 year residency rule and advised us to contact the UK government or take out private medical insurance.

We were informed that they had also written to the UK International Pension Centre in May 2012 to ask them to extend our E106 but they had not received a reply.

We contacted the Centre who advised us that they had no record of the CPAM letter. They informed us that they would only be responsible for our health cover when we reached the statutory age of retirement.

In July 2012 the UK Pensions Centre sent us standard letters saying that we were no longer entitled to health cover paid by the United Kingdom, to give the letter to our local CPAM office to whom we should make application for access into the French health system. They provided translations and a phone number that CPAM officials could call to speak to someone in French to dicuss the matter.

We duly submitted this information to the CPAM who summarily dismissed it and refused to use the phone number provided to talk to the UK Pensions Service. They told us to come back when we had been resident for 5 years.

They were unable (and unconcerned) to explain why there had been no expiry date on our previous attestation or why they had not informed us that we were no longer entitled to health cover through the Couverture Maladie Universelle (CMU).

They additionally informed us that they would not accept an application for a European Health Insurance Card (EHIC), which we needed as we were proposing to travel on holiday to Italy.

When we asked what we should do in the interim we were simply told not to get ill!

Following the advice contained in your Newsletter we returned to CPAM to insist on a letter of explanation why they were refusing us access to the health system, giving them references of the relevant European regulations governing our entitlement. The official gave the regulations a cursory glance and said that they were in English and implied that they were not relevant if not written in French.

On our insistence she phoned a senior colleague, who confirmed what we had been advised. However, she agreed to send a written letter of refusal and told us that if we wanted to appeal to prepare a letter stating our case and bring it to her office. She would then pass this on to the Conciliateur.

A number of weeks passed and we had not had received the letter of refusal so we wrote to the Director of the CPAM office by recorded delivery asking for the letter.

It duly arrived a week later, although to our astonishment it was pre-dated by almost a month! This was a critical issue, as the entitlement to appeal is only available for two months following the letter of refusal. We kept the envelope to show the discrepancy between the date shown on letter and its actual date of delivery.

We then used your articles from your Newsletter to build a clear picture of our history of health care cover to date, residency, financial status and equality of social security treatment, which we sent to the Conciliateur by recorded delivery.

We found all the regulations and sent the French version of everything we could find with text highlighted, including a publication from the European Union entitled 'Your Social Security Rights in Europe'.

A French friend helped us to write the appeal letter in French.

The Conciliateur called us on many occasions to verify information relating to early retirement/public sector status/income etc. She was professional and helpful at all times. She told us that they were overloaded with cases and that she would process our case as quickly as possible.

On 15th October 2012 we received a letter from the Conciliateur saying that on examination of our dossier, and after taking advice from 'experts', that we were an 'exceptional case'. We were permanent residents and had sufficient resources to support ourselves and that being the case we should fill in an application for the CMU take it to our local CPAM office for processing. The date of entry would be backdated to cover reimbursement for medical treatment since May 2012.

After three weeks we managed to get an appointment, when the application was checked and all the required documentation copied. The official then said that she additionally required a translation of our birth certificates by a traducteur assermenté (certified translator) before she could process our application.

We found great difficulty in finding such a translator but eventually found a highly qualified court translator who undertook the task.

On our return to CPAM the official rejected my husband’s certificate on the grounds that it did not have his mother’s and father’s name written on it.

We stood our corner, stating that it was an original birth certificate and that there were regional variations. She eventually took the translations but insisted on taking the original birth certificates. Reluctantly we handed them over, but we insisted on a letter of receipt.

Just before Christmas 2012 we received an email from CPAM with giving temporary cover for the period to July 2013.

In January 2013 we visited the CPAM office to enquire why we had been given cover for only 6 months, and to make application for an EHIC. We also wanted our original birth certificates and translations returned.

Since then we have received a EHIC, as well as a health card (carte vitale) for my husband with my name on an attestation, with an expiry date of 31st January 2014.

CPAM have yet to return our birth certificates and translations.

So what to make of our experience?

In our opinion we had the feeling that there was an unofficial agenda to slow the process down wherever possible and hope that we would give up.

The staff at CPAM seemed to be following regulations that could not be adapted under any circumstances, and neither would they make decisions independently.

All in all, this process has taken ten months, twelve visits to our local CPAM office, seven recorded delivery letters and two rather expensive translations of birth certificates.

But the principle of entitlement has been accepted and we hope that renewal of cover will be simpler in the future.

Our words of advice to others would be:

  • Have every piece of original documentation you can think of on your person because you are likely to be asked for it;
  • In hindsight, a copy of an extended birth certificate would have been useful;
  • Make copies of all original documentation as officials are reluctant to photocopy and would prefer to take your originals or send you away to get copies;
  • Have any relevant legal information on your rights in sight and refer to them;
  • The use of an official translator was crucial in indicating to the French authorities that we were prepared to fight our corner;
  • CPAM officers are frequently ill informed and are reluctant to make decisions;
  • Check their paperwork carefully for date errors…we found many;
  • Remember that many CPAM officials can speak and understand English, despite appearances to the contrary;
  • Always take names and write down a quick précis of the meeting in sight of the official;
  • Always ask how long it will take and what is the next stage. Think of it as an on-going relationship; not something that ever has a final resolution;
  • Be polite, professional, and try to engage. Suppress your rage. Shake hands with them and always call them by name and thank them for their time;
  • Let them know that you are well informed and determined, and you will not give up;
  • Have a bottle of wine chilling in the fridge and consider your time at CPAM as a free French lesson!

Without the guidance we received from your Newsletter would have struggled to proceed."

(Names withheld)

Editors Note: Although this couple went directly to the Conciliateur to appeal their case, the formal route is to appeal to a panel, called the Commission de Recours Amiable (CRA). However, if the evidence from this case can be replicated elsewhere, then the use of the Conciliateur may be the more effective approach. Be warned, however, if the Conciliateur turns down your appeal, it is possible that by then you will be outside of the two month timescale allowed to appeal to the CRA.

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