DISCUSSIONS

Find the answers to many of your expat questions here

View Latest Posts

You're missing out...

As a member you can enjoy exclusive info and offers.

REGISTER NOW

Social Security - Reimbursement

Posted by Wivian-885455 - Created: 5 years ago
0 0
Sorry no image available

8 replies (Showing replies: 1 to 8)

Sorry no image available
Posted by Wivian-885455 - 5 years ago

I did not see the orthodontist as a private patient. My daughter's dentist sent her. Her lower jaw grows quicker than her upper jaw, so she need an "appareil" at night to adjust this. I have sent the devis to RSI and they have approved of the treatment. The SECU and my mutuelle is reimbursing a part of what it will cost. The 150 euro, of which they reimbursed 30 euro, was the initial consultation she had to find out what kind of treatment she will be needing. I just found it strange that the SECU has a base of 43 euro for this, when the actual cost is 150 euro. Where do they find their "bases"?

You write; 

"...if I were you I'd do a serious amount of research in advance before going off to the opthalmologist, orthodontist or anywhere else before first finding out how much the CPAM will reimburse."

Well, my daughters need both the ophtalmo and the orthodentist no matter how much (or little) SECU will reimburse..

I agree with you, this case alone would not count as "fighting for something".. It just that it adds to all the rest.. I have recently built a house, and having had to deal with constructors and entrepreneurs etc with no moral or work ethics whatsoever has lowered my "enthusiasm" a little. I find it tiring constantly having to make sure I get what I pay for and making sure I don't get fooled. It's typical for the area in France that I live in, "everybody"  tries to "arnaquer" (word used by the French themselves) but it doesn't make me feel better..

I have lost counting of all the hours and money spent on arguing, writing mails, phone calls, lawyers, going back and forth to the construction site, all because people do not know their job or do not want to do it properly because it is much cheaper for them to take a "short cut".. And then I get yelled at for asking them to do things according to the contract.

Oh, the list is long and I'm fed up. But I will "spare you" for more details :-)

Anyway, I appreciate your answers!

 

Sorry no image available
Posted by Squeaky-882728 - 5 years ago

Orthodontology doesn't usually start at 6 years of age with deciduous teeth so why did your daughter need to see an orthodontist?

Anyway, for reimbursement of orthodontist charges you have to send the 'devis' off to the CPAM in advance for their approval and to let you know how much, if anything, will be reimbursed.  This is all very clear in the link I posted.

So it seems to me that you saw an orthodontist as a private patient and submitted the bill to the CPAM who have calculated it as a consultation - how they got to the figure of 43 euros I have no idea, but count yourself lucky they even reimbursed you anything. Like I said, you have to send off for approval in advance for othodontic treatment.

I don't know how long you've been in France, but if I were you I'd do a serious amount of research in advance before going off to the opthalmologist, orthodontist or anywhere else before first finding out how much the CPAM will reimburse.

And if you think this is fighting for something, oh boy, ...................... :) :)

Sorry no image available
Posted by Wivian-885455 - 5 years ago

And when I look at your link ameli.fr, 43 euro is to be found nowhere..

I'm just so fed up with having to fight for everything.. Like you don't have anything else to do..

Sorry no image available
Posted by Wivian-885455 - 5 years ago

She is 6 years old...

Sorry no image available
Posted by Squeaky-882728 - 5 years ago

The reimbursement for othodontology depends on whether your daughter was 16 or under when she started her treatment.

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/soins-et-protheses-dentaires/traitements-d-orthodontie_rhone.php

Sorry no image available
Posted by Wivian-885455 - 5 years ago

Thank you for your replies, eurokiné and Squeaky!

The important thing for me is that my daugher has glasses that are comfortable for her. I don't mind paying extra for it. I just doubt that it is possible to find her kind of glasses at 60 euro. First of all, I asked to see all the frames, and there were not many. Then, with the kind of hypermetropie she has got, I had to buy special glasses. Otherwise they would have been so heavy that thet would slip off her nose. I just find it strange that Secu does not reimburse this. It is not my choice, I didn't buy her expensive designer glasses... But anyway, just by curiosity, I will ask what glasses they can propose for my daughter that are reimbursed 60%...

This is just trying to figure out how the system works. My oldest daugther needed to see an orthodontiste. Same thing here.. He charged 150 euro and I was reimbursed 70% of 43 euro (= 30.10 euro). Is there such a big difference amongst the orthodontistes? Is one charging 43 euro and another 150 euro for the same job? According to Secu's "la base" , it should be possible to find one who does the job for 43 euro? I find it strange...

Sorry no image available
Posted by Squeaky-882728 - 5 years ago

"Do they actually think I can get a pair of special glasses for 60 euro?"

Yes, because you can.  Adult and child's specs have a range which are reimbursable but you needed to ask where you got your daughter's glasses from for them to show you the stand with the ones which were reimbursed 60% by the CPAM. I've just helped friends to get both of theirs and as they're on CMU-C they will be reimbursed 100%. Not ugly glasses at all, but not designer ones, obviously.

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/optique-et-audition/les-lunettes-et-les-lentilles/le-remboursement-des-lunettes_rhone.php

 

Sorry no image available
Posted by eurokiné-187861 - 5 years ago

Its the social secuity that set the tarif (no comment) and according to my optician when I questioned the fact there are supposed to be lenses & frames that come in at their tarif. However they wont have lightweight lesnses or anti scratch, anti break anti reflection treatments included so for  bog standard, glass, maybe thick, and untreated lenses and probably a unsightly frame (but Ive never checked it out)you can be reimbursed at 60% by the secu & the rest by your mutuelle. Some mutuelles offer 200 times the secu tarif but 200 times nothing is still nothing

Same situation if you are CPAM or RSI

Sorry, specsavers havent made it here yet