A hell of a disappointment. When Angélique takes a look at her bank account, she is on the verge of falling out of her chair. On her statement, she notices a payment from the Primary Health Insurance Fund (CPAM) of €280. Reimbursement for his last visit to the dentist. This is much less than she expected since she spent almost €750 in the dental office in Germany.
Lack of understanding regarding reimbursed care
The significant difference between the amount received and that paid can be explained by a principle. It specifies that scheduled outpatient care is reimbursed according to the pricing of the patient’s country of affiliation.
Consequently, Angélique can only claim reimbursement for medical procedures covered by French Social Security. As a member of the local Alsace-Moselle health insurance scheme, Angélique therefore expects 90% reimbursement for care.
Except that in his case, the bill of €750 includes dental care covered by the CPAM (according to reimbursement bases) and others which are not. French Social Security therefore pays him around €280, or less than half of the total bill. Very far from the €675 that the Alsatian was hoping for.
Request a quote before consulting a doctor in Germany
The first reflex to have to avoid such disappointment is to find out about the reimbursement rate in France before consulting a doctor abroad. This information, such as the maximum amount, is available on the Social Security website and that of the Alsace-Moselle local health insurance plan. Then, ask for a quote from the German practitioner to find out the prices of the care envisaged. And be able to anticipate the reimbursement amount. Finally, Angélique could have contacted her mutual insurance company to find out if it covered all or part of the remaining expenses.
Access to care sometimes subject to prior authorization
If a scheduled outpatient treatment is reimbursed, such as an appointment with the dentist, this is not the case for all procedures.
In fact, the free access to care guaranteed by the European Union does not apply to certain medical procedures. Those considered expensive or requiring heavy equipment such as magnetic resonance imaging (MRI) or cancer treatments. For example, if Angélique had wanted to go to Germany for an MRI, she would have had to request prior authorization from Social Security. An essential step to be reimbursed.
This also concerns planned hospitalizations. Prior authorization may be refused if an identical or equally effective treatment is available in France within an “acceptable” time frame.
Finally, you should know that in the event of planned or emergency hospitalization as well as for emergency outpatient medical care in Germany, German pricing applies for reimbursement.
European Consumer Center Bahnhofsplatz 3 77694 Kehl (Germany). Website: www.europe-consommateurs.eu
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