CPAM Refunds

[hughnique]

Once upon a time when we had to see the doctor, specialist etc. we paid the fee and within a few days were reimbursed via our bank account. Paying the GP's fee €25, seemed to be phased out some time back, but we have had to pay that if we had to see another doctor at the practice clinic. That coupled with the fact that we are both diabetic, and I am "100%" ?, ALD for my heart, means that we rarely have to fork out at these specialists, but there seems to be exceptions. Having trolled back through our bank account I can find no refunds coming back from CPAM whatsoever, and a trickle from the mutuelle. I think over the last year it has amounted to around the 600€ mark outlay, with nothing at all back from CPAM.
I am aware of the fact that the pharmacie, where I never pay, gets paid direct from CPAM, and on the print off it says that there is a contribution from the patient, normally something like 50c a pop, then there is something else in the back of my head that tells me that CPAM can claw back these contributions from any refunds, but to a maximum of 50€ a year. Couple that with the rumour that the French government, if you have an S1, claim back all medical costs from the UK government, whether true or not? I am beginning to wonder if there is something untoward going on, in so far as if the French are claiming back all medical costs incurred by me, does that include the forfaits? that I would normally be paying back, if so there may be a case of double reimbursement to them. The latest was a visit to have OH's carpal tunnel test, cost 73€, which again has not been refunded, on enquiring with the CPAM english speaking line it appears that CPAM have paid the doctor the refund by mistake and now want me to contact him and ask him to send it back to me, what a bloody cheek. Is anyone else experiencing anything similar or have I got hold of the wrong end of the stick somewhere

[suein56]

If you look on your Ameli account you will see a list of all your Doc visits, all your pharmacie costs etc and all the reimbursements made by Cpam.
It's true medicines usually have a deduction of 50¢ a box but not all of them as some are more. Drs visits are deducted at €1 each and things such as tests etc have a small unavoidable charge as well. It all mounts up .. my OH is ALD, so 100%, for a few health problems but he hasn't had a reimbursement in years even tho he pays for his ORL visits and some other visits.

[L Austin France]

my OH is ALD, so 100%,

What is ALD?..please

[suein56]

Affliction longue durée .. long term illness ie heart problems, diabetes etc.

[hughnique]

The Ameli account is a bit of a nightmare to get on and get any info from, I think the passwords have been corrupted somewhat, I was going to the CPAM this week but now the car is buggered for the next few weeks, I only have my 3.5 ton tipper to swan around in and it is like driving a barge, OH has a bad back and trundling around in that is hell on earth for her.

[suein56]

The Ameli account is a bit of a nightmare to get on and get any info from, I think the passwords have been corrupted somewhat ..

OK maybe so, but it could be quite simply the extra layer of protection that has been introduced to help cut down fraudulent access.
You can ask the Ameli site for help if you are really stuck .. they will sort you out provided you can prove you are who you claim you be.
No need to go to CPAM unless you like going.

[hughnique]

I have had another go Sue, and have spotted a payment to a couple I recognise, one is the opthalmic surgeon, wher we both attend for eye tests etc, with OH she has diabetes and start of cataract, however I can see the payments made to her by CPAM and the fact that they have notified our mutuelle, Have they changed the system as I remember paying, and then getting say 70% back from CPAM after which it came back from the mutuelle, but that doesn't seem to be happening nowadays. I will attempt to draft a message to send them asking for clarification, many thanks.

[Quiksilver]

You make a good point about the forfaits, Hughnique. We pay the contributory CSS (CMU-C / C2S or whatever they're calling it this week). It is infinitely cheaper than paying for a private mutuelle, but I often wonder if, as it comes under the CPAM 'umbrella' the UK is required to pay the complementaire part of our health costs, in which case the French sécu is getting the money twice.
I've also had two instances of the MT getting very stroppy with me when he didn't receive payment for something from CPAM. As my Carte Vitale and CSS paperwork is kept up-to-date, I really couldn't see that it was my problem and told him so. That went down like a lead balloon! I would have more sympathy for the MTs and their need to spend many hours doing admin if ours hadn't insisted that we pay the €25 up front for quite a few years after it should have been unnecessary.

[L Austin France]

Affliction longue durée .. long term illness ie heart problems, diabetes etc.

Thanks. I've got a heart valve defect problem which is stable but inhibiting for strenuous exercise (which I'd avoid anyway) so what benefits of ALD might I expect? I've never heard of it & neither my doctor or cardiologue have ever mentioned ALD.
As far as I know I pay 'top whack' for all consultations & medicins which in fairness are not very expensive.

[DaveW]

For the original poster. I had a similar problem when I had paid the dentist and doctor and not received payment from CPAM. It was to do with tiers payant, I should not have been paying them directly it should be sorted out between CPAM and the Mutuel to pay the doctor/pharmacie. This gets worse if you are ALD. They were getting paid twice by me and CPAM.

I sorted it out with the doctor/dentist and told them to get their act together, which they did.