I spent my weekend balancing my French healthcare checkbook. I’ve been a bit remiss in doing so, and now that I’ve done the tedious calculations, it looks like I’ve paid the price for my head-in-the-sand attitude.
RSI, CPAM, AGESSA, Mutuelles? Oh la la…figuring out the French healthcare system can be hazardous to your health. Have plenty of chocolate on hand for moral support!
And plenty of pretty Loire Valley garden pics to stay zen....
I should preface all of this with the disclaimer that I'm talking about my own personal experience. I'm not an expert, and I can barely figure out my own situation, so please don't post your personal healthcare questions in the comments section. I did my homework, and you will have to do yours, too. Hopefully this article detailing my own incompetence will inspire all of you to do that sooner rather than later!
The Basics of Government-Run Healthcare
If you’re a tax-paying resident of France (or a dependent of one), you automatically are covered by the Assurance Maladie, aka CPAM. This is the government-run health coverage system, and it generally covers between 30-70% of what I’ll call the “Official Rate” of health care costs. For example, the rate for doctor visits is €23. Not all doctors have to stick to these Official Rates. My doctor charges me €25; specialists like dentists, gynecologists, osteopaths, etc. tend to charge around €60. CPAM reimburses 60% of this.
The French Green Card
Everyone who has French healthcare gets a green Carte Vitale, which is like a credit card for health care with your picture on it and a record of your health coverage and history in its little microchip. When your doctor takes it, you still pay him/her directly, but the “paperwork” is all automatically sent to the CPAM to handle your reimbursements. It’s nice when it works. Certain medicines at pharmacies are covered by your health care so when you present your Carte Vitale you don’t pay anything at all. Some specialists won’t take the Carte Vitale and instead make you fill out and mail in the old paper forms, or feuilles de soin. Annoying, but the result is the same. Your reimbursements show up as a deposit in your bank account.
When You're Self-Employed
As a small business owner, I don’t actually have contact with my local CPAM. Instead, I’m a member of RSI (Régime Social des Indépendants), who collect my monthly fees (normally your boss would do this if you’re a salaried employee) and send me my reimbursements. This is obligatory, and is calculated based on your income.
When You're an Author
In addition to the RSI, I’m also a member of AGESSA, which is a special social security office for authors. Everything I make as a writer goes into a separate tax regime than what I make in my company as a small business owner, and thus they also have their own health care and retirement plans. Since I’m already covered through RSI, I don’t need the AGESSA for coverage (you get the same percentage of benefits no matter how much you contribute), but any contributions I make will count towards my retirement benefits, so it’s something to consider if I ever go back to writing full time.
Finally, like most French people, I have a Mutuelle, which is an additional non-obligatory health care plan that covers what the State healthcare does not. This can be anywhere from “a bit more” to 100% of what you’ve actually paid in health care costs. There are basic plans for single people that start as low as €20/month, and family plans that include full dental, contact lenses, maternity and a private room at the hospital for €200/month. I’ve been with one called MMA since 2007, paying less than €100/month for “medium” coverage.
And up until this weekend I’ve been pretty content with the whole arrangement.
Attention! The Nanny State Still Expects You to Pay Attention
But you know how sneaky little things sneak onto your credit card bill when you’re not paying attention? Or strange charges appear in your bank account? When someone was using my credit card last year, they never spent more than €30 at any one time, so almost €2000 was gone before I noticed the odd hotel bill for a place I’d never been. But I caught it at the end of the month and all was reimbursed by my bank immediately.
With my healthcare, it was the reimbursement that never came that caught my attention. I see little deposits from the RSI all of the time in my account, from €3 up to €100. But I had been to a sports specialist to get some custom orthotics (well, it seemed like a good idea with all this running) and was waiting for a hefty reimbursement for the hefty fees I paid. But it never came.
Catching Up on Healthcare Homework
So I started looking at my accounts, tallying reimbursements and payments back to 2007, scanning contracts, scrutinizing fine print, checking my accounts on the websites of the RSI, MMA, AGESSA, even CPAM. I sorted and tagged and paper-clipped every receipt and payment slip I had tossed willy-nilly into my “Healthcare” folder in the filing cabinet (luckily, like all good French citizens, I've become a paperwork packrat). I made a spreadsheet. I started to go blind. The dogs eyed me nervously because they hadn’t been let out for walkies all afternoon. An entire 550g bag of Peanut M&Ms were consumed instead of a well-balanced lunch. But I finally got it all figured out.
The Mysterious "Official Rate"
First of all, the “Official Rate” of custom insoles is only €28 per year. My specialist charged about ten times that (but was in the average “range” of what they usually cost in Paris). I was quite diligent on making sure MMA would cover 100%. But I missed the fine print (and boy is it fine!) that they only cover 100% of the “Official Rate”. So the RSI had sent me their 50% coverage of the €28, and I looked for a deposit of the measly €14 that MMA should have chipped in. And that’s when the other shoe dropped.
Ignorance is Bliss...and Expensive
MMA hadn’t reimbursed anything -- at all -- in years. Five years, to be exact. And I never even noticed. Like the bank account, why would I bother paying attention to €6 here, €15 there? Of course, let's keep things in perspective: the whole point of paying for extra insurance is to cover serious medical expenses (like getting run over by a bus), not these little ones. Based on my spreadsheet, MMA owed me several hundred euros from those five years. Nothing to go bankrupt over, for sure. But I was annoyed. Especially when I saw, in larger print on my contract, that any “missed” reimbursements could only be claimed going back two years and three months.
I went to the offices of CPAM, RSI, and finally MMA to get everything sorted, to confirm what I’d already suspected, and to get the proverbial icing on the cake:
Me: “So, why didn’t the reimbursements get automatically paid, like they’re supposed to?”
MMA Agent: “J’sais pas.” (Translation: “Dunno”)
He avoided eye contact as I handed over the printouts of my medical expenses from the past two years and three months (so that I could at least get those reimbursements), and bid him a bon après-midi.
Amazingly, I'm feeling pretty calm about the whole thing. My current contract can't be cancelled until January 2014, and I’m not about to take an insurance company to court over such a small amount of money. So I consider it the price for the lessons learned:
- Check my reimbursements at least once every two years
- Check the “Official Rate” of reimbursement (at the CPAM website Amlie.fr) and what my chosen medical practitioner is charging before making an appointment for non-urgent healthcare needs
- Shop around to see if I can get a better Mutuelle for next year (I have already noted on my calendar the exact date in November when I need to send the Lettre Recommandée avec Accusé de Réception to cancel the current contract)
- The “bureaucrats” at CPAM and RSI were actually very kind and helpful answering all of my questions. I was in and out of their offices in less than 15 minutes (I could have called, but in cases like these I feel better talking to someone in person). Like the people working at my local income tax offices. The only customer service FAIL in all of this was the for-profit business, MMA. So there will be no stereotypical maligning of French bureaucrats (at least not in this article).
- Know how to choose your battles carefully. Yeah, I’m annoyed at MMA, but not as annoyed as I am with my own complacency that allowed this to continue for so long. I feel very lucky that I'm able to enjoy the benefits of French healthcare when I know how much my family and friends back in the US have to pay for theirs (and I’ve just read the 32-page Time Magazine special report by journalist Steven Brill, “Bitter Pill: Why Medical Bills Are Killing Us”…sobering stuff!).
- Pedro's bladder is getting old. Luckily, my geriatric dogs have pet insurance, too...but that's another article, time to walk the doggies!