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 Post subject: Charges to pensioners for emergency hospitalisation.
PostPosted: Wed Mar 13, 2013 3:44 pm 
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My husband and I have been French residents for over ten years, both registered with CPAM and holding a Carte Vitale. For the first two or three years we had a top up insurance but as we were both in good health we found that it was costing us a lot more than the bills we would have had to pay had we not had it. We were advised that, as pensioners, in most cases should we require hospitalisation we would not be charged, especially if surgery should be involved. During the last two or three years however, we have had three rather unpleasant surprises. My husband was admitted to Urgence following a fall. He was unconscious and a brain scan was required. There was fortunately no damage. Twice since he has suffered attacks of arrythmia which again have meant visits to Urgence, ECGs and scans. On each occasion we have received rather hefty bills which came as a shock. Now I am to have a hernia operation and have been told that this will cost 150€, (not sure whether this is the surgeons fee or a standard charge) which is not expensive but in view of the information we received some years ago I am rather surprised.

As yet I have not queried this with CPAM and before I do so would welcome any information as to our entitlement as pensioners from other British expats and whether anyone has had similar experiences.

Vanessa Woodward


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Wed Mar 13, 2013 4:21 pm 
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Location: Alpes-Maritimes
It's probably a good idea for you to restart your top up insurance. Unless your health issues are Affection de Longue Durée – (ALD) you will be charged the difference between CPAM coverage and the actual costs.

Welcome to the forum


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Wed Mar 13, 2013 5:29 pm 
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Location: The Republic of Limousin
I think Dave's absolutely right - this is why many French pensioners don't have a mutuelle.

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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Wed Mar 13, 2013 6:14 pm 
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Location: Gers 32
We are both retired and have health cover by CPAM . Until recently no topup. We had a similar unpleasant experience - husband had chest pains, went to the doctor, he called an ambulance and husband was in intensive care for 2 days. Then pronounced fit.
We got a bill for nearly 1200€, being one third of the total cost.
After that we got topup insurance.
You only get 100% cover for hospitalisation if it's connected with a condition which has already been accepted by the CPAM as an ALD.


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Thu Mar 14, 2013 3:28 pm 
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Thank you everyone for the information and the benefit of your own experience. It seems that we have been mistaken and were incorrectly informed some years ago. I wonder just what is classed as an ADL. Perhaps we had better re-instate our top up insurance. I have two minor ops. coming up but even if I take out insurance now they probably won't cover me for that. Does anyone know?


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Thu Mar 14, 2013 5:13 pm 
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Location: Ille et Villaine (35)
ALD is affection longue durée, i.e. something that needs long term treatment.
For example, cancer comes under ALD and this may or may not have some sort of timescale like 5 years. Patients under ALD are covered for all appointments, treatment and even transport that are connected with the illness that has been registered as ALD. This is registered on your Carte Vitale so each time it's used, they can tell what is free and what is not.

Regarding minor ops - you should be able to find out the cost in advance. It will also depend on whether you have to stay in overnight.


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Thu Mar 14, 2013 5:21 pm 
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Vanessa Woodward wrote:
Thank you everyone for the information and the benefit of your own experience. It seems that we have been mistaken and were incorrectly informed some years ago. I wonder just what is classed as an ADL. Perhaps we had better re-instate our top up insurance. I have two minor ops. coming up but even if I take out insurance now they probably won't cover me for that. Does anyone know?


Your assurance+top-up should cover you for 'any' treatment-also pre-existing conditions.(mutuelles)

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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Thu Mar 14, 2013 10:02 pm 
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As a general observation I don't believe being pensioners in and of itself endows no special entitlements or benefits medically speaking so it sounds like you were indeed poorly advised on that point.


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Fri Mar 15, 2013 4:41 pm 
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Thanks again. We were certainly misinformed. Our original "attestation" says something about " Global 100%" and we were told that this meant most hospitalisation and surgery would be covered 100% because we were pensioners. Over the years we have learned that this is not so, but it is not until recently that the cost to us have come anywhere near to the cost of a top up insurance.

I have looked at the ameli.fr website but it isn't very informative.

With regard to ADLs I have low grade osteoarthritis and osteoporosis for which I receive medication on regular basis. I pay a percentage of this which suggests that it is not registered with CPAM as ADL. How can I check this? At the moment it seems unlikely but should I need a hip replacement in the future, or fall and sustain a fracture I have a feeling that the subsequent bill might make a big hole in the bank balance!


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Fri Mar 15, 2013 4:45 pm 
Your hospital, or medicine traitant kick off any possibility of an ALD, it is not automatic and needs forms etc to be filled in and then when all is done, you will be informed. Many Doctors will get an ALD sorted out very quickly once the proof is found. You would know if you had an ALD for something.


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Fri Mar 15, 2013 5:44 pm 
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Joined: Mon Feb 02, 2009 9:49 pm
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Location: Gers 32
re hip replacement - I had one done here and it was covered 100% , except for the 16€ per day for the room and food. That was before we had a topup, so I don't see the logic, but not complaining.
Maybe it was considered to be an ALD?


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 Post subject: Re: Charges to pensioners for emergency hospitalisation.
PostPosted: Fri Mar 15, 2013 6:13 pm 
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Location: Ille et Villaine (35)
No, Patf, a hip replacement is not ALD. There is a list of 30 afflictions and these are generally illnesses/diseases that need long term treatment or therapy that would be particularly expensive :

http://sante-medecine.commentcamarche.net/faq/477-liste-des-affections-de-longue-duree-ald


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