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Reimbursement for dental work
http://thefranceforum.net/viewtopic.php?f=23&t=25396
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Author:  Bayleaf [ Wed May 18, 2016 5:55 pm ]
Post subject:  Reimbursement for dental work

If you have a Carte Vitale (with CPAM), and private top up, should you be covered for all dental work, as long as it's not just cosmetic. Or are there instances where you would have to pay up front and not be able to claim any reimbursement? :-?

I'm asking this on behalf of a pensioner expat who has been in the French system for many years.

Author:  Blaze [ Wed May 18, 2016 6:11 pm ]
Post subject:  Re: Reimbursement for dental work

It depends on the cover taken out with the Mutuel - there are different packages, with different rates, and the more basic ones don't cover dental work.
Best to have a look at what is covered, and if necessary, have a word with the Mutuel.

Author:  DaveW [ Wed May 18, 2016 6:20 pm ]
Post subject:  Re: Reimbursement for dental work

Best thing is to get a devis from the dentist then call the mutuel and ask what they will cover. I pay a blinking fortune for my mutuel but still only get half of the cost of a crown covered.

Author:  Bayleaf [ Wed May 18, 2016 6:21 pm ]
Post subject:  Re: Reimbursement for dental work

I'll suggest she phones the English Ameli line to see what rights she has. The top-up company are Swiss Life, and I've heard they can be right obstinate pigs when it comes to paying out, or even being contacted!! b-(

Crossed with you Dave - some of the work has already been done, paid up front, and the Dentist said the Carte Vitale didn't work, or wasn't valid. Definitely a call to Ameli I think.

Author:  Blaze [ Wed May 18, 2016 6:24 pm ]
Post subject:  Re: Reimbursement for dental work

Funnily enough, when I went to the CPAM in Saint Malo to organise the change from Angers, they hrumphed when I mentioned Ameli. Seems it's not all it's cracked up to be.

Author:  DaveW [ Wed May 18, 2016 6:36 pm ]
Post subject:  Re: Reimbursement for dental work

She can also create an account on the CPAM site and download her attestation. That does take some time and effort. For sure, she wont get 100% back from CPAM.

Author:  Blaze [ Wed May 18, 2016 6:50 pm ]
Post subject:  Re: Reimbursement for dental work

I found it much easier going in to the CPAM - I've always found them very helpful.

Author:  wilbro [ Wed May 18, 2016 7:10 pm ]
Post subject:  Re: Reimbursement for dental work

I had over 300 euros worth of work and 100% re-imbursement via CPAM & mutuelle (Pacifica). However there is a limit on dental work by our mutuelle but obtained devis for different options, sent off to mutuelle & got paid for my choice of work. Actual re-imbursement (CPAM & Mutuelle) was in my bank account BEFORE the dentist submitted the cheque I gave him

Author:  Bayleaf [ Wed May 18, 2016 7:48 pm ]
Post subject:  Re: Reimbursement for dental work

Thanks for the suggestions. I wonder if the lady in question just sends off the Dentist invoice - already paid, to the CPAM office, quoting her Carte Vitale number, they'll just reimburse the usual percentage. Then the top-up assurance should refund some of the difference. :-?

What I'm getting from all your replies is that, if you're registered for Carte Vitale AND you pay for top up insurance - you should be eligible for some reimbursement?

Author:  DaveW [ Wed May 18, 2016 8:37 pm ]
Post subject:  Re: Reimbursement for dental work

Easy way is to get the local pharmacy to mise a jour her carte vitale and see if all is OK.

Author:  Blaze [ Wed May 18, 2016 8:43 pm ]
Post subject:  Re: Reimbursement for dental work

It very much depends on the department (this is France ....) because some departments insist that you update your rights every 6 months (as I had to in Maine et Loire). If you fail to do so (as I did to begin with) you have to send off for a new one. What a breath of fresh air in Saint Malo CPAM - she said "I don't know why you sould bother to present yourself every 6 months - I'll make this valid for the next 20 years !!!"

As DaveW says, it would be a good idea if she checks with the borne in the pharmacy, she'll see whether she's up to date or not.

Author:  DaveW [ Wed May 18, 2016 9:05 pm ]
Post subject:  Re: Reimbursement for dental work

Blaze - is that because of an S1?

Maybe not the case for the person with the problem.

Author:  Blaze [ Wed May 18, 2016 9:28 pm ]
Post subject:  Re: Reimbursement for dental work

Ah, yes, you're right, Dave, I hadn't thought of that !

Author:  tinabee [ Fri May 20, 2016 9:35 pm ]
Post subject:  Re: Reimbursement for dental work

Bayleaf wrote:
If you have a Carte Vitale (with CPAM), and private top up, should you be covered for all dental work, as long as it's not just cosmetic. Or are there instances where you would have to pay up front and not be able to claim any reimbursement? :-?

I'm asking this on behalf of a pensioner expat who has been in the French system for many years.


The amount reimbursed from CPAM is dependent on their fixed rates for specific work, which can be found on the Ameli website http://www.ameli.fr/assures/soins-et-re ... taires.php

However, dentists can charge what they like, hence the reason for getting quotes before commencing any treatment. The amount reimbursed by the mutuelle will depend on the terms of the contract, e.g. 100%/150%/200% of standard rates.

Author:  Bayleaf [ Sat May 21, 2016 7:54 am ]
Post subject:  Re: Reimbursement for dental work

Thanks for the link, tinabee. It certainly looks like some - maybe 70%, is remboursable. I asked my own dentist about the situation yesterday, and they said that the lady should have received a feuille de soin to claim reimbursement. If the dentist won't give one, he must be a pretty dubious dentist!!! :-?

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