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You win some, you lose some

I have been on a kind of high since renewing my carte de séjour last week. It may seem trivial to some (“I don’t know why you worry about it because we were sure you will get it”) but for an expat, the actual possession of a confirmation that it’s all good – even if just for another year – means stability for a year to pursue all that I want to chase. It was an important win.

Then came a crash this morning.

Cat figurines

No, no, don’t panic. It has nothing to do with my residency rights. Nobody’s trying to send me away or anything. In fact, the madame processing my carte de séjour last week was nice and helpful when we got there with a big huge folder of all kinds of paperwork plus copy but sans my actual card! The ditzy-me left it in the scanner at home. I was calling myself a hundred kind of stupid and was very glad that she processed my file as usual, with the onus that I retrieved my card and returned to the Préfecture later with it.

Anyway, I digress. My bone is with the CPAM. Again. The crash came when I saw the amount of reimbursement I have just received from the CPAM.

As recounted previously, I was recently issued a social security number and trying to be efficient, I sent away the feuille de soins that I’ve been collecting for nearly 2 years. Remember, there’s a cut-off of 2 years for sending them so it was not like I had a lot of time to waste. In the mean time, I applied for a pin code to access my account on Ameli online, which took a few days to arrive in our mailbox.

When I finally logged in to Ameli, I noted that according to the system, I do not have a médecin traitant declared. This is untrue, as I have submitted the information with my very first application back in June 2011. I could only conclude CPAM has somehow mishandled my dossiers which led to months and months of delay and misinformation, and they only processed my application based on a new submission. Now, they have lost my médecin traitant information too. I made a mental note to get another declaration the next time I’m sick and see my GP. Afterall, the claims documents have been submitted.

My belle-mère then brought to my attention, in late February, that by not making this declaration, CPAM could end up penalising me when it comes to the reimbursement. Instead of the amount in the ballpark of 60-70%, it could be severely reduced.

I have just learned first hand today what severely reduced meant. It’s “near-nothing”. (See update below)

From a total of over €230 which I’ve paid over the last two years for GP, emergency dentist, prescriptions and a medical lab test, I get a whooping €20.24 reimbursed. Yup, less than 10%. Given how thick the envelope was when I did my claim submission – I paid €2.55 for the postage alone (normal post, not lettre suivie) – that whittles my “reimbursement” down to a low low fraction of, errrm, 7%? I am not even sure why I bother to do the claim then…

A friend suggested I could go to the CPAM, bearing the copy of the médecin traitant declaration of which original I have submitted, and dispute the amount of the reimbursement.

I am not entirely sure I have the mental energy to do so. Or to waste more time fighting them.

Major lessons of the day: (1) make sure you have a médecin traitant declared and make sure the information is in the system, and (2) just don’t get sick or have inexplicable toothache or need a medical test or need a medical certificate to allow you to do sports. Because, you know, even if you are victorious in getting a social security number at last, CPAM has the last laugh because they can dictate the reimbursement you are entitled to even when it was them who failed to process your file correctly.

They are happy to get my health insurance contribution, just less happy about reimbursing me for taking care of my health. /le sigh

Update 21 March 2013:

Following a lunchtime discussion yesterday (20 March) with my colleagues (all of whom are French), one of them pointed out that my reimbursement claim via feuille de soins could have been treated separately depending if they were issued by the GP, or the dentist, or the pharmacists, or the medical lab. She further advised to check any CPAM statements that I may receive in due course to work out the exact amount of reimbursement per submitted (category of) feuille de soins.

The conclusion reached at lunch table was: CPAM reimbursement is a blackhole of a system that nobody knows (or want to try to know) what really happens and/or how it is managed. As the majority of people just handed over their carte vitale each time they receive care, this scenario of mine is not a problem they face either.

Nonetheless, given this set of new information, I’ve been keeping an eye on further bank transfer(s) received and hey, there’s another lodgement today! This brings the total reimbursement so far to nearly 30% of my total payment – things are starting to look up.*

It also inevitably piqued a side of me, that is now more determined to figure out and understand how the national healthcare insurance system works. It bugs me that everyone I’ve spoken to seems to have gapped information about the system, and many have also decided that it’s easier to let things be. Maybe I should too, but then again, how can I be content with not knowing something that has direct impact to my life? In case anything happen (touch wood), how could I know what my care options are if I am not in possession of the knowledge relevant to the affordability of care?

* The two lodgements I’ve received relate to my dental care invoices (first emergency treatment, and a follow-up a week later). According to statements on Ameli, I have been reimbursed a full 70% for both dental visits.

Category: Ma vie en France

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6 scribbles & notes

  1. Sarah says:

    What incompetence! Have you got a mutuelle? Can you get some more reimbursement from them?

    • Lil says:

      Unfortunately without a social security number previously, I couldn’t get a mutuelle. Since then, I’m in the process of researching the different mutuelle but haven’t yet got round to getting one.

      C’est vraiment penible!

  2. med says:


    but now u wont encounter such problem anymore right?

    • Lil says:

      Oh dear goodness I certainly hope not! If this repeats then it’ll be on my own stupidity to have allowed it to happen… ><

  3. Joanne D says:

    Wow…I am trying to read this thread and I got so confused. What a complicated procedure they are requiring you to go through. I guess that’s what they try to do, make it so hard so that you will not bother doing it :(

    • Lil says:

      Yes and no. I agree that things are unnecessarily complicated when it could be simpler and more efficient, but I don’t know if I can agree that they are deliberately designed that way to frustrate people. They do have the end result of frustrating people though, so not helping their cause there.

      The way I see it, the paperwork system has been so entrenched it’s difficult to untangle them nowadays without a revolutionary rehaul, which will also very likely face a lot of resistance (changes are often perceived as negative things rather than improvements).

      Say, it was all working nicely before the age of computer. Then came first computerisation and they had to change certain things already. Now there’s split in the system, some people in charge of one, others of another. Misinformation starts to crop up. Pile things on, and it starts looking less pretty. Continue vicious cycle and voila, we get what we get now?

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