Not covered by EHIC?

Health Care & Carte Vitale
1

Hello, I’m in need of some help please understanding some French healthcare administrative issues! It’s a long story and very small sums involved but I’d just like to understand :grimacing:

I’m a UK resident with a second home in France.

Last July I had to go to A&E Limoges following an injury by a falling tree branch and it needed stitches. All dealt with on the day using my EHIC (not yet had to get a GHIC) - all details given and no payment required (as Indeed is my experience with other friends and family visits to a French A&E).

Also as expected they issued a prescription for the materials needed for regular redressing of the wound and another to have my stitches removed a month later. I knew these prescriptions were both at my cost (€90 & €10 respectively) at the Chemist and Health Centre.

So far so good.

About a month ago I received a letter from the hospital. It appeared just to be laying out what treatment I had that day, ie clean up & stitches etc. As I found no “request” for a payment or where / how I should pay if required on the letter I took no action!

Obviously a mistake as I’ve now received a demand from a 3rd party but again details are very vague I’ve quizzed the 3rd party as to what and why and whilst not categoric it seems to relate to part of the treatment listed on the original hospital letter.

I now see on that letter 1 line saying “acted non remboursable (1 FPU 0,00) €19.31” .

As I say not big sums but I thought A&E visits were covered by the EHIC? Also I though the reference to acte non remboursable was used in reference to CPAM claims by French residents?

Any light that you can shine on this type of situation would be very gratefully received.

Thanks
Adrian

2

I believe EHIC/GHIC gives you the same sort of cover as French residents get - which means that not everything is paid for by the State unlike the UK/NHS way - in France it’s roughly 80% of costs that are covered and people either pay the difference out of pocket or have a “mutuelle”, a top-up insurance policy.

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3

Thanks Chris, yes that’s generally my understanding :blush:. I think the 80% (+/-) is correct though I was labouring under the misunderstanding (maybe historic) that the actual triage / repair of the accident was covered 100% by EHIc. May well be I’m wrong :roll_eyes:. Anywho, as long as it’s not just a misunderstanding or mistake by the hospital somehow treating me as a French resident! :sweat_smile:

4

It sounds to me as if your experience is par for the course. EHIC , as @ChrisMann says, gives you roughly the equivalent cover to the French State contribution for treatment, but limited in case of non-accident/emergency treatment.

There always seems to be some sort of supplementary charge, whether it’s for room costs or whatever.

However, I would have thought that the things you got from the pharmacie, while paid for upfront, should be reimbursable by CPAM (or largely so) if you can face asking them directly.
Admittedly, my experience of getting emergency dental treatment reimbursed using an EHIC is quite a while ago, but I did get a decent percentage of it back, including pharmacy costs.

Whether you would want the hassle of tackling CPAM is another matter altogether of course :rofl:

5

Thanks Angela, yep I’m learning on the go here! I’ve done some research just now and it seems everyone now has to make a contribution (under the new FPU rules 2022) of €19.61 for their visit to A&E in France!
Think I’ll just shut up and pay up :thinking::sweat_smile:
Thanks to you and Chris for your help :blush:

6

For users of EHIC/GHIC travel insurance would normally cover any large discrepancy between cost of treatment and what is reimbursed.

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7

Exactly what I (French resident and Carte Vitale holder) paid last summer after visiting the local Urgences for a minor injury requiring stitches.

8

It’s an odd amount to choose, isn’t it? You’d expect it to be a round number!

9

I suspect it’s €16.50 plus TVA. :slight_smile:

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10

Still a bit odd… :rofl:

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11

Thanks - yes I was obviously going on out of date information!

What irks me now is that they could have just asked me for the money on the day, or at least told me that I’d get a bill for it.

Having got the “bill” 5 months later (actually more like a summary of events and was headed up “for my information” it would have been helpful if they had on the letter that I owed €19.61 (being effectively the mandatory excess payment) and where / how I should make payment.

Rant over, not the first or last bit of “complexity” in the French system that I “should” have known about. :sweat_smile: I will do better next time :smiley::sob:

12

Emergency treatment is at 100%, but there is always a forfait. Applies to everyone no matter where resident.

Le prix du forfait patient urgences s’élève à 19,61 euros en 2024 . Ce montant peut être révisé chaque année par la loi de financement de la Sécurité sociale(LFSS).

In general French people know this so hospitals don’t mention it.

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13

Unless you were doing DIY, which it seems most travel insurance do not cover.

14

I shall write to Rachel Reeves to ensure all foreigners using the NHS are charged a little admin.

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15

Except of course the charge in question is levied on everyone, foreigner or not. Perhaps Rachel Reeves could think about that? (Or perhaps not :rofl:)

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16

Really? I thought EHIC/GHIC only reimbursed up to cost to French resident so only if had extra special travel insurance.

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17

That’s certainly what happened for me when I had medical treatment here - it was just like I now get as a French resident.

18

If anyone were to try and run the NHS, I would rather it was the French than Trumping fellon 47.

19

I don’t think you should be irked at all. You were looked after well and you have been billed “as if you were a French resident”, that is inline with EHIC policy. Normally in France complimentary insurance picks up the difference. I suggest you claim against your travel insurance for your 19 quid. :slightly_smiling_face:

Apart from that, my advice is avoid branches in future :slightly_smiling_face:

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20

Thank you John, very useful advice.

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