Expat Forum For People Moving Overseas And Living Abroad banner

1 - 6 of 6 Posts

·
Registered
Joined
·
66 Posts
Discussion Starter · #1 ·
I'm reaching out for some guidance on Ameli paying 100% of the conventionne' in the case of chronic illnesses.

I've begun treatment with a pulmonologist at Pasteur in Nice. My breathing is impacted by an enzyme deficiency that can be synthetically replaced. This requires periodic infusions of the medicine (IV).

The pulmonologist suggested the cent pourcent application. And the woman on the Ameli English help line (always very informative) thought it was a slam dunk. An "insuffisance respiratoire chronique grave" under the Regs.

So, the letter of declination came as a complete shock. It looks like I can appeal, as it were, with the pulmonologist as my advocate

Just wondering if anyone has experience with this process.

Thanks as always,
 

·
Registered
Joined
·
4,909 Posts
My wife has 100% for some but not all medication. It was arranged by the medicin traitant who indicated that the form she filled up needed "careful wording". Try calling the pulmo and maybe he knows a better way or better words. Otherwise try your medicin traitant...they seem to know the hidden rules well through experience.

DejW
 

·
Registered
Joined
·
580 Posts
DejW wrote : Otherwise try your medicin traitant...they seem to know the hidden rules well through experience.

Seconded : my OH's médecin traitant is extremely skilled in this area and it is a skill which is learnt through experience.

Sue

Edit : apologies, for some odd reason I am having a problem with size of type today.
 

·
Registered
Joined
·
4,909 Posts
Sue.....can't resist this one......size doesn't REALLY matter. :) :)

DejW


DejW wrote : Otherwise try your medicin traitant...they seem to know the hidden rules well through experience.

Seconded : my OH's médecin traitant is extremely skilled in this area and it is a skill which is learnt through experience.

Sue

Edit : apologies, for some odd reason I am having a problem with size of type today.
 

·
Administrator
Joined
·
50,385 Posts
And sometimes the 100% gets messed up. DH got 100% for treatment and prescriptions related to his surgery last year and the first time he went in for the round of blood tests that are most definitely related to that condition, sécu paid their usual share (i.e. not 100%) and bounced the bill back to the lab. He explained to the lab that it was some kind of mistake - and they said it happens all the time. They apparently just re-submitted (maybe with an explanation) and everything was fine.

It's a good system, but it does have its glitches. They do seem, however, pretty good about fixing matters when there is a screw up. I like the plan to go through the medecin traitant.
Cheers,
Bev
 
1 - 6 of 6 Posts
Top