It all comes down to what your mutuelle contract is prepared to pay. Sure, they will bill CPAM and your mutuelle directly (IF they have the appropriate contacts with the mutuelle). But, if your mutuelle has a limit, then you will be asked to pay the difference.

There is also the possibility that, if the office doesn't have the appropriate arrangement with your mutuelle, you may have to pay the mutuelle part and then receive reimbursement for that.

 

Reply:

It all comes down to what your mutuelle contract is prepared to pay. Sure, they will bill CPAM and your mutuelle directly (IF they have the appropriate contacts with the mutuelle). But, if your mutuelle has a limit, then you will be asked to pay the difference.

Thanks for your answer!

So far I never had to pay any difference but they were always conv. sec 1. Well the thing is, the secretary didn't ask me the name of my mutuelle to verify if they've appropriate contract with my mutuelle (it's MGEN, which is well-known I think...), but told me that a part would be tiers payant, which is also something I found confusing - if it's a third party payment, then why only a certain part would be third party payment only, not the whole thing?

There is also the possibility that, if the office doesn't have the appropriate arrangement with your mutuelle, you may have to pay the mutuelle part and then receive reimbursement for that.

They didn't even ask me the name of my mutuelle.


At the end, I just want to make sure no money comes out of my pocket which normally happens when I go go to conv sec 1 tiers payant. This doesn't happen when it's conv sec 1 but not tiers payant, as I've to pay first and then get reimbursed. And for conv sec 2, I've never seen tiers payant...

 

ask your mutuelle ...
lets say that the same doctor in secteur 1 charges 40, secu reimburses on that base hence they cover 30 and your mutuelle covers the rest ... now comes the arrangements, either you pay and get reimbursed later or you do nto pay anything... all depends on the doctor... I have seen the 3 types: doctor who I pay all then I get part from CPAM and part from mutuelle, doctor where I pay nothing at all and doctor where I pay the part covered by mutuelle only (which then I get reimbursed) .... my mutuelle communicates well with CPAM so I rarely need to ask where are the payments...
now for secteur 2 doctor who charges 60, it is the same as above except that mutuelle can (or can't) cover the 30 euros of difference... hence that is why you have to check with the mutuelle ...

 

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Yes thank you, I've sent my conseiller an email explaining the situation and how much they'd reimburse.

 

Normally, when there is a full tiers payant, the office will ask to see your mutuelle card. There is a fairly elaborate code on the card that indicates what they pay for, though for services where there are specific limits, you or the office may have to contact the mutuelle first to confirm how much they'll pay.

Be sure you bring your mutuelle card with you when you go in to see the doctor.

 

Thank you for this information, and indeed they ask to see the mutuelle card, which I always carry with me regardless. But the important point here, which isn't completely clear to me is 'partial' tiers payant, I wonder how that works? Does it mean that they'd charge directly the sécu and mutuelle for part of the fee, and the rest (say 10€ e.g.) I've to pay up front? But then, will I be reimbursed for that 10€ on top of the fact that the mutuelle + sécu has already been charged directly? Or does it mean that it won't be reimbursed? Just in case, I've the basic mutuelle from MGEN (costing 30€/month), nothing fancy.

 

this happens and is called 'depassement honoraires' ... you pay these 10 euros, you get a 'facture' then you send to your mutuelle for reimbursing ... mutuelle can give you back or not the money based on the contract and the amount reimbusable ... also do that after they get the notification of the SECU with the original transaction..

 

It can work differently, depending on the mutuelle and on the specific services you are charged for.

I've had these sorts of things handled in a variety of ways. Sometimes, if all your codes are the right ones and the practice has the appropriate liaison with your mutuelle, you pay nothing and the practice bills everything through for direct payment.

Other times, the practice (or clinic) has asked me to contact the mutuelle to ask for them to provide a statement of what they will pay. Then, I am either asked to pay the difference, or sometimes the practice will waive all or part of the unreimbursed amount.

 

Okay thank you again. So I guess my having emailed my counsellor at my mutuelle has been the right step: hopefully he'd give me a quote on what they'll pay and I can go to the doctor's office with that quote. And if it's a decent amount, then hopefully nothing will come out of my pocket.