Business Reimbursement of care: patients without a treating doctor will...

Reimbursement of care: patients without a treating doctor will no longer be penalized

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This is a figure that we did not imagine: according to the director general of the National Health Insurance Fund, Nicolas Revel, interviewed Friday January 10 by the professional magazine "the Generalist", 5.4 million patients do have no attending physician declared. "Among them, a proportion of rather young and healthy patients did not seek to find one", but "more than half of our fellow citizens without a treating doctor are in real search for a dedicated practitioner, often for lack of to have been able to find one when their general practitioner retired, ”he explains.

A problem which illustrates the shortage of generalists and, above all, which until then could result in reimbursement penalties.

Joined on Monday, Nicolas Revel told us that the National Health Insurance Fund "is putting in place a system so that these patients who have lost their treating doctor, or tell us to look for one, are identified and that their consultation is well reimbursed without application of penalty, ie up to 70% of the reimbursement base and 100% for people with long-term illness or pregnant women. "

Until then, these patients suffered a double penalty: no attending physician and consultations supported at 30% instead of 70% of the reimbursement base, on the grounds that they did not respect the course of care. Same thing if this patient was going to consult a specialist, dermatologist, cardiologist type directly … without going through his declared general practitioner.

10 euros payable by the patient for a visit to a general practitioner

But for those who cannot prove that they have lost their attending doctor or that they are looking for one, the consultation of a general practitioner in sector 1 (without excess of fees), billed at 25 euros, will remain covered. up to 30%. Either 7.50 euros reimbursed instead of 17.50 euros (from which 1 € of "fixed participation" must still be removed), or a remaining charge up 10 euros.

However, there are exceptions. Certain specialist consultations are already accessible outside the patient's journey and fully reimbursed without having to go through the attending physician's box. These are gynecologists, ophthalmologists, psychiatrists or neuropsychiatrists and stomatologists. Other cases: up to 16 years old, children are normally reimbursed in all cases.

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