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14 Octobre 2008
It's an administrative document you and a doctore fill in out to ask « Sécurité sociale » if you can be reimbursed (pris en charge) for some specific treatments (often more expensive so they want to check if it's really needed). You must do this BEFORE your treatment.
« entente préalable » means : « agreement given before ».
You need a « demande d'entente préalable » for specific treatments like : physistherapist (kinésithérapie), or long distance transportation by ambulance.
What do I have to do ?
To do a « demande d'entente préalable » you have to fill in WITH your doctor a special form : « formulaire de demande d'entente préalable » (form n°S3108C). You don't need to bring it with you, your doctor will provide it.
How do I know if I need to do this ?
Don't worry, your doctor will tell you if you need one, you do not have to decide.
What do I do then with this form of « entente préalable » ?
You have to send it to your « caisse d'Assurance Maladie » addressed to « M. le Médecin conseil ». Send the complete document (2 pages).
For some special treatments, you must also send your prescription. Just ask your doctor to know if you have to.
Who is “M. le Médecin conseil” ?
You don't need to know his/her name. Just write this title on the envelop.
Each “centre de sécurité sociale” has its own “médecin conseil”, it's a kind of referee who takes decisions regarding special treatments.
But where do I have to send this “entente préalable” ?
You only have to send it to the same place you send your “feuilles de soins”. You(ll find the address written on the reimbursement papers sent by your “Caisse d'Assurance Maladie” each time you go to a doctor or pharmacy.
How do I know if my « demande d'entente préalable » is accepted ?
You receive an answer only if they disagree and won't pay for your treatment. If they accept, they won't say or send anything. If they refuse, you will be informed within 2 weeks.
What if it's an emergency ?
In case of emergency, you don't need « entente préalable ». But in this case, your doctor will specify on the documents it's an emergency.
What if I need a « entente préalable » for my « mutuelle » (complémentaire santé) ?
If you need a surgery for example, the hospital might ask for a « demande d'entente préalable » for your complementary insurance too.
It's only to allow you to benefit the « tiers-payant » (direct payment by your insurer) so you won't have to pay (you have a « dispense d'avance des frais »).
In this case, contact your complementary insurance and ask them directly. Sometimes they just do it by phone if you can give them the name and address of the hospital where the surgery will take place.