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24 Octobre 2008
The « parcours de soins coordonnés » is highly connected to the question of « médecin traitant ».
In order to control its expenses, the French « sécurité sociale » compels the « assurés » to have a « médecin traitant » and to consult him before any other doctor or specialist.
It means that if you choose to go to a specialist without asking your « médecin traitant » first, the « sécurité sociale » won't reimburse you as usual, you will have penalties.
If you think you should go to a specialist, then you must :
- take an appointment to your « médecin traitant »,
- ask if it's necessary to go to a specialist,
- then he will decide if you should go,
- if so, he will write a letter for this other doctor (letter you'll have to give this specialist when you see him)
- thanks to this letter, the specialist can tell the « sécurité sociale » that you followed the « parcours de soins coordonnés ». This specialist will mention it to the sécurité sociale, so you will be normally reimbursed.
What are the exceptions ?
You can directly consult a dentist, gynecologist or ophtalmologist without seeing your « médecin traitant ».
Between 16 and 25, one can go to psychiatrist by your own too.
What if I haven't chosen my « médecin traitant » yet ? Or if I do not follow the « parcours de soins coordonnées » ?
If you decide to go directly to a specialist without asking your « médecin traitant », you can. The only problem is that the « sécurité sociale » will rise « ticket modérateur » by 20 %. In other words, you will be reimbursed 20% less than usual and your complementary insurance might refuse to pay for this.
And if you still haven't chosen your « médecin traitant », any visit to a doctor will be less reimbursed.
How can I choose a « médecin traitant » ?
What if I'm on holidays ?
If you are far away from your home and your « médecin traitant », you can see another doctor.
If your « médecin traitant » is absent, then you can see another doctor.
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