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What are the prices of a doctor (licensed or not)?

Verified 22 April 2022 - Directorate for Legal and Administrative Information (Prime Minister)

When you see a doctor, the fee varies depending on whether the doctor is agreed or non-contracted and of its sector of activity (sector 1 or 2).

In sector 1, the contracted doctor has tariffs set by the national convention and does not exceed them of fees.

In sector 2, the doctor may overpay.

You have the right to be informed about the amount of the acts and benefits offered during medical consultations.

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In the metropolis

Your insurance company can supplement the reimbursement of the health insurance.

Conventional Physician - Sector 1

The consultation shall be €25 by the Convention.

The refund is 70%. So you will be reimbursed €16.50, because you have to deduct package of €1.

To find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Please note

if you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

Conventional Physician - Sector 2

The situation varies depending on whether the doctor is adhering to Optam or not. The Optam (managed pricing optione, formerly contract for access to care) is an agreement between the contracted doctors and the sickness insurance. This agreement authorizes overcharging of regulated fees.

Member of the Optam

The Sickness Insurance reimburses on the basis of the rates laid down in the medical agreement (rates applicable to doctors in sector 1).

The amount of any excess fees remains the responsibility of the patient.

Consultation may be greater than €25, with a general practitioner or specialist, but the basis for reimbursement is €25 (price of a consultation in sector 1).

You will be reimbursed €16.50, after deducting the package of €1.

Example :

If the consultation is €30, you will also be reimbursed €16.50, because the calculation is based on €25 and not €30.

To find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Please note

if you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

Non-Adherent

The doctor who does not adhere to Optam sets his tariffs freely and can therefore practice the extra fees of his choice.

The Health Insurance reimburses consultations and documents on the basis of rates set out in the medical agreement (rates applicable to doctors in sector 2). The amount of any excess fees remains the responsibility of the patient.

Consultation may be greater than €25, with a general practitioner or specialist, but the basis for reimbursement is €23.

So you will be reimbursed €15.10, after deducting the package of €1. This refund will be the same as you paid for the consultation, €25, €30 or €50.

To find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Please note

if you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

Non-contracted medical practitioner (sector 3)

The doctor does not adhere to the medical convention. It offers its prices freely.

The Health Insurance reimburses consultations and deeds on the basis of a authority tariff.

Regardless of the amount of the visit to a general practitioner, you will be reimbursed by €0.61 (€1.22 in a specialist).

Please note

if you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

In Guadeloupe, Martinique, Guyana and Reunion

Your insurance company can supplement the reimbursement of the health insurance.

Health Insurance informs you :

  • Fees for doctor consultations in these departments
  • Reimbursement rules applicable to your situation in the coordinated care pathway.

FYI  

to find out how much a healthcare professional can charge, see the health directory on the Ameli website.

In Mayotte

Your insurance company can supplement the reimbursement of the health insurance.

Health Insurance informs you :

  • Prices for consultations or teleconsultations of doctors in Mayotte
  • And applicable refund rules.

FYI  

to find out how much a healthcare professional can charge, see the health directory on the Ameli website.

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