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What are the rates for a doctor (whether or not they are agreed)?

Verified 16 septembre 2019 - Directorate for Legal and Administrative Information (Prime Minister)

When you see a doctor, the rate varies depending on whether you are agreed or uncontracted and its industry.

In sector 1, the contracted doctor has his tariffs set by the national convention and does not overrun fee..

In sector 2, the doctor may overcharge.

Optam is an agreement between the doctors who are contracted and the health insurance. This agreement allows for framed fee overruns.

Specialized Doctor - Sector 1

Consultation shall be €25 by the Convention. Refund is 70%.. You will be reimbursed €16.50, because the forfeit from €1..

Conventional - Sector 2

Optam Member (Controlled Pricing Practical Option, formerly the Care Access Agreement - CAS)

Health insurance reimburses on the basis of the rates set in the medical agreement (rates applicable to sector doctors 1).

The amount of any extra fees shall be borne by the patient.

Consultation can be greater than €25, to a general practitioner or specialist, but the basis for reimbursement is €25 (price of a consultation in sector 1). You will be refunded€16.50, once the forfeit from €1.. If the consultation is €30 , you will also be reimbursed €16.50, because the calculation is made from €25 and not €30..

Non-member

The doctor who adheres to the Optam freely fixes his rates and can therefore practice the extra fees of his choice.

Health Insurance reimburses the consultations and the acts on the basis of rates set in the medical agreement (rates applicable to doctors in sector 2). The amount of any extra fees shall be borne by the patient.

Consultation can be greater than €25, to a general practitioner or specialist, but the basis for reimbursement is €23.. You will be reimbursed €15.10, once the forfeit from €1.. This refund will be the same as you paid for the consultation, €25, €30 or €50..

Uncontracted

The doctor does not adhere to the medical convention. He practices his rates freely.

Sickness insurance reimburses consultations and actions on the basis of authority fee..

No matter how much you pay for a GP visit, you will be reimbursed for €0.61 (€1.22 at a specialist).

To find out what a convenient rate is for a health professional, see the health directory on the Ameli site ..

  FYI : you have right to be informed about the amount of the documents and benefits proposed during medical consultations.