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Post by wizzard » Mon Mar 25, 2019 8:06 pm

Pierre wrote:
Mon Mar 25, 2019 5:40 pm
One thing that you may wish to keep in mind is that when you transfer from RSI to CPAM, the RSI is so incompetent that they forget to tell the CPAM who your 'Medecin traitant' is so the CPAM assumes you have not declared one therefore your reimbursement percentage drops; so when you next go to the doctor get him to check that he is declared on the Carte vitale as your 'medecin traitant'. I speak from experience cussingblack

Also I discovered last week that if you have an ALD (affliction a longue durée) for a heart problem then all your reimbursed dental work also gets treated as 100% reimbursement ie 100% of the CPAM defined cost not 100% of your total payment but your Mutuel also has to treat it the same way as well.

PG
Thanks for that Pierre. I'm on 100% for heart reasons, have been for many years. Last year I had some expensive dental work and CPAM refund about 20% and the mutuel about 10% - how did you sort that out as I must try and do the same.
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Post by Pierre » Mon Mar 25, 2019 10:55 pm

Hi Wizz I didn't actually 'sort it out' the dental nurse just explained it to me.

When you have a heart op you become an ALD and there is a letter on your AMELI account to that effect and your medecin traitant should also give you a corresponding one. Once you have the heart op, the cardiologist should give you a red bordered card to show to any other medical professional who should take note of the heart situation, the 100% and the antibiotic requirements of the heart condition. Dentists especially; it was only last week when I went for a crown reglue (non reimbursable) that the dental nurse explained that for a heart ALD it was 100% always with a dentist on reimbursable items. I didn't ask about any other ALD but it may be worth a try. Each time you need to make a point of the 100% for the ALD because the person who takes the Carte Vitale only looks at the money bit and doesn't properly look at the 100% bit .

Pierre

PS I dont think that CPAM does retrospective reimbursements

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Post by wizzard » Tue Mar 26, 2019 9:31 am

Pierre wrote:
Mon Mar 25, 2019 10:55 pm
Hi Wizz I didn't actually 'sort it out' the dental nurse just explained it to me.

When you have a heart op you become an ALD and there is a letter on your AMELI account to that effect and your medecin traitant should also give you a corresponding one. Once you have the heart op, the cardiologist should give you a red bordered card to show to any other medical professional who should take note of the heart situation, the 100% and the antibiotic requirements of the heart condition. Dentists especially; it was only last week when I went for a crown reglue (non reimbursable) that the dental nurse explained that for a heart ALD it was 100% always with a dentist on reimbursable items. I didn't ask about any other ALD but it may be worth a try. Each time you need to make a point of the 100% for the ALD because the person who takes the Carte Vitale only looks at the money bit and doesn't properly look at the 100% bit .

Pierre

PS I dont think that CPAM does retrospective reimbursements
Thanks Pierre - I never got any red bordered card from the cardio. Its nearly 9 years since my quad bypass, and the only health costs I've had were dental. I will investigate with CPAM, and the Mutuel - I believe the Mutuel can go back 5 years.
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Post by Jamstealer » Tue Mar 26, 2019 11:47 am

I have a minor heart condition which was assessed as an ALD, my cardiologist notified CPAM; it’s noted on my Ameli account, and comes up automatically when my Carte Vitale is read. So at the dentist I automatically get 100% coverage for my routine 6 months checks; clean and the majority of dental work ( “cosmetic “ wouldn’t be covered)

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Post by Andrew » Tue Mar 26, 2019 1:44 pm

It's a curious rule isn't it? I'm not complaining obviously, but heart condition and dental work? Why dental work and not, say, chiropody? It just seems a bit arbitrary. Though I guess why not? Maybe it's just a recognition of the debilitating nature of heart disease and a bit of a freebie as some form of recompense...

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Post by wizzard » Tue Mar 26, 2019 3:46 pm

Andrew wrote:
Tue Mar 26, 2019 1:44 pm
It's a curious rule isn't it? I'm not complaining obviously, but heart condition and dental work? Why dental work and not, say, chiropody? It just seems a bit arbitrary. Though I guess why not? Maybe it's just a recognition of the debilitating nature of heart disease and a bit of a freebie as some form of recompense...
I've had over 40 sessions of physio for the arthritis and tendonitis in both shoulders - I've not been asked for payment so I'm guessing the ALD is covering it.
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Post by Andrew » Tue Mar 26, 2019 4:28 pm

Ah yes, here was me assuming it was only dentistry. Other treatments are available too. That makes more sense.

I guess you can't free Viagra though, not with a heart condition... though you'd go with a smile on your face. Would an ALD entitle you to reimbursement of funeral costs?

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Post by Jamstealer » Wed Mar 27, 2019 12:07 am

Andrew wrote:
Tue Mar 26, 2019 1:44 pm
It's a curious rule isn't it? I'm not complaining obviously, but heart condition and dental work? Why dental work and not, say, chiropody? It just seems a bit arbitrary. Though I guess why not? Maybe it's just a recognition of the debilitating nature of heart disease and a bit of a freebie as some form of recompense...
Not curious at all. It’s a fact that mouth/gum/tooth infections are dangerous for thse with heart conditions. Cardiologists always recommend patients to pay attention to dental health.

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Post by Andrew » Wed Mar 27, 2019 8:02 am

Jamstealer wrote:
Wed Mar 27, 2019 12:07 am
It’s a fact that mouth/gum/tooth infections are dangerous for these with heart conditions.
Well you live and learn, I didn't know that.

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Post by Andrew » Wed May 22, 2019 3:56 pm

As suspected, I've now got my own account.

I received a letter from UMCAPI advising me of the change and asking for a photo for a new carte vitale. My misses kept her card when she shifted back to CPAM - but I guess her social security number (or whatever) didn't change whereas maybe mine has. I dunno, I just sign the forms and send them back! As long as everything still works, I don't give a monkey's.

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