France has one of the best healthcare systems in the world. However, it is a long way from being free to use, even for people who have good complementary health insurance (mutuelle).
In terms of hospital care, fees and certain extras can quickly push up the bill so prospective patients should take a few essential factors into consideration.
Find out where your doctor operates
Private clinics and state hospitals do not charge the same rates, especially when it comes to the cost of a room, meals, etc.
Some private clinics are conventionné, which means they have signed an agreement with the French social security system to charge regulated rates. Those that do not are called non-conventionné, in which case out-of-pocket expenses will be higher. Some mutuelle companies exclude clinics that are not under agreement.
Even within state hospitals, doctors may work part of the time in the private sector, and may therefore charge extra fees.
Or the surgeon might be freelance and set their own rates for their short term contract.
Similar situations arise with anaesthetists and even surgery nurses, who can also demand fees way above the officially approved scales (base de remboursement or BR) used by the government and complementary health insurance companies.
Get a quote
Quotes are obligatory and must be signed by the patient before hospital treatment, but they are notorious for their complexity and refer to grades and charges rather than euros.
If the person asking you to sign the devis (quote) is not able to give you a straight answer as to how much your hospital stay will cost, stand your ground and ask for someone else to do so.
You can also take the unsigned devis to your GP (médecin traitant), explain that you do not understand it, and ask them to cost it for you, getting a price for the amounts not covered by the state or health insurance companies.
Note that even if your devis says medical fees are reimbursed at 100% of the BR, this does not mean you will have nothing to pay. It simply means that the social security and mutuelle reimbursement reaches 100% of the rate set by the state
An example might be a devis where the surgeon charges €1,500 for the operation but the state has a BR for it of just €412.31. If the state only pays 80% of the latter, the mutuelle might pay 100% of the rest, but only to cover the €412.31, not the full fee of €1,500. In this example the patient will still have to pay €1,087.69.
Find out how much your mutuelle will contribute
Ask a representative from the insurance firm to cost out each line of your devis. If they grumble about doing so, change to another one – you can now do so easily after a year. Before cancelling, however, check the waiting period for your new mutuelle and whether you need to fill in a medical questionnaire on applying.
To get better reimbursements, you could also increase your coverage or take out a supplementary policy focused on gaps in hospital coverage.
"If you want to be protected against excess fees, you should opt for minimum coverage of 150% for hospitalisation. Or even 200% or 300%, or at actual cost, depending on the level of services required and the excess fees charged," advises David Trohel of brokerage firm santiane.fr in consumer rights magazine 60 Millions de consommateurs.
Remember the forfait hospitalier
State hospitals in France charge a daily €20 forfait hospitalier to cover the cost of the room and food. The state does not reimburse this (except in special cases such as the last four months of pregnancy or if you are covered by the Complémentaire Santé Solidaire scheme), but mutuelles usually do.
Cut out unnecessary extras
Other hospital expenses can include private rooms and additional services such as wifi, telephone, TV, etc.). Private clinics often charge more, putting patients in single rooms rather than a double, and offering extras such as subscription TV, wifi, telephone etc), which are not always available in state hospitals. You can ask for a double room rather than the more expensive single to save money.
Reimbursement varies according to your mutuelle (the state will not cover this). Note that most contracts limit reimbursement of private rooms and/or comfort costs to 60 or 90 days a year.
Beds and meals for accompanying persons are usually extra.
Be aware, too, that you will be billed for transport to and from the hospital unless your doctor has prescribed it, and provided it is an approved form of transport.
Long-term conditions still require mutuelle insurance
Under France’s ALD exonérante care system for long-term illnesses (affection de longue durée), healthcare costs are covered up to the maximum that can be refunded by social security. However, this only covers treatment directly related to the illness and you still have to pay for certain expenses such as fixed hospital charges. For this reason, good mutuelle cover is still advised.
Shop around
If, after studying the devis, you think the price demanded for hospitalisation is excessive, ask your médecin traitant if there is an alternative.
Although the boundaries of healthcare in France are fairly fixed, usually around university hospitals, it is possible that by having the operation in another hospital, in another health authority, the prices may be lower.
The hospital might even be nearer – large parts of Charente, for example, are attached to the university hospital in Limoges, even though Bordeaux university hospitals are much closer.
A final word
Hospitals and clinics are used to people having difficulty paying big fees straight away, and most have well-oiled systems where the hospital stay can be paid off monthly.
