“We have to bring out the atomic weapon”. At the end of the third round of negotiations between the unions of private doctors and Health Insurance on consultation rates, Thursday February 8, the Doctor for Tomorrow collective encouraged its members to turn their backs on Social Security. “We don’t have a tractor, our weapon is the threat of collective unconventionality», insisted in a video posted on social networks its president Mélanie Rica-Henry, who sits at the meetings as an observer. In three days, several hundred doctors have already joined the movement initiated almost a year ago by the media general practitioner and president of the French Union for Free Medicine (UFML), Jérôme Marty. But what are we talking about concretely?
By freeing themselves from the conventional rules of Social Security, these doctors will become free to set their prices as they see fit. For example, 50 euros per consultation with a general practitioner, as the Doctor for Tomorrow collective has been calling for since its creation at the end of 2022. That is, much more than the price increases proposed by the general director of the National Health Insurance Fund (Cnam ) Thomas Fatôme and his number 2 Marguerite Cazeneuve.
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Doctors for Tomorrow calls on all liberal doctors to join the Collective Deconvention Action@MedPourDemain #liberaldoctors #ActionDeconventionnementCollectif @Drmartyufml @DrMartyJerUFMLS @Assur_Maladie @AssembleeNat @Senate #syndicatmedecin pic.twitter.com/n9xq88uUN9
— UFML SYNDICAT – union of liberal doctors (@UFMLSYNDICAT) February 9, 2024
Consultations which are almost not reimbursed by Health Insurance
Be careful not to confuse these free rates with those set by numerous specialist doctors. In Social Security jargon, doctors are divided into three sectors. The first brings together the doctors who bill the rate serving as the basis of reimbursement for Health Insurance, namely 26,50 euros with a general practitioner – without excess fees, therefore. The second sector rather brings together specialist doctors who are authorized to claim additional fees. They are free to set their prices beyond 31.50 euros but patients are always reimbursed based on this base price. The third and final sector is not regulated by Health Insurance: all the doctors who are part of it then set their consultation rates freely… but to the detriment of their patients’ budgets.
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READ ALSO General practitioner, pediatrician, gynecologist… future consultation prices offered by Social Security
When a patient consults a doctor not approved by Health Insurance, Social Security actually applies a authority tariff. In other words, it is the minimum service in terms of covering health costs. For a consultation with a non-approved general practitioner, Social Security only pays 0,61 euro to the patient. The amount rises to only 1.22 euros if the patient consults a specialist. And this, regardless of the rate you are charged.
Let’s take the example of a general practitioner not approved by Health Insurance who charges 60 euros for his consultation. Social Security covers 0.61 euros, which leaves a remainder to be borne by… 59,39 euros for the patient. For a non-approved gynecologist who sets the price of his consultation at 90 euros, Social Security only reimburses you 1.22 euros. Your remaining liability therefore amounts to 88,78 euros. These amounts can, however, at least partially, be covered by your mutual insurance company. To do this, it is in the patient’s interest to subscribe to higher level offers than the basic guarantees offered by complementary health insurance. This means paying, perhaps more, for your health insurance to guarantee optimal coverage for your consultations with non-contracted doctors.
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Nearly 4,000 doctors ready to unconventionally
Health Insurance must meet with each of the six signatory unions before bringing together all the stakeholders in March for a probable final negotiation session. But for the moment, neither MG France nor Avenir Spé-le-Bloc, the majority among general practitioners and specialists, say they are ready to sign the agreement. If the negotiations fail again, the liberal doctors risk carrying out their threat. As of January 12, they are at least 3 840 doctors to have written their letter of intention to withdraw from the convention.
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2024-02-12 12:53:45
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