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Development of sickness insurance on complex new consultations with physicians

Ⓒ AFP/Archives – FRED DUFOUR – | The new rates of 46 and 60 euros will apply to “complex” consultations (scoliosis or gestational diabetes) or “very complex” such as informing a patient newly diagnosed with cancer about his treatment

The first consultation for contraception among young girls aged 15 to 18, whose tariff will increase to 46 euros on 1 November, will be 100% covered by the Social Security, recalls Tuesday health insurance.

Following the switch from the generalist consultation to 25 euros on 1 May, further upgrades will come into effect on 1 November, as stipulated in the medical agreement signed in August 2016 by the Health Insurance and the unions of liberal doctors.

The publication of these upgrades in the Official Gazette last week had aroused indignant reactions on social networks, some of which were offended by the fact that contraception was considered a complex and costly act.

These new rates of 46 and 60 euros will apply to “complex” consultations (such as scoliosis or gestational diabetes management) or “very complex” (such as “informing a patient” newly diagnosed with cancer or Alzheimer’s disease “), general practitioners or specialists.

About thirty reasons are concerned by these new consultations, which will “have no financial impact for patients with a mutual”, insists the Health Insurance: they will be reimbursed according to the usual rules, to 70% for the share assumed by the social security, to 30% for the share assumed by complementary health.

Two-thirds of these consultations will be even 100% covered by the healthcare system because they concern the management of complex and unstable diseases for patients benefiting from the long-term illness (ALD) regimen, claim to the third-party payer (waiver of advance costs).

Other “high public health issues” will also be fully reimbursed by the healthcare system, such as the three compulsory follow-up consultations for infants and the first consultation for contraception and prevention of sexually transmitted diseases among girls of 15 at 18 years old.

The latter will be able to “ask their doctor to remain anonymous and to benefit from the dispensation of advance costs, as is already the case for emergency contraception”.

In total, the “estimated cost” of these new tariffs is estimated at “37 million euros for Health Insurance”.

They aim to “take into account the complexity of certain medical situations and to value the more important time physicians have to devote to it”, insists the organization.

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