Author of the answer : Dr Régis GuinandCatégorie : Générale
an intervention has a security tariff of 300 euros, the security reimburses 300 euros (100%) …
A surpass of 300 euros is practiced by the surgeon (the doubling of the safety rate), it will be refunded in full by your complementary organization (mutual, insurance) provided that your contract specifies a rate of assumption of 200% (the 100
first% it is the safety that refunds): estimate of 600 euros in total (300 300) In case of 140% contract you will be refunded the value of 40% of the safety rate is 120 euros, so it will remain 180 euros at your expense …
It engages you after agreement like any estimate of a craftsman …
In the field of orthopedic surgical procedures, social security fully reimburses the ‘base’ cost of an operation (except cosmetic surgery and certain assimilated acts), ie 100% of the safety rate.
So if your mutual shows a support of 100% of the safety rate it does not actually support … nothing at all!In order for your mutual insurance company to cover a fee overrun, it is necessary that the rate displayed on your insurance or mutual insurance contract be greater than 100% or that the coverage is ‘at actual expense’.
Example:an intervention has a security tariff of 300 euros, the security reimburses 300 euros (100%) …
A surpass of 300 euros is practiced by the surgeon (the doubling of the safety rate), it will be refunded in full by your complementary organization (mutual, insurance) provided that your contract specifies a rate of assumption of 200% (the 100
first% it is the safety that refunds): estimate of 600 euros in total (300 300) In case of 140% contract you will be refunded the value of 40% of the safety rate is 120 euros, so it will remain 180 euros at your expense …
In general the cards of the body summarizing the care does not specify the support for overruns but are subject to prior agreement on presentation of a quote … which is not to facilitate the task!
An estimate is systematically made for any excess of fees …It engages you after agreement like any estimate of a craftsman …
