Expats: French Social Security
431
Jean’s reply:The Sécurité Sociale system works in many ways like most American HMO health plans. Some doctors and other medical professionals are registered (almost 100% of them) with the system, and some are not. Of those who are registered, some doctors are registered as charging the exact amount defined in the policy; others are registered as charging more (there is a maximum limit). Medical personnel can also perform treatments that are not covered, mostly because they are done purely for comfort or for cosmetic reasons. Because the Sécurité Sociale (known as the “Sécu”) is covering less and less, mutuelles, which are secondary private health insurance policies, are now offering plans of various scopes of coverage.
The first level pays the difference between the Sécu reimbursement and the amount defined by the Sécu policy
The second level pays the difference between the Sécu reimbursement and the amount actually paid by the patient.
The third level pays also a fraction of what is not covered by the Sécu, as long as it has some medical merit.
The best coverage covers any medical expense in full, first as a complement to the Sécu system, and second, covering everything medical that is not covered by the Sécu.
From what you say, your mutuelle does not cover anything outside the Sécu coverage and only works as a complementary system. My conclusion is that you based your decision to have this dental work done on bad information. Legally speaking, there is not much you can do, since you authorized and paid for the procedure and you knew that it was HN. It would be virtually impossible to prove that the dentist had deliberately given you false information and that you had no way of verifying the exact terms of your policy. It is legally assumed that you knew the nature and the extent of the coverage of your mutuelle when you purchased it.
My advice is to go back to your dentist with the negative answer from the mutuelle and make a huge scene, the French way, saying it is a disgrace to be lied to that way, you will report him to the “conseil de l’ordre,” and so on. By the way, it took my American wife about five years living in France before she mastered this “technique,” which emphasizes drama and never mentions having rights to something or deserving customer satisfaction. You could get a break in the cost of the procedure. This is not a sure shot, but you should really try. This dentist misled you quite a lot; the decent thing to do would have been to warn you of the risk you faced and make sure you got a confirmation from your mutuelle regarding its terms about HN.
There is a “conseil de l’ordre” for each profession in France that requires a license. Only senior professionals in the field are members of this body, which attempts to find a compromise between preserving the profession’s good reputation and helping a fellow professional. As always in France, unless you have sufficient written documentation of what has happened, you will not get proper satisfaction from this procedure, as it becomes your word against this professional’s.
As for the tax write-off, I cannot see how a dental expense in France can be considered as a professional expense in the USA.
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Jean’s reply:
The Sécurité Sociale system works in many ways like most American HMO health plans. Some doctors and other medical professionals are registered (almost 100% of them) with the system, and some are not. Of those who are registered, some doctors are registered as charging the exact amount defined in the policy; others are registered as charging more (there is a maximum limit). Medical personnel can also perform treatments that are not covered, mostly because they are done purely for comfort or for cosmetic reasons. Because the Sécurité Sociale (known as the “Sécu”) is covering less and less, mutuelles, which are secondary private health insurance policies, are now offering plans of various scopes of coverage.
The Sécurité Sociale system works in many ways like most American HMO health plans. Some doctors and other medical professionals are registered (almost 100% of them) with the system, and some are not. Of those who are registered, some doctors are registered as charging the exact amount defined in the policy; others are registered as charging more (there is a maximum limit). Medical personnel can also perform treatments that are not covered, mostly because they are done purely for comfort or for cosmetic reasons. Because the Sécurité Sociale (known as the “Sécu”) is covering less and less, mutuelles, which are secondary private health insurance policies, are now offering plans of various scopes of coverage.
The first level pays the difference between the Sécu reimbursement and the amount defined by the Sécu policy
The second level pays the difference between the Sécu reimbursement and the amount actually paid by the patient.
The third level pays also a fraction of what is not covered by the Sécu, as long as it has some medical merit.
The best coverage covers any medical expense in full, first as a complement to the Sécu system, and second, covering everything medical that is not covered by the Sécu.
From what you say, your mutuelle does not cover anything outside the Sécu coverage and only works as a complementary system. My conclusion is that you based your decision to have this dental work done on bad information. Legally speaking, there is not much you can do, since you authorized and paid for the procedure and you knew that it was HN. It would be virtually impossible to prove that the dentist had deliberately given you false information and that you had no way of verifying the exact terms of your policy. It is legally assumed that you knew the nature and the extent of the coverage of your mutuelle when you purchased it.
My advice is to go back to your dentist with the negative answer from the mutuelle and make a huge scene, the French way, saying it is a disgrace to be lied to that way, you will report him to the “conseil de l’ordre,” and so on. By the way, it took my American wife about five years living in France before she mastered this “technique,” which emphasizes drama and never mentions having rights to something or deserving customer satisfaction. You could get a break in the cost of the procedure. This is not a sure shot, but you should really try. This dentist misled you quite a lot; the decent thing to do would have been to warn you of the risk you faced and make sure you got a confirmation from your mutuelle regarding its terms about HN.
There is a “conseil de l’ordre” for each profession in France that requires a license. Only senior professionals in the field are members of this body, which attempts to find a compromise between preserving the profession’s good reputation and helping a fellow professional. As always in France, unless you have sufficient written documentation of what has happened, you will not get proper satisfaction from this procedure, as it becomes your word against this professional’s.
As for the tax write-off, I cannot see how a dental expense in France can be considered as a professional expense in the USA.
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