You can consult a health specialist without first seeing a GP in France but it could – depending on the type of specialist and your insurance coverage – cost you more.
The process is usually as follows:
You have an illness or an injury, say, for example, you have injured your knee. You should normally go to see your designated GP (médecin traitant).
There is a system of designated doctors in France where you choose (in agreement with the doctor) a personal GP in order to benefit from lower fees and more informed health care. Read about this in our article here: Why having a designated GP in France saves you money.
If you do not have a designated GP, you can still get a consultation with a doctor in your area but it could cost more and/or you may be more poorly reimbursed.
Your GP will note your knee injury and then may send you to a specialist, such as a physiotherapist. In this way you will be considered to be on the ‘coordinated healthcare pathway’ (parcours de soins coordonnés).
Being on a parcours de soins coordonnés means better state reimbursement rates for treatment.
Fees for seeing a specialist while on the ‘coordinated healthcare pathway’
Visits to a specialist on the ‘pathway’ can be one of two kinds: suivi régulier (if you are expected to be seeing the specialist on an ongoing basis) or avis ponctuel (for a one-off expert opinion).
A sector 1 specialist can charge a fee of €30 for a suivi régulier consultation (note that certain specialisms fall outside this and have specific set fees, such as a psychiatrist, whose basic rate for suivi régulier is €50.20, or a cardiologist, €51).
Sector 1 means a professional who applies the standard rates set out by France’s social security. A sector 2 specialist can charge above these rates. There are more doctors and specialists in sector 1 in France but sector 2 health professionals are not uncommon.
If you go to a sector 1 specialist, 70% of the €30 will be covered by the basic social security healthcare coverage, meaning €21 is covered, with €9 that is not covered, known as the ticket modérateur.
In actual fact there is, in most cases, also a €1 levy on any medical consultation, known as the participation forfaitaire, which is also not state-reimbursed.
The €9 ticket modérateur will be covered for people who have top-up health insurance policies, commonly referred to as mutuelles. This means that in the end they will only be out of pocket for the €1 participation forfaitaire.
Fees for seeing a specialist while outside the ‘coordinated healthcare pathway’
For a consultation with a sector 1 specialist outside the ‘pathway’, the doctor may charge more – up to €35 – however to complicate things further, basic French healthcare will only calculate a reimbursement against €25 of this, and then only at a rate of 30%.
This means that out of a €35 fee the state would cover only €7.50, minus the €1 participation forfaitaire, leaving€28.50.
Mutuelle policies do not compensate for penalties linked to going outside the health pathway if they are of a so-called ‘responsable’ kind, which is the vast majority of them.
This means if you see a sector 1 specialist without referral you will not obtain more than the €9 reimbursement you would have obtained for seeing one ‘in the pathway’.
Exceptions for certain specialists
There are some exceptions where you can go directly to a specialist without first seeing your GP and still be considered as being on the ‘coordinated healthcare pathway’.
This includes if you have a long-term illness (affection de longue durée) and see a certain specialist regularly or if you are going to see:
- A gynaecologist
- an ophthalmologist
- a psychiatrist
- a dentist, orthodontist, dental specialist (un stomatologue)
There are also exceptions linked to emergencies or being away from home.