Insurers forced to increase pay-outs

TOP-UP healthcare insurers are being forced to reimburse in full certain bills from doctors who charge above the standard rates.

The Health Ministry has said a decree being published today requires that, under certain conditions, insurers reimburse customers who visit “sector two” doctors (those allowed to charge more than the fixed rates on which state reimbursements are based).

The decree reportedly is “particularly” aimed at hospital doctors like surgeons, anesthetists and obstetricians who often practice such tariffs.

However the insurers will only be held to the obligation if the doctor has pledged to limit their dépassements (money charged above the standard rate) to 50% of the standard rate and also to carry out 30% of their medical acts at the standard rate. In return social charges levied on the doctors’ work at the standard rate will be paid out of the state health insurance funds.

This would improve the amount many patients receive in reimbursements from their top-up insurers, notably where they are on cheaper policies that do not already cover in full such dépassements.

It is expected that the insurers will speak out against the move, which had been suggested in the past, but not taken up. The head of La Mutualité Française, a body representing many such insurers, Etienne Caniard, has previously claimed that such a scheme would “probably have an extremely limited impact on customers”.

Consumer bodies have also warned that such a move would be likely to lead to insurers putting up premiums to cover the cost, while many sector 2 doctors said it ought to come in parallel with a reevaluation of the standard rates.