How to save money on seeing a specialist doctor in France

Seeing a specialist in France can cost far more than the official state tariff – even for the same type of appointment. The amount you pay depends largely on the doctor’s ‘sector’ and whether they have signed a controlled pricing agreement with Assurance Maladie (the French public health insurance system).

Knowing how these categories work, and what terms such as ‘sector 2’, ‘dépassements d’honoraires’ and ‘Optam’ mean in practice, can make a substantial difference to your final bill.

The three ‘sectors’

Doctors in France fall into three categories:

Sector 1 (conventionné secteur 1) doctors have signed an agreement with Assurance Maladie and must charge the official state tariff, known as the tarif de convention (TC). 

Social security reimburses 70% of this tariff in most cases. If you have a mutuelle (top-up insurance), it usually covers the remaining 30%. A €2 fixed patient contribution is deducted and never refunded.

Sector 2 (conventionné secteur 2) doctors are also signed up to Assurance Maladie but may charge extra fees above the TC. Reimbursement from social security is still based on the TC (or, sometimes, even a reduced level) not on the actual fee charged. The patient pays the difference unless their mutuelle covers it.

Sector 3 (non-conventionné) doctors are not signed up to the state system. Social security reimbursement is very minimal.

Most specialists are in sector 2.

What is Optam?

Optam (option pratique tarifaire maîtrisée) is a voluntary agreement open to sector 2 doctors where they agree to limit their extra fees in exchange for bonuses and fiscal advantages.

For patients, this has two effects:

• Fees are usually lower than with non-Optam sector 2 doctors.

• The reimbursement base is higher.

Reimbursements vary depending on the exact type of specialist you are consulting (some have specific higher rates) and also whether you are referred for a one-off opinion on a specific question, or potentially for ongoing care. Note also that reimbursements are less if you go directly to a specialist without referral by your GP. 

For a ‘standard’ specialist consultation with GP referral for ongoing care, such as a consultation with an ENT specialist, for example, the reimbursement base is €31.50 under Optam, compared to €23 without it. Social security reimburses 70% of this amount minus the €2 contribution deducted from all medical appointment reimbursements.

Mutuelles are also obliged to offer better guarantees for Optam consultations under 'responsible' contracts (which applies to most of them). For example, a policy might offer 170% of the base for Optam and 150% for non-Optam, and will therefore reimburse significantly more in the first case.

The percentage applies to the official base tariff, not to the total fee charged. A 150% mutuelle does not refund 150% of the bill, but up to 1.5 times the base amount.

Why this matters

This affects both consultations with doctors and in some cases, procedures carried out by them, such as operations. 

For example, one reader was quoted €1,556 for a knee operation that was reimbursed on a base tariff of €778.06. As his mutuelle offered only 105% for non-Optam surgeons, his reimbursement was €816.96 in total (€739 out of pocket), whereas the same mutuelle offered 125% for Optam surgeons. 

The latter would have seen him reimbursed €972.58 (out of pocket by €553.42).

For a €70 consultation with a non-Optam specialist assuming that the mutuelle reimburses 150% of a base rate of €23 for ‘standard’ specialist consultations:

Under responsible contract rules, Optam procedures must be reimbursed at least 20% more than non-Optam equivalents. In practice, the difference can be substantial.

The amounts above also factor in the €2 participation forfaitaire levey that is not reimbursed. Readers should also note that the exact amounts they are reimbursed will vary in reality depending on the type of specialist, the doctor’s sector and the mutuelle contract.

How to check

Optam participation is not always clearly shown on booking platforms. The official directory at annuairesante.ameli.fr lists whether a sector 2 doctor is Optam or ‘honoraires libres’.

For patients, the key is simple: before booking a specialist, check the sector and whether they have signed Optam. The label can determine how much of the bill you ultimately pay.

Patients should also note that the fees for several sector 1 and Optam specialists increased from January 1, 2026, following agreement between medical unions and Assurance Maladie.