A doctor under contract: what is he or she supposed to do? What does this mean? ?
Many people still do not understand the concept of a contracted doctor. However, it is important to understand the difference between a contracted doctor and an uncontracted doctor in order to benefit from better insurance coverage.
A contracted doctor is What is a ?
To begin with, it is important to know that there are two categories of conventioned doctors. On the one hand, you have doctors covered by sector 1, and on the other, those in sector 2. Whether he is in sector 1 or 2, a conventionned doctor is a doctor who A doctor who charges fees that can be totally or partially reimbursed by the health insurance system.
In other words, if you choose to consult a conventionned doctor, you can be sure to benefit from a consequent coverage from your insurance and your mutual insurance company. It is therefore important to find out when you choosing your preferred doctor , to know the status of the latter.
S’he is not covered by a convention’Does this imply ?
When a doctor is not under agreement, it means that he belongs to sector 3. For doctors in this category, the reimbursement from the mutual insurance company is very low. In addition, since they have not signed a medical agreement regarding their fees, they can to set the amount of their fees in all freedom.
This is why consultations with unregulated doctors are generally very expensive. It is important to know that sector 3 includes a large number of specialists such as psychiatrists, ophthalmologists, etc. However, there are also general practitioners who choose to be out of agreement.
In reality, this does not only present disadvantages for patients. Indeed, if some health professionals decide to be unregistered, it is also in the interest of their patients. The fact that they are free to set their own rates allows them to offer longer consultations.
They can take their time to see each patient and give them all the attention they need, without having to respect a deadline.
On the other hand, if the reimbursement of a consultation with a non-referred doctor is low, you will not have this problem for examinations or prescribed medication. Indeed, the status of the attending physician does not impact the percentage of reimbursement for examinations and medication.
In other words, all that changes when you choose an unregulated doctor is the amount of reimbursement for consultations. Compared to other medical expenses, the Social Security covers you in the same way as patients of conventionned doctors.
What is the difference between sector 1 and sector 2 ?
There are two types of contracted doctors. Even though they have all signed the medical agreement, they are not subject to the same rules.
Doctors covered by the sector 1 agreement
Thus, the first one is the sector 1 doctor. This health professional has chosen to apply only the rates fixed by the convention.
This agreement requires them not to charge any extra fees, except in a few exceptional cases. He can charge additional fees when he has to travel or intervene outside normal hours.
In sector 1, we find a large number of professionals. In addition to general practitioners, we also have specialists such as dermatologists, dentists, ophthalmologists, and many others. All these doctors choose to apply the Social Security rates.
Thus, when you are reimbursed for the consultation fees, you will be able to recover almost the entire amount spent. With the health insurance, you will be reimbursed for 70% of the price. Then, with your mutual insurance company, you will be reimbursed for the remaining 30% of the cost, minus 1 euro that you will have to pay for.
If you have not yet subscribed to a mutual insurance company, don't hesitate, because it offers many advantages. Some mutual insurance companies may even cover up to 200 or 300% of the consultation fees. This allows you to go to a sector 2 doctor. Note that if you have difficulty in calculate the reimbursements of the mutual health insurance , there are several online tools that can help you.
Doctors covered by the sector 2 agreement
To come back to the sector 2 doctors, they are also free of charge, signatories of the medical convention. However, unlike sector 1 doctors, they are not obliged to set their rates according to the Social Security base. They practice free tariffs, with the possibility to charge extra fees.
Also, with sector 2 doctors, the basis for calculating reimbursement is the same as for sector 1 doctors. This is already a major advantage over non-registered doctors.
Moreover, among the doctors in sector 2, you can find some who choose to adhere to the option of controlled tariff practice. We then talk about a doctor who is an OPTAM member. These professionals are those who agree to charge moderate extra fees.
Patients can therefore benefit from a more substantial reimbursement.
How to know if a doctor is covered by a convention ?
You have several options for find out if a doctor is covered or not. The simplest solution is to ask him/her. When making an appointment for a consultation, you can ask the receptionist or the medical secretary if the doctor is covered by a convention.
If this option is not available, you can look up the name of the doctor or his practice in the Social Security or Health Insurance Directory. If they do, you will have proof that they are covered by the convention. You will even be able to see if he is in sector 1 or sector 2.
You did not have time to check the information before the day of the consultation ? Well, it's not late yet. Just look at the rates posted in the waiting room. If they are higher than the usual rates, then they are probably an unregulated doctor. At this stage, you still have time to turn back.
Does this affect the reimbursement of my care?
As mentioned above, the status of your attending physician does not affect the reimbursement of your care. In other words, whether or not the doctor is covered by a convention, the same percentage of the cost of care, and even of medication, is covered.
So if you wish to benefit from a longer consultation, or under particular conditions, which may lead to additional fees, you can turn to a doctor who is not covered by a convention. All you will have to pay are the fees related to the consultation.
For care, examinations and medication, you can count on the reimbursement of your insurance and your mutual insurance. This can be total or partial, depending on the care and the terms of your insurance contract.
