Health reimbursement calculation

No matter what health bill we have received, we don't always understand the breakdown of benefits and in this article, we will try to guide you.

How is the reimbursement calculated?

We will refer to an example and together we will demonstrate the calculation. So, take a blank sheet of paper and draw a vertical line with the number zero at the beginning of the line and 1 billion at the end. You are going to draw a line and put the number 25 euros, which is the fee for the general practitioner, and a physiotherapy session at 17.2 euros. These are the basic social security rates. The basis of the price comes from the social security rate. You should also know that social security reimburses 60 to 70% of the basic rate. Then, it will be the mutual insurance company which will supplement. This means that it is possible that the bill exceeds the basic rate.

Reimbursement of the mutual insurance company

Reimbursement of the bill without exceeding the basic rate. Let's take the example of the physiotherapist's session at 17.2 euros. So, you are going to subtract the 60% reimbursement of the SÉCU, which makes 10.32 euros. And then, you take a calculator to know the amount reimbursed by your mutual insurance company which is: 17.2 - 10.32 = 6.88 euros which is the amount reimbursed by the mutual insurance company. This is what will be written on the tariff table of the mutual insurance company with 100% of total reimbursement on the basic tariff of the mutual insurance company. So, if you have an overrun and the bill is displayed at 25 euros, then the arrow continues. You will pay nothing if the tariff proposed by the mutual insurance company covers 200%, which means 17.2 x 2 = 34.40 euros, on the basic price. Of course, you will not see this small amount of overrun on the 25 - 34,40, but the mutual insurance company assures you that it will pay the whole bill.

If you think the calculation is wrong, you can ask the health insurance company for an explanation, and don't ignore it, because it is possible that there is a mistake in the calculation.