Established by the law of August 13, 2014, the Care course is intended to facilitate the care and medical monitoring of a patient. It also aims tohelp with reimbursement of health expenses. Definition, rules to follow and information to know, Thelem Assurance explains the specificities of the coordinated care path.
Treatment path, definition
The Care course is defined by the designation of a doctor, named attending physician, to whom the patient should preferentially refer to ensure his medical follow-up. In the event of a health problem, the attending physician may refer his patient to a colleague or a specialist for additional care.
Why choose an attending physician?
The choice of attending physician is done freely with the agreement of the latter. Only children under 16 should consult the doctor chosen by one of the two parents. The attending physician can be a general practitioner or a specialist, be approved or not and can practice alone, in an office or in a hospital center.
The choice of a referring doctor has a double advantage:
- better monitoring of your health thanks to an attending physician who knows you well
- better reimbursement of your medical expenses if they follow the course of treatment.
The attending physician will be the one you see first when you are ill, the one who will refer you to a colleague if you need to see a specialist, and who will establish the treatment protocol to be followed if you have a long-term illness. duration.
How to declare your attending physician?
The doctor’s statement can be made online or by mail.
The online declaration is made by the attending physician himself on his Ameli professional space.
The declaration by mail must be made jointly with the attending physician to whom you must have the Cerfa N ° 12485 * 03 form completed. Once completed, the form should be sent to your primary health insurance fund.
What are the consequences of not respecting the course of care?
When the Care course Health insurance reduces the reimbursement rate for your medical consultations.
So as part of a Care course follow-up, that is to say if you consult your attending physician, the CPAM will reimburse you for 70% of the price of your consultation minus € 1 for flat-rate participation.
If you leave the treatment course, the CPAM will reimburse only 30% of your medical costs, less 1 € of fixed contribution.
Exceptions to the treatment path
In some cases, you have the option of seeing another doctor if your doctor is not available. In the following situations, your reimbursement will not be impacted by non-compliance with the treatment course:
- in the absence of the attending physician if the consultation is carried out with his replacement,
- in the absence of the attending physician if the consultation is carried out with another practitioner practicing in the same medical practice or health center,
- in case of emergency,
- if you are far from home (business trip, vacation, etc.).
Certain health professionals can also be consulted without going through your doctor:
- gynecologists,
- ophthalmologists,
- psychiatrists,
- les neuropsychiatres,
- stomatologists
- dentists,
- midwives,
- pharmacists,
- medical transporters,
- medical auxiliaries,
- etc
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