Loïs Rakotonoera – published on 01/03/24 at 3:06 p.m.
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At the start of the year, you have decided to take care of yourself by going for a check-up with the doctor or dentist. And to avoid breaking the bank, it is better to go to sector 1 doctors. But what is the difference between a sector 1 or sector 2 professional? How do Health Insurance and your mutual health insurance reimburse their consultations? We take stock for you!
What do sector 1 and sector 2 mean?
And approved doctor adheres to the national medical convention established with Social Security. She defines the pricing of medical procedures. However, we distinguish 2 sectorswhich refer to different pricing for medical procedures.
The sector 1 approved doctor
A sector 1 doctor strictly applies the rates set by Social Security. By choosing a sector 1 doctor, your consultation can be fully reimbursed by Health Insurance and your mutual insurance company.
In 2024, the price of a consultation with a general practitioner in sector 1 goes from €25 to 26,50 €.
The sector 2 approved doctor
A sector 2 doctor free fee invoice : the price of the medical procedures he performs therefore includes both the basic rate defined by Social Securityand an additional sum called “ fee overrun“. The price of a consultation therefore varies depending on the practitioner.
What is Optam and what is its impact on the price of consultations?
The practical, controlled pricing optionor Optis a device that regulates fee overruns. Sector 2 contracted doctors with Optam therefore practice rates higher than those established by Social Security but their amount is limited.
In addition, Optam requires practitioners to not apply an excess on part of the medical care that they offer.
In 2024, a consultation with a sector 2 doctor with Optamis reimbursed on the basis of €31.50, compared to €30 previously.
Pour a consultation with a sector 2 practitioner without Optam support ends at 23 €for a general practitioner or specialist.
How does Health Insurance reimburse consultations with sector 1 and 2 doctors?
Whatever the price of your consultation, the portion reimbursed by Health Insurance will always be the same. If your consultation takes place as part of the coordinated care pathwaythat’s to say on prescription from your doctor your reimbursements are distributed as follows:
- Social Security covers 70% the basic rate defined by the national medical convention;
- Your complementary health insurance covers 30% remaining.
Can mutual health insurance reimburse excess fees?
Some supplementary health insurance reimburses excess fees sector 2 doctors.Compare several quotes from mutual health insuranceto find the best offer!
2024-01-03 21:04:30
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