To be better reimbursed, consult a doctor "Optam"
Soon comes back, and like every year, comes the time to book your annual appointment with the ophthalmologist ... Take care of yourself, it's good, be properly reimbursed, it's better! For that, have you heard about Optam? Implemented in 2017, the Optam (Option pratique tarifaire masterisé) for physicians in sector 2 * succeeds the Healthcare Access Contract (CAS). For surgeons and obstetricians, it is the Optam-Co, which works in the same way.
In concrete terms, Optam's signatory doctors undertake to limit the excess of fees. In return, they benefit from increased rates on certain technical acts (Optam-Co) or get a premium (Optam). For us, in addition to a price that does not fly, complementary health and mutual have the right to refund the excess fees of these doctors without cap. This is not the case with the doctors who did not sign the agreement and practicing the excess.
Specifically, for a consultation at a price of 60 €, according to the rates in force, 30 € will be covered by the Health Insurance and 30 € by your complementary (provided it adheres to the responsible contract). Nothing will be your responsibility. Conversely, if your consultation takes place with a doctor who is not a member of Optam, each party will only pay € 23. It will remain at your expense 14 €. A significant sum.
How do I know if my doctor is a signatory of Optam?
To find out if your doctor has subscribed to the Optam, simply go to directoriesante.ameli.fr and complete the search criteria by selecting the "Fees with controlled overruns (Optam)". Or by simply asking the question to your doctor.
* Unlike the physician contracted in sector 1, the doctor contracted in sector 2 has the possibility to charge a free fee.
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