Buy drugs in pharmacies or consult a doctor without having to pay up front? This may be possible thanks to third-party payment. What is this ? How do I know if I benefit from it?
Definition: what does third-party payment mean?
It is a system that allows not having to advance the part covered by Health Insurance during a medical consultation or the purchase of medicines. Third-party payment can be totalthe patient then has no expenses to advance, or partial, the patient should advance the user fees. If third-party payment has become widespread in pharmacies for about twenty years, this is not yet the case with doctors where it only applies under certain conditions.
Who can benefit from third-party payment?
Third-party payment applies first of all to certain categories of patients with low resources:
- Beneficiaries of Complementary Universal Health Coverage (CMU)
- THE illegally staying foreigners on French territory benefiting from State Medical Aid (AME)
- Beneficiaries of Aid for obtaining Complementary Health (ACS), i.e. households with low incomes but not benefiting from CMU
But it also applies to certain types of care, regardless of the patient’s resource conditions:
- Since January 1, 2017, pregnant women and people on long-term sick leave (ALD) can benefit from third-party payment for all their medical consultations or paramedical care (general practitioners, specialists, midwives, nurses, dental surgeons, physiotherapists, etc.).
- Care provided during hospitalization in an approved establishment.
- THE contraception consultations for young girls from 15 years old.
- THE consultations inherent to a work accident or an occupational disease.
Everyone benefits from third-party payment at the pharmacist, when buying drugs reimbursed by Social Security. But also during examinations or care provided in a radiology or medical analysis office.
When does third-party payment apply?
The waiver of advance fees is made only on the part covered by the Health Insurance, which will then reimburse health professionals directly. THE co-payment therefore remains to be advanced by the patient, unless he benefits from the CMU which will then take charge of the supplement.
What is the third-party payment card?
The third-party payment card is provided each year by the complementary health insurance, and allows not to advance the costs of the mutual part. To do this, it must be presented at the same time as the carte vitale, at a pharmacy or at certain health professionals who accept it (medical imaging centres, opticians, analysis laboratory, etc.). On this map some information is mentioned useful: membership number, social security number, card validity period and mutual insurance contact information.
Patients concerned by full third-party payment (ACS, CMU) have a “Complete Third Party Payer” card (TPI) issued by their health insurance fund.
What is generalized third-party payment?
The health system modernization law integrates that third-party payment is generalized, for the part reimbursed by Social Security. It means that third-party payment is a right for all French people. Third-party payment exempts you from having to advance money to pay for your health care. Depending on the share of the costs they bear, it is the Health Insurance and your complementary health insurance that pay the health professional directly.