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Reimbursement without Médecin Traitant - Eye

Can you still get reimbusersed for an ophtamologist visit without having a declared doctor (médecin traitant)? What about prescription glasses?

I know you can visit them directly without a referral and still get reimbursed, but do you have to have a doctor declared anyways?
I really need to redo my prescription glasses and I finally got an appointment with a doctor yesterday so I went and paid (used my carte vitale too). But now I just saw something saying you only get reimbursed the maximum amount if you have a declared doctor. Is that true?

Similarly, I now really want to go buy my new glasses with my new prescription. I have my carte vitale and mutuelle, can I still have the full benefits of those when buying the new glasses without having a declared doctor? I have been trying to find one for a really long time with no success and I would rather not wait to buy my new glasses (prescription changed a lot).

Thanks!

Vida

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Géraldine

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Bonjour Vida,

You can visit a specialist and get prescritpion even if you have not declared a médecin traitant but you will be redunded only 30 % on the amount caisse primaire d'assurance maladie (CPAM) can refund. 

You will find more information on this ameli website age dedicated to médecin traitant.

If you have difficulties finding a family doctor, I invite you to discuss this situation with a counselour contacting your CPAM on the phone or using l'Espace d'échanges on your ameli account. 

Have a nice day

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Vida

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Bonjour Géraldine,

I replied earlier but it's not showing up for me, so I'm sorry if it comes through twice.

Thank you for your response, the links were particularly useful. By following the first one, I agree that unfortunately I will only be reimbursed 30% instead of 70% for the visit as I have not declared a doctor yet. However, if I understand correctly, it seems like I might still be able to be fully reimbursed for my glasses. Can you please help me verify that?

On that first link (médicin traitant), under the section "Autres exceptions au parcours de soins coordonnés", it says that "Il existe d’autres exceptions au parcours de soins coordonnés. Dans les situations suivantes, vous ne supportez pas la majoration du ticket modérateur, que vous ayez déclaré un médecin traitant ou pas :" and it lists several cases, the last one being: "fournisseurs d'appareillages (opticiens, etc.)."

I understood that to mean that I can still get reimbursed normally for equipment suppliers, more specifically opticians, even without declaring a medicin traitant. As such, I can still get my glasses reimbursed to the full extent by the CPAM and my mutuelle. Is that correct?

Thanks and have a nice day!

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Vida
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Géraldine

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I confirm that your refund for glasses wont' be submitted to a 30 % refund even if you have no médecin traitant yet.

I would like to emphasise the fact that glasses are mainly supported by your top up insurance exept for "Classe A" glasses that are part of 100% santé scheme.

I advise you to read this topic about glasses refund to get more information.

Have a nice day.

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Géraldine
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