Healthcare pathway and general practitioner (GP)

Why register a GP?

Your general practitioner/family doctor has to be the first doctor you visit for an opinion about your health to make sure your medical care is optimal.

As he/she is up to date with your medical file (exam results, diagnosis, treatments…), you get better health care, thanks to treatment based on your specific health needs.

If your health requires that a long-term disease be recognized, your GP will set up the medical protocol (called  "protocole de soins ") and submit the request to your CPAM. 

Pay attention : If there is no GP recorded on your file at CPAM, or if you see a specialist without being referred by your family doctor, or if you see another general practitioner than the one who is declared on your file, your reimbursements may be reduced.

As an example: for a consultation costing 30 euros, your CPAM will cover 70% of that amount if you respect the health care pathway, compared to 30% if you do not.

Some specialists can be visited without being referred by your GP:

- Ophthalmologist;
- Gynecologist or midwife;
- Psychiatrist or neuropsychiatrist, if you are between 16 and 25;
- Stomatologist for dental treatment.

How to register a "Médecin traitant"?

Every person above 16 years old needs to have a registered "Médecin traitant". You are free to choose this GP, however you can only have one on your file. 

Registration can be done digitally with your carte Vitale by your doctor, or sending back to your caisse primaire d’assurance maladie (CPAM) the 3704 form ("Déclaration de choix de médecin traitant") you have filled in with your doctor.

You can find generalist or specialist contact details on "Annuaire santé" website: http://annuairesante.ameli.fr 

To get more information, you can visit ameli website: Le rôle du médecin traitant et le parcours de soins coordonnés.

How I will be refunded ?

As mentioned above, your reimbursements may be reduced if no GP is recorded on your file (see "Why register a GP ? ").

However, other things can change how much you get reimbursed.

The doctors' fees and CPAM’s basis of reimbursement for each medical act, depend on whether the doctor is a general practitioner or a specialist, and on the convention they signed with CPAM (conventionned 1 or 2):

- Doctors in sector 1 apply the rates which are set by an agreement signed with "Assurance Maladie".

- Doctors in sector 2 are free to set their own rates and may therefore charge, with tact and moderation, additional fees (such as "dépassements d’honoraires") which are not refundable by your CPAM.

Have a nice day.