[Forum ameli pour les assurés] Suivi de la question: Reimbursement without Médecin Traitant - Eye

Réponse de Géraldine

Géraldine — Fri, 19 Jan 2024 07:35:07 GMT

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.

Réponse de Vida

Vida — Thu, 18 Jan 2024 11:11:28 GMT

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!

Réponse de Géraldine

Géraldine — Thu, 18 Jan 2024 10:01:50 GMT

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