THE THIRD PARTY PAYER SYSTEM: WHAT ARE WE TALKING ABOUT?

Logically, when you go to a doctor, whether a general practitioner or a specialist, you have to pay the costs arising from the consultation and then wait for reimbursement from the Health Insurance and possibly from the complementary health insurance to which you have subscribed. From now on, faced with this type of case, the so-called “third party payer” is particularly interesting. This is a device through which a patient consults his or her GP or acquires a drug without having to advance the slightest cent. Close-up of this system.

THIRD PARTY PAYER: WHAT EXACTLY DOES IT CONSIST OF?

The third party payer is a system which aims, under certain conditions, to exempt people who are covered by the Health Insurance or who have taken out a mutual health insurance policy from having to advance their medical costs and expenses. However, when a person does not have one, he or she has to pay the bill himself or herself and is then reimbursed by his or her health insurance fund and mutual health insurance company. On the other hand, if they benefit from the third-party payer, their health expenses will systematically be covered by the Health Insurance.

THE THIRD PARTY PAYER CAN BE FULL OR PARTIAL

When you are a beneficiary of the third-party payer, you may not be liable for certain contributions to health expenses, such as the flat-rate contribution of €1, the medical deductibles that exist for medicines, medical transport or paramedical acts. This concerns exclusively patients who benefit from the CMU-Complementary, the AME and those who have joined the ACS and have taken out a health mutual insurance policy. In this case, the third-party payer is considered to be “full”.

On the other hand, some patients, despite the fact that they have a third-party payer, still have to pay these co-payments. In this case, we speak of the so-called “partial” third-party payer, i.e. these patients remain liable for the health care expenses that remain their responsibility. To do this, the Health Insurance can either deduct them from their subsequent reimbursements or ask the patients to pay them directly.

COMPULSORY AND OPTIONAL THIRD-PARTY PAYMENT

In principle, the third party payer applies automatically for persons who have a complementary CMU, or who benefit from the AME or ACS. Other cases may also allow the patient to access this system: accident occurring in the course of a profession, occupational disease, AFD (long-term illness), hospitalisation in a hospital establishment that has signed agreements with the Social Security…

In addition, a patient may be entitled to a so-called optional third party payment in certain cases such as the acquisition of a drug reimbursed by the Health Insurance; medical care, examinations and analyses offered by radiology practices; consultation with a general practitioner if the patient is facing financial problems…

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