Choosing your attending physician, is it mandatory?

HYEME student health insurance

For better management of your expenses healthyou must have an attending physician to coordinate your care and regular follow-up.

Choose and declare your doctor to Social Security is an important step in respecting the coordinated care pathway. This is the guarantee of an effective medical follow-up.

The coordinated care pathway: what is it?

The coordinated care pathway is a device that consists of consulting your doctor before consulting another general practitioner or specialist, called a correspondent. It concerns all insured persons affiliated to Social Security, aged 16 or over.

Thanks to coordinated care pathwayyou benefit from coordinated medical follow-up, rigorous management of your medical file and personalized prevention.

Compliance with the coordinated care pathway determines the assumption of health expenses and allows better reimbursement by health insurance and responsible complementary health insurance.

Respecting the course of coordinated care necessarily involves doctor’s statement to Social Security.

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Declare your attending physician to Social Security

The main player in the coordinated care pathway is the doctor.

All patients must designate the attending physician of their choice and declare it to Social Security by completing the ” Statement of choice of attending physician ” available on www.ameli.fr.

Patients who do not declare a treating doctor or directly consult another doctor, general practitioner or specialist, are considered outside the coordinated care pathway except for certain cases.

Who should choose a treating physician?

People aged 16 and over

Whether you are insured or covered by your parents’ Social Security, you must have an attending physician.

If you are under 16, at least one of your two parents or the holder of parental authority chooses the attending physician and declares it to the Primary Health Insurance Fund.

If you are a minor between 16 and 17 years old, you can choose your attending physician yourself, but you must have the agreement of one of your parents or the holder of parental authority, who must also sign the declaration. of the attending physician.

Only one attending physician can be designated, even if you have two places of residence.

To note : if you are under 16 and have not declared a treating doctor, you will still be reimbursed.

People with exonerating long-term illness (ALD)

Like the other insured persons, you must have appointed an attending physician. He can be a generalist or a specialist. It is he who will establish a care protocol.

You can directly consult the doctors for the specialties mentioned without going through your general practitioner.

Persons not affected by the choice and declaration of an attending physician

You are not concerned by the statement of a treating physician or by the coordinated care pathway if you are:

  • foreigner passing through French territory;
  • affiliated with a social security fund of an overseas community (COM);
  • recipient of state medical assistance.

How do I choose my attending physician?

The choice is free and individual. If you are over 16, you must have your own GP.

Choice of doctor

You are free to choose your attending physician. However, the doctor you have chosen must agree to fulfill this role.

The attending physician may be:

  • a general practitioner or specialist;
  • a contracted doctor from sector 1 or sector 2;
  • a doctor who has signed the Controlled Tariff Practice Option (OPTAM);
  • a doctor who has signed the Option of Controlled Tariff Practice in Surgery and Obstetrics (OPTAM CO);
  • or a non-signatory physician.

He can practice alone, in a group practice, in a health center or even in a hospital.

It can be your family doctor or another doctor. There are no geographical constraints.

It’s up to you to choose the doctor who knows you and who suits you best.

If you are a student, you can choose your general practitioner in the city of your parents or in the city where you are studying.

A doctor for the whole family

Members of the same family may have the same attending physician or different attending physicians; in all cases, each of them must declare their doctor individually. There is no collective declaration.

How do I declare my attending physician?

You must declare your attending physician to the Health Insurance Fund if you are in one of the following situations:

  • you do not yet have an attending physician;
  • you change it;
  • your general practitioner ceases his activity, changes activity or moves.

You have two options for the declaration of your attending physician.

Declare my attending physician online

This declaration can be made online by the doctor you have chosen, with your consent.

In practice, during a consultation at his office and on presentation of your Vitale card, the doctor sends the declaration to the Primary Health Insurance Fund.

It’s quick and easy: no form to fill out, no mail to send, your declaration is recorded immediately.

Declare my attending physician by mail with the form

The declaration of choice of attending physician can also be made using the form “ Statement of choice of attending physician » :

  • complete and sign this form for the choice of attending physician and ask the doctor you have chosen as your attending physician to sign it;
  • submit it to your Primary Health Insurance Fund or send it by mail in an envelope stamped at the current rate.

How to change treating doctor?

You can change your attending physician, without any conditions to fulfill and without needing to justify yourself. You are also not required to inform your previous attending physician. However, it is more courteous to do so to allow him to organize himself.

You must make a new declaration to your health insurance fund (CPAM) to carry out the change of attending physician.

This change will be effective on the date of appointment of the new attending physician.

Why choose a treating physician?

The attending physician offers better medical follow-up because he is your first health contact. He offers you appropriate care and directs you to a specialist if necessary.

In addition, your care is better reimbursed. In the case of a GP contracted in sector 1 whose cost of the consultation is 25 euros and if it is your attending physician, the consultation is reimbursed by Health Insurance at 70%, i.e. 16 .50 euros after deduction of 1 euro of fixed participation. If it is another doctor, the consultation is reimbursed by Health Insurance at 30%, ie 6.50 euros after deduction of 1 euro of flat-rate contribution.

The role of the attending physician

Your attending physician is responsible for:

  • your care and your medical follow-up;
  • coordinate care by referring you, if necessary and with your agreement, to a corresponding doctor. This is usually a medical specialist. Your attending physician can also refer you to hospital or other doctors;
  • manage all your medical records;
  • provide you with personalized prevention;
  • set up the care protocol to be adopted in the case of a Long-Term Condition (ALD).

Consulting your doctor brings you a double advantage:

  • you are better cared forthanks to a follow-up adapted to your state of health by a doctor who knows you well;
  • you are better reimbursed if you consult it as a priority before contacting another health professional.

Choosing and declaring my general practitioner: what effect on my reimbursements?

If you designate an attending physician and follow the coordinated care pathway, you will be better reimbursed. However, in certain situations, you are normally reimbursed even outside the course of treatment.

Am I obliged to choose and declare my attending physician?

Choosing and declaring your attending physician is not an obligation, but if you do not do so, you are considered outside the coordinated care pathway, and you will see the amount of Social Security reimbursements reduced by 40%.

If you do not declare your attending physician to Social Security or if you consult a specialist directly without being directed by your attending physician, the support rate from Social Security will be minus and your participation will be increased.

Your supplementary health insurance (mutuelle) will not cover this increase either and the remains dependent will be important.

If you do not follow the coordinated care pathway and you consult a doctor who practices fee overrunsthe Social Security coverage rate will be reduced and your participation increased.

Your supplementary health insurance (mutuelle) will not pay for the increase or the fee overruns and the rest to be paid will be even more important. This is why it is important to respect the course of coordinated care and to take out a supplementary health insurance of the HYEME type which supports fee overruns.

You are considered out of course if you have declared a treating doctor but you consult another doctor without going through the first one. In other words, if you consult another doctor without being directed by your attending physician, you will be less well reimbursed except for the exceptions below.

In which cases am I still reimbursed normally?

You are normally reimbursed even outside the coordinated care pathway in the following situations:

Whether, in case of emergency or travelyou consult a specialist directly without having been directed by your attending physician, you are not considered outside the coordinated care pathway.

You follow the coordinated care pathway if you consult certain specialists directlyas :

  • gynecologists for check-ups;
  • ophthalmologists;
  • psychiatrists or neuropsychiatrists for young people aged 16 to 25;
  • stomatologists.

Whether you have an exonerating long-term illness (ALD) ora chronic illnessif you follow a sequence of care and you consult a specialist directly without having been referred by your attending physician, you are not considered outside the coordinated care pathway.

You also respect the course of coordinated care if you consult another doctor in case ofabsence of your attending physician

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