Health: how long must be reimbursed by the mutual?

Do you go to an osteopath, to a dentist with an excess fee or another general practitioner? Do not wait to send your care sheet or your invoice to your health fund to get it reimbursed as soon as possible. In other cases, everything happens automatically.

How do I get a refund from my health fund?

When the health insurance is directly linked to your mutual, everything happens automatically. For example, if you consult your GP for a wet cough that you cannot get rid of and which prevents you from sleeping at night, you will be asked to put your vital card in a box before you take leave.

Social Security will then process your case, repay its share to the bank account linked to the social security account, and send the necessary information directly to your mutual health insurance. The latter will then be able to repay the amount to which you are entitled according to your contract.

If the teletransmission did not work or if it is not offered, you must send the care sheets to your primary health fund (CPAM), which will then send the file to your mutual insurance company. This solution requires more time to get reimbursement from the share of the mutual health insurance.

A third case exists: sending the request for reimbursement directly to the mutual insurance company for care that is not covered by Social Security anyway. Before drafting your letter, check that your contract allows for partial or full reimbursement of the treatment in question. This could be, for example, treatment with an osteopath or adult orthodontics. You can do this via the mutual insurance application to save time. And if you need these health professionals, do not hesitate to compare health insurance policies to find a contract adapted to your needs.

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How long does it take to get the money back from your health fund?

It all depends on the means used, among the three mentioned above. The fastest is, as you can imagine, teletransmission, which allows you to be reimbursed in a few days from Social Security and a little more from your mutual health insurance after receiving the information. When the postal route is necessary, count a month on average before you get a refund from the Health Insurance, then from the mutual.

Finally, your mutual responsiveness depends on the chosen organization and the nature of your request. It is sometimes necessary to send an additional document, which extends the delay. Another element to consider with mutual insurance is the waiting period.

What is the waiting time?

Period after the conclusion of the contract in which you do not receive reimbursement for your health expenses, the waiting period has a variable duration depending on the contract. This generally applies to the most expensive treatments, which may require a waiting period of 3 to 6 months or even longer. The purpose of the mutual health insurance is to avoid abuse on the part of the insured. You can compare insurance contracts to choose insurance with a low deadline. And if you’re not happy with your current mutual insurance, know that you can change it.

For more specific information about your file, read the general conditions in your insurance contract. The waiting period set by the Health Insurance is set at 3 days, during which you do not receive unemployment benefits. Depending on the collective agreement and conditions, some companies can cover it in the event of sickness absence.

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What if there is no refund?

The first thing you need to check in the “My information” section of your Ameli account: whether your complementary organization is indicated and known to you and your loved ones by your health fund. Click on “Your Complementary Organization” and check that the mention “Yes” appears in the “Teletransmission” line to benefit from the automatic transmission of payment information from your fund to your mutual insurance company.

If all the information in the Ameli account is entered correctly, but you notice a payment problem, contact your joint health insurance company to resolve the error with an adviser. If you notice that your fund does not know any supplementary organization, you must inform your mutual insurance company so that it takes the necessary steps to activate the automatic sending of payment information. Be careful and don’t miss anything! In some cases, it may happen that you forget to write your social security number on your treatment card! An error that extends the payment period… Don’t forget any information when you need to send a care slip to get a refund.

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