Agreements, types of sector, fee overruns, user fees… It is not easy to always understand the prices of doctors.
Here are some clarifications.
The reimbursement basis
This is the part of the care that your health insurance fund covers.
Within the framework of the coordinated course, it is, with a few exceptions (pregnancy, CMU, etc.), 70%.
Since July 1, 2005, the sum of 1 euro lump sum has also been deducted from your reimbursement.
The part of the expenses which remains at your expense after reimbursement is called "user fee".
It is this amount that your complementary health insurance can cover.
For example, on a consultation with a general practitioner at 25 euros, Social Security will reimburse you 16.50 euros.
Sector 1
Sector 1 brings together all the health professionals who have undertaken to respect the reimbursement base established by the Health Insurance.
For a general practitioner, this rate has, for example, been set at 25 euros since May 1, 2017. Only certain specific requests (consultation outside opening hours, specific acts, etc.) may authorize the doctor to claim an overrun at the patient.
Sector 2
Also called a “free-fee-agreed sector”, sector 2 groups together practitioners authorized to charge excess fees.
However, Health Insurance requires them to set their rates with "tact and moderation".
No excess fees are covered by Social Security.
On the other hand, your complementary health insurance can reimburse up to 300% or more of the agreed rate.
Sector 3
Not contracted, the doctors in sector 3 have not established any agreement with the Health Insurance and therefore freely set their rates.
They are only 500 in France.
Please note: the CPAM will only reimburse consultations with a sector 3 doctor for around 1 euro ...
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