The course of treatment consists of choosing and appointing a referring doctor to your Caisse Primaire d'Assurance Maladie (CPAM). The chosen doctor is then your privileged interlocutor for any health problem: he or she will refer you to specialists if necessary and will establish your course of treatment.
By consulting your referring doctor as a priority, you benefit from a better reimbursement of your health expenses. Otherwise, you are less well covered by the Health Insurance and your complementary health insurance.
An example to better understand :
- You consult a sector 1 general practitioner.
- The consultation costs €25.
- If you follow the course of treatment (the Health Insurance reimburses you 70% of this amount - 1 € flat-rate contribution (amount at - your expense) i.e. 16.50 €.
Your mutual health insurance company will reimburse you the remaining 30%, i.e. €7.50. You are responsible for the remaining €1. In the event of a consultation outside the course of treatment, the Health Insurance will reimburse you 30% of the consultation - 1 € flat-rate contribution (amount at your expense), i.e. 6.50 €. Your mutual insurance company always reimburses you 7.50 €. The remaining €11 is at your expense.
In certain cases, the use of a doctor other than the attending physician is allowed. If you are faced with a major health emergency, while travelling or on holiday or if your GP is absent, you can consult another doctor without affecting your reimbursements.
Certain specialists can also be consulted without having to go through an attending physician, this is the case for: the dentist; the ophthalmologist; the gynaecologist; the paediatrician; the psychiatrist (for 16-25 year olds).