Changing Mutuelle

[manonthemoon2]

Although not in France I do know of an English speaking insurance broker that comes highly recommended. I wouldn’t give the details on the open forum though

would you mind messaging me his details please?

[Hotrodder]

Well here we are again. I am thinking about changing mutuelle again. We have a really high percentage for reimbursements but the cost per month has gone up 30% since 2022.
I have started to look at the offerings and I have encountered the age barrier for my OH. Some companies won’t take on an over 75. Others appear not to accept over 85 but does that mean they will terminate a contract if you get that far?
Many of the companies give measly reimbursements and they all seem to use different acronyms for the tables of examples. It’s exhausting.
I still haven’t got my head around the mutuel versus assurance side of things. I will take my time and spend rainy afternoons looking though the reams of offerings.

Do please keep us posted of anything you feel is helpful.

[Blaze]

When I was admitted to the urgences with what turned out to be gall bladder problems, I was kept in for 3 nights for tests. As they did not operate, I had to pay full whack for the bed and at that time I didn't have a mutuelle. The cost was over 1000€ However the secretary said she'd try and find a mutuelle would backdate an inscription for me. She came up with ECA who were quite happy to foot the bill and who were cheaper than many other companies. That was a nice saving ....

[Headers]

I am working my way through this now.
I am pretty sure our current coverage is way too high and we will never use the levels offered. I have put in a call to them and await their response.
I am astonished by the massive variation in costs for the various offerings and I definitely need to put a spreadsheet together to see what the differences are.
It is interesting that it seems possible to tailor your contract. If you do it online you get a package with things in it you don’t need or you may not get things you do need. When I have spoken to the sales people they seem able to tweak the offering. For example, many mutuelles have a 3 month waiting period for certain things. It is possible to get that block removed. I see this as a negotiating point to make the sale.
My current mutuelle gave me 2 months free when I joined so that is another opportunity to be investigated.


Costs are not the only consideration however as the service level is an important factor. One offering from a courtier(broker?)looks good on paper but when you look at the feedback from customers, they are pretty poor. I am wary of using a broker as they are getting a kickback and are very pushy.
As an aside, I have regular TEP scans and my ALD is about to expire and not be renewed. So I tried to find out how much a TEP scan costs. Not an easy task. I discovered the list of costed acts. It is immense. There must be an opportunity for simplification in this area alone. Each act is described and costed separately. So a TEP seems to cost for example 86,50(absolute bargain) while another TEP costs 89.32. What on earth is the point of separating out all these different acts for the sake of a few euros. If they banded them they could save a fortune on faffing around with monstrous databases.there must be many examples of French bureaucracy making the system creak!

[MAD87]

OH and I have a flesh-and-blood broker who's always available for a chat about costs. She came here a faw weeks ago after I told her I'd received an offer from another company promising the sun, earth and moon. I wasn't altogether happy with that offer. Result, the monthly fee for the 2 of us was reduced by €30 to €190

[exile]

@Headers
The monstrous database arises very simply. You have a treatment. Whoever provides that sends a bill for payment. It is recorded and payment made - with the mutuelle involved probably at the point where the payment demand is made but it could be when the state makes payment.

The database is nothing but an accounting series of entries, which any organisation is required by law to keep if any finance is involved?

What you see is nothing more than an extract of the vast list of financial entries related to you. To lump them together would involve more work, not less.

[Headers]

@Headers
The monstrous database arises very simply. You have a treatment. Whoever provides that sends a bill for payment. It is recorded and payment made - with the mutuelle involved probably at the point where the payment demand is made but it could be when the state makes payment.

The database is nothing but an accounting series of entries, which any organisation is required by law to keep if any finance is involved?

What you see is nothing more than an extract of the vast list of financial entries related to you. To lump them together would involve more work, not less.

The monstrous list refers to the pricing structure for all the different actes. It not mine it’s how the system codeifies the base costings. The minuscule level of detail serves no one.

[exile]

It does that because each act attracts a cost that has to be paid and paid on/by a specific date.

Think of it like your till receipt at the supermarket.

They could just give you a receipt for €122.
They could break it down into segments - dairy, alcoholic drinks, fruit and veg, butcher etc
But what they actually give you is an itemised bill - milk semi-skimmed 2 x 1.15 2.30, butter x 1 4.50 4.50 and so on

Why?
because in their case they track each item through the tills and so know their (theoretical) stock level and so know when to order fresh stock and how much stock - simplistically based on the rate of purchase.

Your Ameli account is the same except that instead of tracking stocks and reordering, they are tracking work done and payments to be made. It has to be done at the itemised level because each individual action creates an individual cost.

[Headers]

I’m sorry everyone but you are looking at the opposite end of the accounting problem. What I am describing is how centrally all the actes are costed to the centime. This really adds a level of complexity that isn’t required to run the system. I don’t know if they analyse all the different actes to see which are the most used, but there are other ways to do that without embroiling the billing system in it.

[exile]

You've clearly never been exposed to accountancy systems like SAP. They call themselves "enterprise systems" but they are accountancy by any other name - with just a hint of Big Brother . Everything is accounted for to the last centime because the last centime has to be paid but not one centime more. That accuracy aka complexity is absolutely demanded by accountants and auditors. Otherwise internal or external fraud becomes so much easier.

And since they have the numbers it is a simple table to feed the data back to @Headers. That you find it complicated matters not. That it makes it difficult for you to analyse, will never have occurred to them or even worried them. As I said earlier, doing anything else complicates their system; a system that they are obliged to have. Be very clear, the system is not there to help you, it is there to run the business and especially the accountancy side of the business. Your reports are a simple to run off-shoot but the system was never, ever designed to make analysis from your side easy.

It is possible for someone with access to their system to construct a query to give you the numbers you want in the format you want them*. That however would be a personalised query specifically for your needs. The needs of others might be subtly different and so that service is not offered because it would be very labour intensive.

*and while that might sound easy, it would require you to specify in precise detail exactly what you want and that in turn would mean you would have to understand their system and how it is constructed. Of course you and I don't know that.

I have no idea what IT system the health system uses but it clearly uses one. It could be SAP, BAAN or a number of others.