What are the prices of a doctor (licensed or not)?

Verified 15 May 2024 - Directorate for Legal and Administrative Information (Prime Minister)

When you see a doctor, the fee varies depending on whether the doctor is agreed or non-contracted and of its sector of activity (sector 1 or 2).

In sector 1, the contracted doctor (general practitioner or specialist) has tariffs set by the doctors' agreement and does not exceed them of fees.

Please note

Exceptionally, the contracted doctor (sector 1) may charge extra fees. This is the case if you have a specific requirement (place or time of consultation) or if you do not comply with the coordinated care pathway.

In sector 2However, the doctor (general practitioner or specialist) may overpay.

You have the right to be informed about the amount of the acts and benefits offered during medical consultations.

To find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Here's what you need to know:

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In the metropolis

Your insurance company can supplement the reimbursement of the health insurance.

Conventional Physician - Sector 1

The consultation shall be €26.5 by the Convention.

Reimbursement by the Health Insurance is 70% if it's your primary care physician.

The reimbursement by the Health Insurance is therefore €16.55, because you have to deduct package of €2.

Please note

If the doctor is not your doctor: the reimbursement is 30%.

However, direct access is allowed and allows a refund to 70% for the following specialists:

  • Gynecologists

  • Ophthalmologists

  • Psychiatrists/neuropsychiatrists for patients 16-25 years

  • Stomatologists.

Conventional Physician - Sector 2

The situation varies depending on whether the doctor is adhering to Optam or not.

The Optam (managed pricing optione, formerly contract for access to care) is an agreement between the contracted doctors and the Health Insurance. This agreement authorizes overcharging of regulated fees.

To find out how much a healthcare professional can charge, see the health directory on the Ameli website. This directory indicates whether the doctor is in controlled excess (Optam) or free fees.

Member of the Optam

The Sickness Insurance reimburses on the basis of the rates laid down in the medical agreement (rates applicable to doctors) sector 1).

The upright any overshooting of fees remain at the patient's expense.

Consultation may be greater than €26.5, a general practitioner or a specialist.

However, the basis for reimbursement is €26.5 (price of a consultation in sector 1).

You will be refunded from €16.55, after deducting the package of €2.

Example :

If the consultation is €30, you will also be reimbursed €16.55, because the calculation is based on €26.5 and not €30.

So it remains €13.45 at your expense once deducted the package of €2.

Reminder

To find out how much a healthcare professional can charge, see the health directory on the Ameli website. This directory indicates whether the doctor is in controlled excess (Optam) or free fees.

Please note

If you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

Non-member of Optam

The non-Optam physician sets its rates freely and can therefore charge any extra fees it chooses.

The Sickness Insurance reimburses consultations and medical procedures on the basis of rates laid down in the medical agreement (rates applicable to doctors) sector 2).

The amount of any overruns of fees remain at the patient's expense.

Consultation may be greater than €26.5, a general practitioner or a specialist.

However, the basis for reimbursement is €23.

You will therefore be reimbursed for €14.10, after deducting the package of €2.

This refund will be the same as you paid for the consultation, €26.5, €30 or €50.

Reminder

To find out how much a healthcare professional can charge, see the health directory on the Ameli website. This directory indicates whether the doctor is in controlled excess (Optam) or free fees.

Please note

if you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

Non-contracted medical practitioner (sector 3)

The doctor does not adhere to the medical convention. It offers its prices freely.

The Health Insurance reimburses consultations and deeds on the basis of a authority tariff.

Regardless of the amount of the visit to a general practitioner, you will be reimbursed by €0.61.

This refund is €1.22 to a specialist doctor.

Please note

If you are affiliated with local regime of Alsace-Moselle, you benefit from specific rates of reimbursement for acts of community or hospital care. This scheme provides a supplement to the general scheme.

In Guadeloupe, Martinique, Guyana and Reunion

Health Insurance informs you :

  • Fees for doctor consultations in these departments
  • Reimbursement rules applicable to your situation in the coordinated care pathway.

FYI  

to find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Your insurance company can supplement the reimbursement of the health insurance.

In Mayotte

Health Insurance informs you :

  • Prices for consultations or teleconsultations of doctors in Mayotte
  • And applicable refund rules.

FYI  

To find out how much a healthcare professional can charge, see the health directory on the Ameli website.

Your insurance company can supplement the reimbursement of the health insurance.

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