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Planned surgical intervention or accident, all life events requiring hospitalization.
Hospitalization costs are partly reimbursed by health insurance, at 80%, and your mutual reimburses the remaining 20%.
However, your hospital stay can be extremely expensive as not all costs related to your hospital stay are covered by Social Security.
Excess fees, accommodation costs, comfort expenses can increase the bill and your out-of-pocket costs if you don't have good mutual insurance.
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What are the steps to obtain compensation in the event of hospitalization?
Here are some tips to ensure the conditions for reimbursement of your costs related to your hospitalization:
If your hospitalization is planned, the first advice is to take stock with your mutual insurance company in order to know which expenses will be reimbursed, which will have to remain your responsibility and finally, whether or not you will have to make an advance for expenses.
Take care to check whether the hospital or clinic is approved or not and whether health professionals charge overcharges.
In this case they must expressly provide you with this information beforehand.
As a reminder, if Social Security reimburses 80% of your hospitalization costs, the remaining 20%, i.e. the co-payment, remains either your responsibility or is reimbursed by your mutual health insurance.
Do not hesitate to contact your health insurance provider to avoid any unpleasant surprises.
Don't forget to take into consideration the cost of care, health or comfort expenses that may be necessary when you leave hospital.
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How long does it take to get reimbursed by your mutual insurance company after hospitalization?
To be reimbursed quickly, it is better to send as soon as possible the elements useful for processing your file.
Teletransmission by vital card is generally preferred because, when you present your vital card to a healthcare professional, the information is communicated directly to Health Insurance.
To ensure that your hospitalization expenses are reimbursed more quickly, you must also send your hospitalization slip and the detailed paid invoice to your mutual as soon as possible.
You have a maximum period of 2 years to make your reimbursement request.
The deadline for reimbursement of medical expenses is therefore subject to their transmission and also varies depending on the nature of the medical procedures and care.
Varies depending on the mutual insurance company, reimbursement generally takes place from a few days to a month.
This advance on health costs is sometimes significant and is therefore likely to unbalance your budget.
It is better to be clear on the conditions and reimbursement deadlines in the event of hospitalization and compare the offers of complementary health insurance according to your current and future needs.
Some patients are even completely exempt, such as beneficiaries of maternity insurance, a disability pension or state medical aid (AME).
Conditions of your hospitalization and costs of your stay, amounts and deadlines for reimbursements, so many questions that it is better to consider before being hospitalized to avoid large expenses from weighing heavily on your budget.
A day of hospitalization costs on average nearly 1,400 euros in the medical department, 1,700 euros in the surgical department and more than 3,000 euros in intensive care.
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Which costs are reimbursed by Health Insurance and which are reimbursed by mutual insurance?
Hospitalization expenses are reimbursed at 80% by Social Security.
They include the medical procedures and care necessary for the care of the patient: consultations, examinations, x-rays, medical analyses, nursing care, medications, etc.
Your mutual insurance company can supplement the amount of this reimbursement up to 20%.
The hospital package, of a daily amount of 20 euros, corresponds to the costs of your accommodation in the hospital or clinic for any stay longer than 24 hours: participation in the maintenance of the room and equipment, meals, hygiene of the linen... It amounts to 15 euros in a psychiatric ward.
If your hospitalization is likely to last several days or even weeks, this health expense can represent a significant cost.
The responsible supplementary health insurance covers the entire remainder of the hospital package amount.
Costs for personal comfort, single room, access to television, telephone, etc. are optional services and are not covered by Social Security and can also increase the bill significantly.
These costs remain your responsibility but the employer's individual or collective health supplements often offer hospitalization packages allowing you to at least benefit from reimbursement of the individual room package.
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