The French Health Care System: Carte Vitale

I’ve been writing recently about the wonderous ease of the French Health Care System, hailing it for the way it functions. Today, the “wonderous wheel” has ground to a halt. I feel like I’ve just woken into yet another bureaucrazy nightmare. I’ve written about several of those on this blog, sad to say.

It all started when several weeks passed, and I had yet to receive a reimbursement for a doctor’s appointment I had in early January. Reimbursements tend to happen fairly quickly, so I was getting concerned. Since I knew my French was not up to the task, I hired someone to help me out. images

You see, when I arrived here, I applied for my Carte Vitale as a dependent of my spouse. That process went fairly (and surprisingly) smoothly. But once I went into business, I was responsible for my own cotisations (taxes paid to healthcare) and no longer a dependent of my spouse. I never used my Carte Vitale that first year. Didn’t need to. I used it for the first time last year in the Fall. Ironically, I was reimbursed by check for a trip to my general doctor with no problem whatsoever. So why now all of the sudden was I not being reimbursed?

When my helper emailed me back saying I needed to apply for a new Carte Vitale, the card that coordinates the coverage, along with a copy of my translated birth certificate, I thought he might be joking. Birth certificate? They already have my birth certificate. That’s how I got the Carte Vitale I have now. But no. There was no joke.

He wrote: I just spoke to someone who works at La RAM. The Carte Vitale that you have worked last year when you used it – even though you had already registered as a micro-entrepreneur – because it takes them a certain amount of time to process the administrative change. They call this period a “temps de mutation”.

Damn mutants! Figures!

Turns out, the Carte Vitale I have now is no longer valid and still tied to my husband, despite the fact that it has my French social security number on it. Supposedly, it hasn’t been valid since opening my own business in January of 2016. Nevermind the fact that it has been OVER A YEAR, and they never mentioned anything to me this whole time. Nevermind that no one asked for anything in the correspondence that said, “Welcome to RAM.” Nevermind that I have an online account with them stating I am covered and that reflects my chosen general doctor. Nevermind that check I cashed with my reimbursement back in November.

No. Forget all that. Now I have to send them a translated birth certificate and my bank details. After some time, they will decide to send me yet another form I have to fill out and send with a copy of my passport with a new photo. After some time, they might process that and send me a new Carte Vitale. Seriously?????

So now, I am required to collect a pile of “feuille de soins” or papers that verify any medical treatments I receive in order to be reimbursed retroactively. Seriously?????

Ah, another day in the life in France.

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The French Health Care System Part VII: Summary and Next Steps

I feel like now would be a great time to summarize my experiences so far under socialized medicine. Bear in mind my lens is one that compares my fortunately meager-though-life-long experience in the states with what I am going through now in France. Also bear in mind I live in the countryside; no doubt an experience in a larger city might not resemble my own documented throughout these posts. Generally speaking though:

  1. Everything costs less.
  2. Care is more congenial though not necessarily punctual or private (or cutting edge–that said, my generalist seems very open to research presented).
  3. Prescriptions and necessary tests are generously bestowed.
  4. Wait times for an appointment to see a specialist can be just as long here as anywhere.
  5. There is no centralized system of information, it seems, so one just carries her entire medical history around from one appointment to the next. That said, it would follow that it is up to me and me alone to make sure anyone I see knows all the facts.
Surgeon Wearing Scrubs And Mask
Surgeon Wearing Scrubs And Mask

The most annoying things about needing medical attention here are the same annoyances everywhere…the appointments, the driving around, the waiting. Here, there’s the language issue. But there, there’s the exclusionary and excessive costs. Here, there’s a certain laissez-faire attitude, but in the states, there’s that impersonal assembly line. So far, this leads me to put socialized medicine way ahead. Will that hold true?

The next step for me is an appointment with a GYN, which I was finally able to make with one in Bordeaux, in January. (Hey, not bad! Only a month away!) She speaks English, and though I was recommended to a couple of others closer to home, the language thing definitely influenced my choice. Medical stuff is stressful enough without a language barrier. Besides, having tried to make appointments with others and not being able to get through on the phone, I was happy to finally get a human on the other end of the line and just book.

I’m still in the midst of making my MRI (IRM here) appointment at the nearest hospital that offers it. I had a truly ridiculous Franglish conversation with the appointment person via phone, and we ended up moving the conversation to email which works better for me. I had to fill out a questionnaire saying I had no implants or metal parts, etc, etc., and now I’m simply waiting to here back. I’ve heard that MRI’s can take weeks to get here, but maybe not so much again in the country vs. city. We shall see. Fingers crossed it all goes smoothly and with plenty of time before my doctor’s appointment in January.

UPDATE: Finally arranged the MRI. It’s a good thing I followed up because the receptionist said she had emailed me my appointment a week ago; I never received it! She claimed it probably went to spam, which it did not, so I don’t know what happened. At any rate, I have an appointment in January (so four weeks away), and thankfully, the day before my specialist!

Obamacare & International Health

I was, as a single person, not all that enthused about Obamacare until I realized that I qualified for free care. Not having had any health insurance for the last 10+ years of my life due to cost, learning that gave it a bit more luster. Now that I’m married, though, I no longer qualify for subsidies and the cost of insurance has gone up 4000%. Bummer. And of course, if I don’t purchase, penalties ensue. Fortunately, Stuart and I have decided to settle where he is now, in France. This will exempt us from having to enroll in Obamacare. Good thing, too, because if we both had to, we’d be talking around $8000 a year. Ridiculous! That money is better spent, in my opinion, on maintaining our good health through whole, healthy foods and alternative care, like bodywork and acupuncture, for well-being. That’s my two cents, but of course, each must come to his or her own conclusions.

Thing is, I’m not in France yet, and we’re not sure when things will be in place for that to happen. So, it seems I will be required to purchase health insurance or face the penalty consequences. Ironically, the penalty is based on AGI (Adjusted Gross Income) of household income. I don’t know anything about anything about any of this, but it sounds to me like the IRS is expecting me to report my nonresident alien spouse’s income to determine my penalty. Excuse me? He has absolutely no obligation to the US government to report his foreign income. He isn’t American! How can they justify penalizing me based on his income??? It’s messed up!

Aside from the tangle of US taxes and Obamacare, one of the things we are currently trying to figure out is whether Stuart can enroll me as his spouse on his insurance in France. We’re waiting for quotes from the insurer. If I need to hold a Cart de Sejour before being allowed to enroll, in other words, be permanently in France, then I will need some kind of international medical insurance in the interim. Fortunately, international insurance plans don’t cost $4000 a year like Obamacare!

I’ve been looking at Cigna Global and HTH among others. Anyone out there have experience with international health plans, good or bad?

Where to Land Continued: USA

Last post, I discussed the various pluses and minuses of relocating to the UK as the non-EU spouse of a UK citizen who is currently living in France. Today, I’m clicking my heels and asking, “Is there really no place like home?”

I’ve lived in the US my whole life. Though I’ve been lucky enough to do some traveling, I’ve never been gone for long. In fact, the longest trip outside the US was actually to the UK with my sister in the 80’s. We stayed 3 months, and I’d never been so happy to see the backside of a country upon my return. But I’m a different person now…happier, more mature, more cultured…I hope.

I love America and the ideals for which it stands…or at least stood. Let’s face it. It isn’t what it once was. It has entered a rather ugly adolescence of violent crime, political bickering, biased media, and corporate greed. It is tainted by an absolutely dreadful educational, health, and corrupted financial system with imbalances and senses of entitlement bordering on the insane. Will it continue the plunge into the shadowy depths  of overweight, undereducated sheeple led by a government of bullies, manipulators, and liars before it re-emerges as an adult nation with a better sense of responsibility and the intentions of our forefathers…which I’m sure it will…one day?

That said, it’s home to me and therefore “the devil I know”. Here I have a house, a business, friends, and family. I live in a great city, one of the best, which has isolated me from a lot of the worst parts of US living. My life has been good.

The question is, if we were to go through the 6-9 month process (the longest of all three possibilities) of applying for a CR1 visa for Stuart, would it be worth it?

Yes: Stuart could eventually become a US citizen (and despite everything I’ve written so far, this is still a pretty awesome country). That would make things a lot easier legally and financially should something happen to either of us. Eventually, Stuart and I would both be able to come and go as we please, too.

No: I alone cannot meet the financial requirement to bring him here. It would involve getting a sponsor, which we do have, but I’m not crazy about the idea of burdening a loved one.

Yes: Because of current exchange rates and the fact that Stuart’s income is the Pound, our standard of living would be significantly higher here…and wow, wouldn’t I like to experience that for once!

No: Enter US taxes…on worldwide income. As it is, because we married this year, I will no longer be getting what would have been an over $500 tax return unless we choose to file jointly…and we can only elect to do that once in a lifetime. But frankly, I can’t see dragging Stuart into the US tax system prematurely.

Yes: I’d be near friends and family. Business relationships and musical collaborations would go on as before.

No: Obamacare. As a single, poor person, I was really excited about Obamacare. I would have had health insurance for the first time in 12 years for a whopping premium of FREE. But now that I’m married, that premium has jumped to over $4000…and that’s just for me. And if we don’t buy, we face increasing penalties. Compared to the healthcare systems of our other options, the US doesn’t stand out.

Yes: From coast to coast, America can’t be beat for landscape, cool cities, an abundant lifestyle, and all the things that make America the amazing melting pot it is. And…we both understand the language. And…I already have a driver’s license.

There’s always culture shock to consider too. But of course, that will happen for one of us no matter where we go.

So…now that I’ve summarized the pros and cons of life in our three countries of choice, what do you think? Where would you go? France, the UK, or the US?