Saturday, February 11, 2017


Jude recently spent 4 hours in ER at a local hospital here in Paris.  A couple weeks later a bill for the visit arrived.  It was less than 28Euro.  This included medications, doctors analysis, and treatment.

The cost of the visit comes as something of a surprise.  It's a pleasant surprise, to be sure, but still, it's a surprise.  Ten years ago in the USA we paid over 1200USD for a very similar ER visit.  The US ER costs these days are surely higher, right?  How is the number one ranked healthcare system in the world able to charge so little?  One possible answer is that the French government is actively involved in negotiating the best trade-off between cost and quality.  Another possible answer is that healthcare in Europe is not run as a for-profit business.  However one looks at it, the costs of being tended to are significantly less here than in America.

Jude did a little research and one day said we needed to apply for French healthcare.  What she found was that part of being an immigrant in France includes the right to ask to participate the in single-payer state-sponsored health care system.  It's called l'assurance medicale or securite sociale.  When successful, the insured persons receive their carte vitale, which is the insurance card issued by the French government.  It's not free, but it might be a lot less than what a person pays in America.

In our case the process took us two years to complete.  This isn't "normal" in that the process should have taken only three to six months after meeting certain basic conditions.  We were turned down the first time we submitted our papers and that cost is over a year to figure out where we went wrong.  The devil was in the details.

French law grants immigrants the right to ask for their carte vitale three months after arriving.  That's how one of the laws reads.  But there's a second law that says an immigrant needs to reside here six months after the start of the civil calendar.  The civil calendar starts on January 1.  So you can start the process three months after January 1, but we needed to prove we lived here at least six months over the course of the year.

This means that when they ask you for scanned pages from your passport, if you have a stamp from a non-Schengen country, you might be denied your health insurance request.  This happened to us.  We went to a friend's wedding and cleared out our Plan B storage unit back in the States in May, five months into the French civil calendar year.

Even though we hadn't left the country for the two prior years, our health insurance request was not valid since we couldn't prove we'd been here six months in the year we filed our request.  A friend of Jude's has a very kind husband who helped us understand what went wrong.  In retrospect is all seems so simple.

In short, here's what we did.

  1. We visited the local CMU office and asked for an application.  We filled it out, attached the requested documents, and mailed the application to the address found on the application.  
  2. We answered the French state's further requests for documentation.  In our second attempt we were asked to provide two additional pieces of information.  One of these was a request for our tax information.  It was our income that was used to calculate what we pay.  I had wrongly assumed the calculation of what we were to pay was what we spent living here, but it's not.  This was an important distinction for us.  What we spent was more than what we earned in interest.  Happily, the number on the letter was given to our doctors and the benefit of the French healthcare system was immediately realized (by reducing our already very low out of pocket expenses). 
  3. Some time after we received our letter which stated we were being granted health insurance, we were asked to send our photo to another part of the French processing system.  Within a month we received our cartes vital, complete with the aforementioned photo.

Sculpture ~ Paris, France

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