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{"id":8924,"date":"2017-01-03T05:20:15","date_gmt":"2017-01-03T04:20:15","guid":{"rendered":"https:\/\/vosgesinfo.fr\/laplainedesvosgesinfo\/2017\/01\/sante-le-tiers-payant-etendu\/"},"modified":"2017-01-03T05:20:15","modified_gmt":"2017-01-03T04:20:15","slug":"sante-le-tiers-payant-etendu","status":"publish","type":"post","link":"https:\/\/vi.si-developpement.fr\/laplainedesvosgesinfo\/2017\/01\/sante-le-tiers-payant-etendu\/","title":{"rendered":"Sant\u00e9 \u2013 Le tiers payant \u00e9tendu"},"content":{"rendered":"

\"sant\u00e9\"<\/a><\/p>\n

Depuis le 1er<\/sup> janvier 2017, les personnes atteintes d\u2019une affection de longue dur\u00e9e (ALD) et les femmes enceintes n\u2019auront plus \u00e0 faire l\u2019avance des frais li\u00e9s \u00e0 leur sant\u00e9.\u00a0 Plus de 11 millions de personnes sont concern\u00e9es par cette mesure. Plus largement, \u00e0 compter de cette date, tous les patients auront la possibilit\u00e9 de demander \u00e0 leurs professionnels de sant\u00e9 d\u2019appliquer le tiers payant sur la part des d\u00e9penses qui est rembours\u00e9e par l\u2019Assurance Maladie obligatoire.\u00a0 Zoom sur ces \u00e9volutions.<\/strong><\/p>\n

Tiers payant\u00a0: de quoi s\u2019agit-il\u00a0?<\/strong><\/p>\n

En g\u00e9n\u00e9ral, lorsqu\u2019un patient consulte un professionnel de sant\u00e9 lib\u00e9ral, il le r\u00e8gle imm\u00e9diatement et directement. \u00c0 partir du 1er<\/sup> janvier, les femmes enceintes et les personnes atteintes d\u2019une affection de longue dur\u00e9e (ALD) n\u2019auront plus \u00e0 avancer d\u2019argent \u00e0 la pharmacie, chez le m\u00e9decin ou lors d\u2019un rendez-vous avec un professionnel de sant\u00e9 pour la plupart de leurs soins, gr\u00e2ce \u00e0 un dispositif simplifi\u00e9.<\/p>\n

L\u2019objectif\u00a0? Simplifier la vie des Fran\u00e7ais et leur faciliter l\u2019acc\u00e8s aux soins<\/strong><\/p>\n

Cette \u00e9volution cible volontairement les patients qui re\u00e7oivent le plus fr\u00e9quemment des soins et qui sont donc amen\u00e9s \u00e0 d\u00e9penser plus souvent pour leur sant\u00e9\u00a0: en moyenne, une femme enceinte avance 640\u00a0\u20ac pour son suivi de grossesse et une personne diab\u00e9tique en ALD 1\u00a0100\u00a0\u20ac par an[1]<\/sup><\/sup>. La dispense d\u2019avance de frais constitue une bonne nouvelle pour des assur\u00e9s susceptibles de faire face \u00e0 des d\u00e9penses de sant\u00e9 multiples.<\/strong><\/p>\n

Comment en b\u00e9n\u00e9ficier\u00a0?<\/strong><\/p>\n

Pour b\u00e9n\u00e9ficier du tiers payant, les assur\u00e9s devront simplement se munir de leur carte Vitale.<\/strong><\/p>\n

IMPORTANT\u00a0:<\/strong> Pour disposer du juste niveau de prise en charge auquel il a droit, chaque assur\u00e9 doit mettre \u00e0 jour sa carte Vitale au moins une fois par an et \u00e0 chaque changement de situation. C\u2019est le cas par exemple lorsque la caisse a pris en compte la d\u00e9claration de grossesse ou apr\u00e8s r\u00e9ception d\u2019une attestation des droits mentionnant l\u2019exon\u00e9ration du ticket mod\u00e9rateur. Cela permet au professionnel de sant\u00e9 de pouvoir r\u00e9aliser sa feuille de soins \u00e9lectronique au plus pr\u00e8s de la nouvelle situation du patient et ainsi de lui faire b\u00e9n\u00e9ficier d\u2019une prise en charge adapt\u00e9e.<\/p>\n

Bon \u00e0 savoir\u00a0: ce droit pour les patients en ALD et les femmes enceintes s\u2019applique aux soins pris en charge \u00e0 100 %.<\/strong><\/p>\n

    \n
  1. Les personnes dites en ALD exon\u00e9rante<\/strong> n\u2019ont plus de frais \u00e0 avancer lors des consultations et soins concernant leur affection<\/u>. Ils ne b\u00e9n\u00e9ficient pas de cette facilit\u00e9 pour leurs autres d\u00e9penses de soins.<\/li>\n
  2. Dans le cadre de l\u2019assurance maternit\u00e9, les femmes peuvent profiter de la dispense d\u2019avance de frais sur la totalit\u00e9 de leurs d\u00e9penses de sant\u00e9, entre le 1er<\/sup> jour du 6e<\/sup> mois de leur grossesse et jusqu\u2019au 12e<\/sup> jour apr\u00e8s l\u2019accouchement.<\/u> <\/strong>Ce droit s\u2019applique \u00e9galement pour tous les examens obligatoires li\u00e9s \u00e0 la grossesse et \u00e0 la naissance (par exemple, les consultations pr\u00e9natales), qu\u2019ils concernent la m\u00e8re ou le p\u00e8re (ex.\u00a0: examen du futur p\u00e8re), et pour les examens obligatoires de suivi du d\u00e9veloppement et de la croissance de l\u2019enfant qui sont r\u00e9alis\u00e9s r\u00e9guli\u00e8rement jusqu\u2019\u00e0 l\u2019\u00e2ge de 6 ans<\/li>\n<\/ol>\n

    Dans le cadre de la g\u00e9n\u00e9ralisation progressive du tiers payant, tous les patients ont, \u00e0 partir du 1er<\/sup> janvier, la possibilit\u00e9 de demander \u00e0 leurs professionnels de sant\u00e9 d\u2019appliquer le tiers payant (dispense d\u2019avance des frais) sur la part des d\u00e9penses prises en charge par l\u2019Assurance Maladie obligatoire. Ils devront pour cela pr\u00e9senter leur carte Vitale.<\/p>\n

    Questions-r\u00e9ponses<\/strong><\/p>\n

    Le tiers payant signifie-t-il z\u00e9ro d\u00e9pense\u00a0?<\/em><\/strong><\/p>\n

    Qui paye mon m\u00e9decin\u00a0?<\/em><\/strong><\/p>\n

    Avec le tiers payant, ce sont les caisses d\u2019assurance maladie qui remboursent directement les m\u00e9decins des actes pratiqu\u00e9s sur la part qu\u2019elles prennent en charge. Les patients pris en charge \u00e0 100 % n\u2019auront plus de frais \u00e0 avancer, except\u00e9s les \u00e9ventuels d\u00e9passements d\u2019honoraires, la participation forfaitaire ou la franchise m\u00e9dicale.<\/p>\n

    Le tiers payant est-il r\u00e9serv\u00e9 aux professionnels de sant\u00e9 \u00e9quip\u00e9s d\u2019un lecteur de carte Vitale\u00a0?<\/em><\/strong><\/p>\n

    Le droit au tiers payant pour le patient est li\u00e9 \u00e0 la pr\u00e9sentation de sa carte Vitale\u00a0: la gestion chez le professionnel de sant\u00e9 \u00e9quip\u00e9 d\u2019un lecteur de carte Vitale est alors automatique et simple. Si le professionnel de sant\u00e9 n\u2019est pas \u00e9quip\u00e9 de lecteur, le tiers payant peut tout de m\u00eame \u00eatre pratiqu\u00e9 ; une feuille de soins pr\u00e9cisant que le patient n\u2019a pas pay\u00e9 la part obligatoire lui sera alors remise.<\/p>\n

    Parce que le tiers payant doit \u00eatre simple, rapide et s\u00e9curis\u00e9 pour les professionnels de sant\u00e9, des engagements et\u00a0de\u00a0nouveaux services leur sont apport\u00e9s\u00a0: mise en place d\u2019une plateforme d\u2019accompagnement accessible au 0972\u00a072 72 50 (service gratuit + prix d\u2019appel), garantie de paiement sur la base des droits figurant dans la carte Vitale pr\u00e9sent\u00e9e par l\u2019assur\u00e9, paiement rapide, assorti de p\u00e9nalit\u00e9s en cas de retard de plus de 7 jours ouvr\u00e9s et possibilit\u00e9, pour les professionnels, d\u2019avoir un suivi automatique des paiements par feuille de soins.<\/p>\n

    [1] La participation forfaitaire est une contribution de 1 euro qui est demand\u00e9e aux patients \u00e2g\u00e9s de plus de 18 ans pour toutes les consultations ou actes r\u00e9alis\u00e9s par un m\u00e9decin, mais \u00e9galement sur les examens radiologiques et les analyses de biologie m\u00e9dicale. La franchise m\u00e9dicale est une somme d\u00e9duite des remboursements pris en charge par la caisse d\u2019assurance maladie obligatoire sur les m\u00e9dicaments, les actes param\u00e9dicaux et les transports sanitaires.<\/p>\n

    [2] La convention sign\u00e9e par l\u2019Assurance Maladie et les repr\u00e9sentants syndicaux des m\u00e9decins encadre les tarifs des consultations et des actes m\u00e9dicaux. Les taris d\u00e9finis dans ce cadre constituent la base de calcul des remboursements des r\u00e9gimes d\u2019assurance maladie obligatoire et compl\u00e9mentaire. Les d\u00e9passements d\u2019honoraires sont la partie du montant factur\u00e9 qui d\u00e9passe ce tarif, qui peuvent \u00eatre pratiqu\u00e9s par certains professionnels (par exemple les m\u00e9decins exer\u00e7ant en secteur 2). Selon les contrats, ces frais peuvent \u00eatre pris en charge partiellement ou totalement par les organismes d\u2019assurance maladie compl\u00e9mentaire.<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

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    M\u00eame en cas de tiers payant, les assur\u00e9s sont toujours redevables \u00e0 l\u2019Assurance Maladie d\u2019une participation forfaitaire et d\u2019une franchise m\u00e9dicale[<\/sup><\/sup><\/a>1]<\/sup><\/sup>, \u00e0 l\u2019exception de ceux qui en sont exon\u00e9r\u00e9s\u00a0: les b\u00e9n\u00e9ficiaires de l\u2019assurance maternit\u00e9 (au cours du cong\u00e9 maternit\u00e9), de l\u2019ACS (Aide pour l\u2019acquisition d\u2019une compl\u00e9mentaire sant\u00e9), de la CMU-C (Couverture maladie universelle compl\u00e9mentaire). Par ailleurs, les d\u00e9passements d\u2019honoraires[2]<\/sup><\/strong><\/sup> ne sont pas couverts par l\u2019Assurance Maladie et sont \u00e0 r\u00e9gler au professionnel de sant\u00e9 lors de la consultation ou de la visite.<\/strong><\/p>\n