THIRD-PARTY PAYMENT for opticians

What is third-party payment? How and when can you benefit from it?

When a patient is not entitled to third-party payment, we know the procedure: he pays in advance for his consultation, nursing or dental care, pharmacy, X-ray or ultrasound examinations and new spectacle frames. His health insurance fund and supplementary health insurance providers then reimburse him for the costs incurred, minus the co-payment.

If you benefit from third-party payment, you won't have to pay your medical providers or your referring doctor. The cost of a general practitioner's consultation will be fully or partially covered by the compulsory health insurance scheme, depending on the case.

The patient is always responsible for the co-payment.

Using third-party payment is very simple for the insured, who no longer have to wait for reimbursements after having advanced the costs incurred.

opponents, on the other hand, point to the risk of disempowering patients by creating the false impression that medical treatment is free.

THIRD-PARTY PAYMENT will not apply to pharmacies if you refuse generic drugs or have not declared a referring doctor. You will have to pay your bill and the consultation fees, and you will be reimbursed later.

Please note, however, that not all supplementary health insurance providers offer third-party payment for all medical procedures. In pharmacies, all supplementary health insurance providers offer this service. This is not always the case for hospitalization, analyses, certain dental treatments or optical expenses.

Don't hesitate to ask the medical professional what will be covered in your case, after carefully reading the general conditions of your health insurance contract. A health bill had initially planned to generalize third-party payment to all insured persons by January 1, 2017, which remains complicated to achieve given the complexity of the system.

How does third-party payment work at the optician's?

To qualify for third-party payment at your optician's, you need to meet a few conditions.

First and foremost, you need a prescription less than 3 years old to qualify for reimbursement. Without a prescription, you won't be reimbursed. If you've mislaid your prescription less than 3 years old, and your eyesight hasn't changed, you can ask your ophthalmologist for a duplicate.

You'll need to bring your carte vitale and your supplementary optical insurance providers card with you.

Once you've made your choice of glasses, your optician will contact your insurance company. Your supplementary health insurance providers will confirm whether they will cover all or part of the cost of your purchase. If necessary, you'll have to pay the difference between the amount covered by your supplementary health insurance providers and the cost of your glasses, known as the "reste à charge".

Your optician will then be paid directly by your supplementary health insurance providers.

So, if the amount of your reimbursement is equal to the price of your prescription glasses, you won't have to pay anything, and you'll go home with your frames on your nose or your contact lenses in your pocket. As contact lenses are not reimbursed by French national health insurance, except in exceptional cases involving complex corrections, your supplementary health insurance providers offer you a certain number per year, depending on the terms of your contract.

Your supplementary health insurance providers will pay your bill directly to the optician. But as you probably know, your health insurance fund reimburses a very small proportion of your glasses. If you choose French national health insurance's third-party payment scheme, it will pay your optician immediately. In general, opticians apply simultaneously to both organizations for third-party payment.

THIRD-PARTY PAYMENT will soon be available to all opticians

Today, almost all opticians offer third-party payment through their supplementary health insurance providers and French national health insurance.

Adopted on December 1, 2015, one of the main measures of the health bill is to generalize third-party payment to all insured persons from January 1, 2017.

Healthcare professionals will be assured of rapid compensation by accepting the generalization of third-party payment. Doctors are not convinced by this health law, which will add to their administrative workload.

The Mutualité Française believes that doctors' work will be made easier, since they will no longer have to manage cheques and deal with unpaid bills.

The government remains confident that, once the working tools are in place, practitioners will get used to them, as was the case with the electronic healthcare reimbursement form and the carte vitale. From November 20, 2017, third-party payment will become a right for all French people.

By modernizing the health law, the government intends to guarantee all people on modest incomes access to healthcare as well as healthcare products at affordable prices such as eyeglasses or dental care.

Can I benefit from THIRD-PARTY PAYMENT at Mymonture?

For the moment, you can't benefit from third-party payment for glasses at Mymonture because it's impossible to use the carte vitale remotely. We are currently working on a solution.