In most European countries, there are social assistance schemes designed by governments to best help people with low resources to access health care. In France, third-party payment is one of those devices through which a better quality of care can be provided to the less well-off without them having to fear for reimbursements.
Third-party payment: deciphering the concept
Third-party payment is a system of exemption from advance medical expenses initiated in France since 2016 and for certain specific categories of people. In general, when you consult a medical professional, it is your duty to settle it immediately. It is well after the health insurance (as well as your complementary health if you have one) you reimburses after receipt of the care sheet. However, thanks to third-party payment, things are no longer so for some individuals. With this device, the insured are no longer required to advance the medical expenses that the health insurance and their mutual must support. The healthcare professional sends the healthcare bill directly to the healthcare organization in order to be paid by the latter.
Third-party payment concerns in particular all or part of the costs incurred and supported by these two organizations. Thus, medical deductibles, excess fees, and flat-rate participation are not, for example, covered by Social Security.
In reality, everything starts from the concept of generalized third-party payment, a reform desired by the French government which aims to advance the medical costs of all patients. It is a zero procedure and zero cost program for the patient, but its entry in December 2017 had been postponed by the Minister of Health Agnès Buzin. Indeed, for health professionals, third-party payment is a very commendable approach, but the requirements related to its application are very restrictive. It is in this that it is above all a question today of a outsourced third-party payment management to simplify the implementation of reform in health organizations.
The adoption of third-party payment is not currently an imposition for medical players, but the concept has already been applied since 2017 by pharmacists, biology laboratories and in certain healthcare establishments.
Third-party payment and support: what do you need to know?
There are currently two types of third-party payment:
- the total third-party payment,
- partial third-party payment.
The first type of third-party payment indicates that the patient has no costs to pay. It is entirely exempted from paying the healthcare professional immediately. However, medical deductibles and flat-rate participation remain your responsibility. In addition, exceptions apply in particular for persons who benefit from complementary health insurance (CSS) or state medical assistance (AME) and for pregnant women. If you are possibly concerned by a contribution to medical expenses, the Health Insurance will take care of asking you for a direct repayment or recovering the amounts due on your subsequent payments.
On the other hand, with partial third-party payment, you pay directly yourself the part of the costs not covered by health insurance. This share also corresponds to the co-payment. Its rate varies according to your situation, whether or not you comply with the coordinated care pathway, procedures and medications. The moderating ticket can be partially or entirely covered by your complementary health insurance, if you have one. It is also covered by AME or CMU-C (Complementary Universal Health Coverage).
Note that Health Insurance absolutely does not cover the excess fees of health professionals, drugs not reimbursed as well as the increase for a consultation outside the coordinated care pathway.
Third-party payment outsourcing for healthcare professionals
Third-party payment is very clearly today one of the most effective means of improving patient care. With such a device, it is easier to increase coverage of medical care from health centers and services by making their procedures more accessible to all. This is precisely one of the reasons why the system tends to become widespread and why it is increasingly adopted by health organizations and institutions. However, although it is practical, third-party payment is not an easy device to set up.
This solution indeed requires the active involvement of all the players involved in the payment process. This includes both insurers, banks and the state. For medical actors, third-party payment management is one of the most constraining realities in the field of health. Not only does this imply a higher work margin, but also significant expenses. According to studies by the Union of Community Pharmacists Unions (USPO), in 2017, the management of this device already represented the equivalent of a part-time job, a situation that has not changed. until there.
In this context, the outsourcing of third-party payment is today the most appropriate solution to promote the unconstrained application of this system for health actors. Indeed, outsourced management makes it possible to benefit from the innovation capacity of the third-party operator thanks to online services and innovative management solutions. This favors a modernization of the system in order to improve the services to your members and help you better control repayments. You will therefore be able to concentrate more easily on the exercise of your profession while accelerating the digitization of your offers.
By using a third-party payment manager, it is easier to understand the optimization levers, to delegate the tasks related to management and to exercise real expertise. This choice gives you access to tools that allow you to control your third-party payments and also to benefit from a single transfer. On the other hand, you will be able to prepare your 2035 declaration more easily. In addition, depending on the third-party payment outsourcing solutions you opt for, you will also be able to delegate the administrative management of the system to an expert in your activity. in order to save time and devote more time to your customers.
How do I benefit from third-party payment?
Third-party payment applies to very specific situations. Its application is automatic and ipso jure for all those with few resources, but have CSS or benefit from AME, maternity insurance (due to pregnancy) or care related to an act of terrorism. This also concerns:
- the beneficiaries of preventive measures within the framework of organized screening,
- victims of an accident at work or an occupational disease, those who are hospitalized,
- people with a long-term illness (ALD),
- cases of voluntary termination of pregnancy (IVG),
- insured persons under the age of 26 who consult a healthcare professional for contraception.
In addition, third-party payment also applies at the initiative of the health professional. It is then possible to benefit from it when the pharmacist delivers, for example, medicines reimbursed by health insurance or when you have to carry out examinations or treatment in a radiology or medical analysis office.
In addition, to benefit from third-party payment, you must necessarily present your up-to-date Vitale card and your CSS certificate or your AME certificate. If you are registered with the CMU-C or with the ACS (Aid with the payment of a Complementary Health), you must present your up-to-date Vitale card followed by the document justifying the opening of your rights in these organizations. For cases of accidents or occupational illnesses, simply present the Carte Vitale and the accident or illness form. The deduction of costs is done automatically. You will then only have to pay the part that will eventually be payable by you.
To update your third-party payment Vitale card, you can go to most pharmacies, to the multiservice terminals accessible in health insurance reception points and in some health facilities.