# No Reimbursements for certain claims after major surgery ?



## John Sergeant (19 d ago)

On the statement from my Complementary Insurance there are lines where they acknowledge money spent and amount under Base RO but zero remboursement . Why ? This was very special reconstruction surgery done by a worlld renowned Professor


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## Bevdeforges (Nov 16, 2007)

I think you may need to refer to your complementary insurance policy document for clarification. Depending on the level of contract you have with them, some types of surgery and/or hospitals may require, for example, that you notify them ahead of time to get a quote for what they will and won't cover. Other policies may limit coverage for certain kinds of treatment to fixed limits (either as a %age of the Base amounts - say, 200% or 300% - or a fixed amount). In some cases, the hospital or clinic will require you to get an initial quote from your mutuelle so that they can bill you for the "excess" before you leave the hospital, while they will handle billing the mutuelle directly for their share. 

Unless you have a very expensive mutuelle, I don't believe any mutuelle will pay/reimburse "whatever the hospital or doctor bills" without regard to the publish base fees. But you can also sent the mutuelle an inquiry to ask them why they reimbursed as they did and see what they say. (They do occasionally make mistakes.)


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## BackinFrance (Nov 26, 2020)

I agree with Bev.


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## ccm47 (Oct 15, 2013)

Almost certainly you have a nominated conseiller for your mutuelle. That's why you can't save money by doing everything online. So contact them.
We started looking at other mutuelles when a not quite routine type treatment was not reimbursed. Our conseiller came to the house the next day "as he was passing". After a reasonable chat he sorted things out for us, got us a full reimbursement and advised us to contact him directly next time we had any problem treatments.


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