# Something very strange and unfair seems to be in play in kiné reimursements, the base for reimbursement is very very low and practiced by no kiné!



## van_suso

Hello,

Sorry for the long post, but it's long only because I augmented it with links and details, to be as clear as possible.

To give you an idea why I'm asking this, please see this screenshot below: 










You'll see that the base for reimbursement by SS is only 16,13€ where most (>95%) kinés charge more than 30€ (mine did 35€ for every subsequent session and 50€ for the first session). *It seems impossible to find a kiné that charges the rate given by SS, and my kiné told me that everything would be reimbursed by SS but to my utter disappointment, it wasn't the case, I've had three to four sessions with him and in each of them, I lost 35 - 16,13 = 18,87€ out of my pocket, even with my GP's prescription!* So I came here for help and solving this puzzle: 

i)* How will I ever be able to find a kiné that actually practices the rate given by SS*, and why didn't my kiné warn me of that - was he knowingly lying to me? 
ii) *Doing some quick internet search, it seems to me that contractual kinés aren't allowed to charge more than 16,13€/hour but they do thayt anyway - is it truly illegal?* It seems a lot of kinés are doing systematic over charging and getting away with this, please see here: Mon kiné a t'il droit de me faire payer un dépassement d'honoraire sachant qu'il est conventionné ?
iii) *Why is sécu only reimbursing on the meagre base of 16,13€/séance where almost all kinés charge almost twice that amount (and more than 50€ in the first séance)? Am I missing something here?! *

iv) *Please, if you know of a kiné in Paris that practices the SS rate of 16,13€, let me know*, I'm really really surprised that SS remburses a rate practiced by almost no kiné in Paris! *When you search for kiné with "sans dépassement d'honoraires", you see a list of many many kinés, all conventionné, but there's no mention of conv sec 1 or 2, which apparently doesn't exist*, as you'll find in the answers in the link above. I just feel like the there's something strange about this situation!


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## Bevdeforges

Well, first the bad news - I've never actually known the Sécu list of "base" charges to worry too much about what practitioners are actually charging. But the standard rate of 16,13€ per séance is really pretty old - basically the base rate used last time I needed a kiné (well before the pandemic). And as it is, the Sécu only reimburses 60% of that - or 9,68€ . And actually, that 16,13€ base rate is for each appointment in a series of treatment appointments as prescribed by your doctor. 

The rest is picked up by your mutuelle, assuming you have one. (And this is where the 150%, 200% and other percentage based rates come in on your mutuelle list of payments.) 

And checking the Améli listing for kiné, they mention that the price per session charged by even a "conventionnée" practitioner can vary, based on the specifics of the appointment and the services rendered. One place to check on practitioners' fee schedule is to see if they have a listing on Doctolib (or Maiia, or one of the other medical appointment services online). I've noticed quite a few post an "initial consultation" at 50€ or so, and then the regular appointments to carry out the agreed upon plan of therapy at a lower rate (for which 30 or 35€ isn't all that uncommon). 

How much of your charges is being reimbursed by your mutuelle? That's usually the key thing. I know most people in the Paris area make a point of having a mutuelle that will cover up to 200 - 300% of the base Sécu rates, simply because Paris area practitioners do seem to have a blanket exemption based on the higher costs of doing business in the Big City.


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## van_suso

Bevdeforges said:


> Well, first the bad news - I've never actually known the Sécu list of "base" charges to worry too much about what practitioners are actually charging. But the standard rate of 16,13€ per séance is really pretty old - basically the base rate used last time I needed a kiné (well before the pandemic). And as it is, the Sécu only reimburses 60% of that - or 9,68€ . And actually, that 16,13€ base rate is for each appointment in a series of treatment appointments as prescribed by your doctor.
> 
> The rest is picked up by your mutuelle, assuming you have one. (And this is where the 150%, 200% and other percentage based rates come in on your mutuelle list of payments.)
> 
> And checking the Améli listing for kiné, they mention that the price per session charged by even a "conventionnée" practitioner can vary, based on the specifics of the appointment and the services rendered. One place to check on practitioners' fee schedule is to see if they have a listing on Doctolib (or Maiia, or one of the other medical appointment services online). I've noticed quite a few post an "initial consultation" at 50€ or so, and then the regular appointments to carry out the agreed upon plan of therapy at a lower rate (for which 30 or 35€ isn't all that uncommon).
> 
> How much of your charges is being reimbursed by your mutuelle? That's usually the key thing. I know most people in the Paris area make a point of having a mutuelle that will cover up to 200 - 300% of the base Sécu rates, simply because Paris area practitioners do seem to have a blanket exemption based on the higher costs of doing business in the Big City.


Thanks for your answer! My mutuelle (MGEN) pays the remaining 40% of the base price of 16,13€ set by sécu, i.e. they're paying 6,45€ per session while sécu paus 9,76€/session, so this means I only get a combined mutuelle + sécu reimbursement of 16,13€ and end up paying 35 - 16,13 = 18,87€ per session out of my pocket. No kiné charges less than 30€ for a set of sessions and some even charges more than 40€ for a set of sessions, and the first visits are 50€ for my kiné. But I wonder why the base rate by sécu is so ridiculusly low, 16,67€ is not barely one third of the first visit cost of 50€ and much less than one half of 35€ charged for every subsequent session. Something is amiss here, it seems they set the base rate long ago and didn't modify it accordingly. My main problem now is with the base rate.


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## BackinFrance

You need to review your mutuelle as you clearly don't hate sufficient cover. If a kine charged the base rate represents littlisted by Ameli they would very quickly go broke, especially in a major city such as Paris, which would make things even worse. But if you look on the bright side, at least Ameli is giving you a refund, although it represents only a small part of the outlay. Now If you were able to receive the service in a public hospital, which is highly unlikely, the fee would be very different.


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## Bevdeforges

van_suso said:


> Something is amiss here, it seems they set the base rate long ago and didn't modify it accordingly. My main problem now is with the base rate.


Fact of the matter is that they don't necessarily modify the base rate to match "market conditions." The base fee for GP appointments was stuck at 23€ for years until they raised it to 25€ a few years ago. You probably don't find many GPs in Paris who will charge only 25€ for an office consultation, either.

I just checked our mutuelle cover (since I had a rather long run of kiné treatment back before the pandemic) and I see we have 300% cover for kiné visits (meaning that they will pay the difference between what the Sécu reimburses and 300% of the base rate). I was wondering about that since most of the kinés around here seem to charge anywhere from 20 to 30€ per visit.

You definitely want to take a look at your mutuelle coverage to see if you can up the cover to more like 200%. Living in Paris that would seem to be a minimum - though the monthly premiums for your mutuelle will definitely go up.


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## suein56

Bevdeforges said:


> You definitely want to take a look at your mutuelle coverage to see if you can up the cover to more like 200%. Living in Paris that would seem to be a minimum - though the monthly premiums for your mutuelle will definitely go up.


Bev is entirely right ..
Depending on which area of Paris you are living in then 300% or 400% is the more normal Mutuelle coverage needed as the fees charged by Parisian medical practitioners are so high.
To achieve full repayment (mostly) at the base 100% Mutuelle cover then you need to move to live somewhere where the practitioner costs are less onerous i.e. in the Brittany area - possibly excluding Rennes and Nantes.


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