The addition of supplementary costs to a medical bill is costing health insurers more than 300 million euros a year, according to Solidaris mutual insurer. In normal circumstances, doctors agree a convention with the health insurance companies which sets the rate at which they charge patients for agreed services. Some doctors, however, prefer to work outside the system, which means their patients pay more, but the insurer still pays only the rate agreed with the sector.
The problem comes when the extent of the practice makes it almost impossible for patients to find a doctor – in particular a specialist or dentist – who does not charge the supplements, which have to be paid by the patients themselves without being reimbursed.
Solidaris examined 30 million notes from doctors for fees to be reclaimed by patients, and found in 2017 that 50% of them included supplementary services. The bill then came to 290 million euros, which is sure to have topped 300 million euros by now.
Fewer than one in ten doctors is outside the convention, but they account for 20% of claims. Specialists number 17% but make up 48% of claims. And 39% of dentists are outside the convention, while accounting for two-thirds of claims.
The problem for the health sector as a whole is that some patients, forced to pay a supplement in order to find treatment by a specialist or dentist, are being discouraged from seeking dental or medical treatment because of an inability to pay, even if fully insured.
On average, the surcharge paid out of the patient’s own pocket is nine euros. However Solidaris found that tariff only applies to GPs; physiotherapists charge of average 12.7 euros more; medical specialists 22.5 euros, and dentists a whopping 36.2 euros extra for a consultation.
“People on low incomes also have to pay these high supplements,” said Paul Callewaert of the socialist mutuality. “And for that reason they might postpone or even cancel a visit to the doctor.”
The insurer is calling for more transparency. “Doctors in their practice and on their website need to make it clear whether they follow the official remuneration tariffs, and how much they charge in supplements,” Callewaert said. “And patients need to be able afterwards to see what they have paid for from the certificate the doctor provides.”