Comparateur de Mutuelle Santé

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Vous êtes ici : Articles comparateur MutuelleMutuelle: délai de remboursement

Mutuelle: délai de remboursement

Mutuelle: le délai de remboursementIl peut y avoir un délai maximum pour se faire rembourser. Ça arrive: on oublie une feuille de soins dans un coin, ou bien on voit un professionnel qui ne pense pas à nous dire que sa prestation peut être prise en charge par la mutuelle à laquelle on a adhéré. Un peu rageant de payer une complémentaire santé, et ne pas se faire rembourser ses soins! Attention, car il est parfois trop tard pour bien faire.

Mutuelle: délai maximum de remboursement

La réponse dépend de plusieurs critères:

  • la dépense est-elle sur la nomenclature des actes ou médicaments pris en charge par la Sécurité Sociale?
  • avez- vous avez changé de mutuelle?

Dépenses prises en charge par l'Assurance Maladie

Délai de prescription

Il y a une prescription biennale: vous avez deux ans pour demander le remboursement auprès de votre caisse primaire d'Assurance Maladie. Ceci concerne les soins médicaux comme les indemnités journalières. Le délai court à la date des soins.
Attention de ne pas confondre le délai de prescription avec le délai de carence, qui n'a rien à voir...

Cas particulier: la maternité

Si les remboursements concernent la maternité, le délai de 2 ans démarre à la date de la première constatation médicale de la grossesse.

Part de remboursement par la mutuelle

Dépenses prises en charge par l'Assurance Maladie

Dans tous les cas de figure, vous devez respecter le délai de prescription biennale de l'Assurance Maladie, car c'est elle qui déclenche le remboursement de la part Mutuelle.

Si vous avez changé de Mutuelle

Si vous avez changé de mutuelle entre la date des soins et le moment où vous réclamez le remboursement, c'est en principe la date du soin qui est prise en compte. Donc, c'est la mutuelle qui détenait votre contrat au moment du soin qui doit vous rembourser. En principe. Car lorsque le contrat a été résilié au profit d'une autre mutuelle, votre ancienne compagnie peut faire des difficultés.

Dépenses non prises en charge par l'Assurance Maladie

Certains contrats de Mutuelles remboursent des dépenses non prises en charge par l'Assurance Maladie (frais liés à des cures, lit accompagnant en cas d'hospitalisation etc.). Tout dépend de votre contrat de complémentaire santé, et des conditions de la compagnie. Contactez votre assureur ou votre mutuelle au cas par cas.

Notre conseil

Il est fondé sur le bon sens:

  • évitez de changer de mutuelle si vous avez des soins ou des traitements en cours, ou un besoin médical urgent.
  • renvoyez vos feuilles de soins dès qu'elles vous sont remises. Vérifiez toujours que la date y figure bien.
  • si vous changez de mutuelle, renseignez-vous sur les conditions de délai de carence de la nouvelle compagnie.

La question ne se pose pas pour vous en cas de Tiers-payant, dans la mesure où vous ne faites pas l'avance de dépense: votre mutuelle paie directement. À condition que le professionnel dispose de la télétransmission carte Vitale, et accepte le Tiers-payant de votre compagnie.

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