Teleconsultation: this is how you are reimbursed

Teleconsultation is slowly settling into the medical landscape. A decision of the National Union of Health Insurance Funds, published in the Official Journal on Wednesday, January 5, lists the acts and services covered during a teleconsultation. First principle, it can be performed by a doctor, whatever his medical specialty. “Teleconsultation includes an interview with the patient and possibly a clinical examination if the patient is accompanied by a health professional or if the available equipment allows it, as well as the examination of documents transmitted by the patient or by his representative” , specifies the text.

At the end of the consultation, the doctor can send a prescription to the patient by secure means. This consultation is billed in the same way as if it had been carried out face-to-face. It must be carried out in accordance with the coordinated care pathway. Indeed, as during a physical consultation, to benefit from the best reimbursement rate, you must first consult your doctor before making an appointment with another general practitioner or specialists. Teleconsultation is billed at the same price as a “classic” consultation. The prices are between 23 euros and 58.50 euros depending on the specialty and the sector of practice of the doctor. Doctors have the right to charge excess fees. Note that if the patient is accompanied by a health professional during the teleconsultation, he is also remunerated under the conditions of a classic consultation.

During the pandemic period, teleconsultation was covered 100% by Health Insurance. The measure was to stop on December 31, 2021. But as part of a government amendment, tabled in the bill strengthening the tools for managing the health crisis currently under consideration in Parliament, it is proposed to extend this Full coverage until July 31, 2022. Outside of these periods, the teleconsultation is reimbursed according to the classic circuit with coverage up to 70%. The rest to be reimbursed by the mutuals. However, teleconsultation remains 100% covered by Health Insurance in certain cases, for example for patients with a long-term illness (ALD). Several payment methods can be used, such as online payment by credit card, bank transfer or sending a check. The Health Insurance website specifies that you “will be able to find the trace of this invoicing under the caption teleconsultation in your statement of reimbursements, which can be consulted in particular in your ameli account”.

Finally, this decision recalls that “only a doctor from the same territory as the patient can carry out the teleconsultation”. However, there are exceptions when the patient resides in an area where the absence of care has been noted but also if the specialist who must be consulted is located in another territory. When the consultation is finished, the teleconsulting doctor must archive it in his own patient file and then transmit this information to the treating doctor or to the person who requested the act. And if the patient has opened a shared medical file (DMP), the information related to the consultation must be entered there.