What you should know before having surgery in France

France is world-renowned for its healthcare system, with high standards of care and accomplished physicians. Nonetheless, it can still be difficult for foreigners to navigate the French healthcare system, particularly for more-involved procedures that might involve in-patient treatment.

Here is what you can expect for having an operation in France: 

The general process

The specific steps will depend on the procedure you are having, but in most cases, you will follow steps similar to the ones outlined below:

The appointment with the anesthesiologist: You will need to schedule this, and it should take place at least 48 hours before your operation. For this visit, you should bring any related medical documents, such as relevant cardiovascular or blood tests, documentation showing what medication you are currently taking, as well as any reports offered by previous doctors on the subject of your procedure and why it might be necessary.

This is also a good time to inform the doctor of any known allergies. 

The pre-operative check-up: Your doctor may order this for you. This is when they would inform you of whether you should avoid smoking, drinking, or taking certain medications, as well as how you should dress for the visit (no makeup, nail polish, etc).

You would also be given information about when to begin fasting from water and food prior to the procedure. In French, this is called "à jeûn" (ah juhn). Keep in mind that your doctor may require you to do additional testing prior to the procedure - such as blood tests, cardiological consultations, or a urine test.

The pre-operative shower: you will likely be advised to do this before your surgery. Your doctor should give you documentation explaining what this is and how it works, but typically the patient must shower using a disinfectant soap either the night before or day of their operation.

Paperwork: This may be referred to as the "Préadmission" or "une admission préalable."

Prior to your operation, typically the same day as your anesthesiologist appointment, you will need to either visit or make an appointment with the hospital's admissions office.

Some hospitals might allow you to do this step online. You will need to provide them with the following documents prior to your operation:

• Your carte vitale (or proof of social security coverage, if you have a temporary number)
• Proof of ID (either a French ID card or passport - keep in mind that a driver's licence likely will not suffice)
• Proof of address (this might be a recent bill or a rent-receipt for last month)
• For pregnant women, a "maternity follow-up sheet"
• If applicable, your membership card for your additional insurance (mutuelle)
• If applicable, a certificate from your employer stating the accident occurred at work
• If you are European and do not have French health insurance, a European health insurance card (EEC)

For minors, you will need to provide documentation of both parents' informed consent for the procedure, as well as signed 'authorisation to operate.'

When you leave you will be given official discharge paperwork. These are necessary for you to take recovery days off from work and to continue being paid. You will likely also need to demonstrate proof that there is an adult available to escort you home from the hospital. 

Fees

The French healthcare system operates on a reimbursement model - so you pay, and then some or all of the cost is reimbursed via your carte vitale and/or mutuelle.

Payment will depend slightly on whether you received your operation in a public or private hospital. As a general rule, French social security covers up to 80 percent of fees for hospital visits. Certain types of procedure - such as cancer treatments - are reimbursed up to 100 percent.

However, you will be responsible for the cost of the hospital stay itself. Room fees are standardised across France, and as of January 2018, they were listed as €20 per day for a hospital or clinic, and €15 per day for a psychiatric facility. While these fees are not reimbursed by social security, they may be paid by your additional insurance provider (mutuelle) if you are covered by one. 

Some groups, such as pregnant women (those hospitalised during the last four months of pregnancy, for childbirth, or during the 12 days after childbirth) are not required to pay a hospital fee. 

Additionally, if your hospitalisation is attributable to your work (either an occupational hazard or an accident), then you are not required to pay these fees either. The same goes for those treated in "home hospitalisation" and those who qualify for state medical aid. You can learn more about this HERE, as it is an option for those who may not be able to afford hospital fees.

You will also be responsible for "comfort" costs - these might include access to a single room, a television, wifi, etc. However, these may be covered by your complementary insurance (mutuelle). 

If you are not insured in France and have not qualified for state medical aid, then you will be responsible for paying for all of your care. 

How to pay

The actual process of paying varies slightly from hospital to hospital - most hospitals have this information on their website.

However the most common format is that you will have to pay the room costs (€20 per day) before you leave, and then will be sent a bill for the medical treatments - so you should remember to take cash or a debit card with you when you go into hospital, or make sure the person coming to pick you up has cash or a debit card.

If you do not have medical cover in France you may be required to pay the full bill before you leave.

For the main part of the bill, the most common process is for the hospital to send you a bill, with the costs reimbursed to you later if you are covered by the French social security system.

If you are sent a bill, then you will likely be able to pay online (often using this site), by cheque, in some cases by bank transfer. You may also visit the hospital's "main treasury" to pay your invoice.

During your pré-admission, you should ask about the payment process and what you will be expected to pay in-person before departure.

Tips

• Keep all of the forms that the hospital provides you with, including any discharge-related paperwork. This might be necessary for both your insurance company and for the reimbursement process.
• Always ask questions if you do not understand a word being used. If you are concerned about your French level, consider bringing a more fluent friend along to pre-operative meetings, like the visit with the anesthesiologist. While the hospital might be able to request the assistance of an interpreter, do not count on this. 
• Be sure to ask specifically what the price of your surgery involves - it might include post-operative care, which would also fall under the 80 percent reimbursement scheme for those with French social security. 
• If you have a mutuelle, send a dévis (quote) to your complementary insurance company to find out exactly what they will cover (they might cover "extra" things, like a single room, which may be worth considering).
• Consider scheduling any pre-operative appointments as early as possible, in order to have extra time if extra testing is necessary in the interim. 
• And of course - be sure to have your carte vitale with you at all times.