As part of the coordinated care pathway, all insured persons must declare a referring doctor, called a “general practitioner”, in charge of their medical follow-up. As the privileged interlocutor of the patient, he ensures the coordination of the care of the latter. But in some areas, it is difficult to find a? Treating physician. A situation that would concern at least 10% of French people.

Where does the role of the attending physician come from?

The role of the attending physician is a creation of the law of August 13, 2004. “From now on, each social insured must appoint a treating physician of his choice, failing which he sees the reimbursement of his care by the health insurance plans very widely. reduced ”specifies Dr Frédérick Cosnard, medical director.

The intention of the legislator was to develop the quality and coordination of the care provided to the insured persons. The attending physician is indeed intended to play a pivotal role in the new course of care and the agreement entrusts him with the task of coordinating information concerning the patient.

Since 2017, the designation of an attending physician has been extended to children under the age of 16. At least one of the two parents or the holder of parental authority chooses the attending physician and declares it to the child’s health insurance fund.

Note that for children under 16, there is no reduction in reimbursement in the absence of a declaration from the attending physician or failure to comply with the coordinated care pathway.

In case of unavailability of the attending physician

If the attending physician is unavailable, his replacement (or his colleague in the case of an office or a health center) will use treatment sheets and tick the box “attending physician replaced”. The reimbursement will be made at the normal rate.

If you are far from home (geographical distance, vacation), you can consult a doctor other than your doctor. This doctor will then check the box “Outside residence” on the care sheet. You will be reimbursed normally.

In case of emergency

In an emergency, you can also consult a doctor other than your doctor. This doctor will then tick the “Emergency” box on the treatment sheet. You will be reimbursed normally.

Young children are not affected by the system of the care pathway: parents can take them to the pediatrician, doctor or specialist, without going through the attending physician.

At the heart of the coordinated care process, the attending physician plays a central role in the personalized and coordinated medical follow-up of the patient.

His missions :

• ensure the first level of care;
• guide the patient in the course of care. He is your privileged interlocutor, he informs you and puts you, if necessary, in contact with other health professionals (other specialist doctors, hospital doctors…);
• provide preventive care (screening, health education, vaccination, etc.) and contribute to health promotion according to your lifestyle, your age or your family history, nutritional advice;
• establish a care protocol for a long-term illness (ALD), in consultation with the other stakeholders; the protocol is drafted by the attending physician (general practitioner or specialist) in liaison with or according to the proposal of the corresponding physician (s) participating in the care of the patient;
• promote coordination by synthesizing information transmitted by the various stakeholders and integrating this summary into the personal medical file;
• provide the patient with all information to ensure permanent access to care during the hours when the practice is closed.

The benefit of having a treating doctor

Consulting your attending physician allows you to be better treated at the same time, thanks to a follow-up adapted to your state of health by a doctor who knows us well; and to be better reimbursed if you consult him as a priority before going to another healthcare professional.

“Indeed, the Health Insurance reimburses differently the people who have an attending physician and those who do not. For any consultation with your attending physician, you are reimbursed at 70%. This rate is also valid if you consult a specialist following his recommendations. On the other hand, if you have not declared an attending physician, health insurance will reimburse you only 30% of the conventional rate for your consultation. “

For example, if your general practitioner is the attending physician that you have declared and he does not practice excess fees, his consultation will normally cost you 25 €. “The Health Insurance applies a reimbursement base of € 25 and a reimbursement rate of 70%. You will therefore receive a refund of € 17,5 – € 1 for the flat-rate participation, i.e. € 16,5. But if you consult the same general practitioner, without him being your attending physician and without having declared one in addition, you will then be reimbursed only 7,5 € (30% of 25 €) – 1 € for the flat-rate participation , or € 6,5 ”.

There is no constraint, any doctor can fulfill this role on the condition that he gives his agreement: general practitioner or specialist, with conventional rates or free fees, doctor practicing in town, in hospital or in health center. The main thing is to choose the doctor who knows you best.

Medical deserts

In some territories, especially those identified as “medical deserts”, it can be difficult to find a physician who is still accepting new patients to become their treating physician. “In order to minimize the risk of being penalized in your reimbursements by default of declaration of an attending physician, while this absence of declaration is not your responsibility but indeed because of the absence of a doctor agreeing to play this role in sufficient proximity to your home, you must contact the mediator of your primary health insurance fund to officially inform him of your inability to have an attending physician.

Assistance from your mutual

In addition, in this case and in order to be able to benefit from medical consultations while awaiting the intervention of the CPAM to refer you to a doctor who can become your treating doctor, check with your mutual insurance company in order to know if it provides you with a teleconsultation service included with your complementary health contract.

Complementary health care providers, particularly among those with Santéclair services, are more and more numerous to take full charge of so-called “out-of-care” teleconsultations, which can be of great use when encountering a consultation difficulty, in particular. in connection with the impossibility of finding an attending physician ”.

The declaration of your attending physician

You must declare your attending physician to your primary health insurance fund if:

• you did not yet have one and you have just made an agreement with a doctor who agrees to become one;
• you change it;
• your attending physician ceases his activity, changes or moves.

The different means of declaration

There are two possibilities for declaring your attending physician.

Online

This declaration can be made online by your chosen doctor, with your consent.

In practice, during a consultation at his office and on presentation of your Vitale card, the doctor transmits the declaration directly to your primary health insurance fund.

It’s quick and easy: no form to fill out, no mail to send, your declaration is registered immediately.

Via a form

The declaration of choice of attending physician can also be made using form S3704 Declaration of choice of attending physician (PDF):

• complete and sign this choice of attending physician form and ask the physician you have chosen as attending physician to sign it as well;
• then return it to your primary health insurance fund or send it by post in a prepaid envelope at the current rate.

The coordinated care pathway encourages patients to consult their doctor before making an appointment with a specialist. This approach conditions the level of reimbursement of compulsory health insurance (AMO).

“However, certain specialists can always be consulted directly without going through the attending physician: ophthalmologist, gynecologist, stomatologist (except for major surgical acts), psychiatrist or neuropsychiatrist (for patients between 16 and 25 years old)”.

You can change your attending physician, without any conditions to be met and without having to justify yourself. You are also not required to inform your previous attending physician.

You simply need to make a new declaration to your primary health insurance fund to change the attending physician.