After the announcement, last March, of the assumption of responsibility for consultations with the psychologist, the large federations of complementary health insurance have just specified the contours of this device in a notice sent to complementary health insurance organizations.
The objective of this note: ” help »Complementary health organizations to better regulate the effective implementation of these reimbursements, both for individual and group health contracts.
While the document leaves a wide margin of appreciation to OCAMs, certain general principles are nevertheless set out therein, including:
- the generalized implementation of this system must be effective as of 1er July 2021 at the latest. The document recommends however the opening of a support ” ideally »Before 1er next July and retrospectively, for all reimbursement requests issued since March 22, 2021;
- reimbursement at the first euro of at least four consultations, up to a minimum of 60 euros per session;
- all policyholders and their dependents are affected by the system, whether they are beneficiaries of a collective or individual health contract;
- the freedom for the patient to consult or teleconsult the psychologist of his choice, on the sole condition that the latter has an ADELI number.
As for the following points, they are left to the appreciation of complementary health organizations:
- patient referral procedures: if the reimbursement of psychological consultations will not be conditional on the transmission of a medical prescription, the notice specifies, however, that these consultations must be included in a ” care path for which the attending physician is the focal point “. Certain organizations may therefore be required to request proof of this referral from the doctor (mail, etc.);
- number of sessions reimbursed: the document provides for the payment of a minimum of 4 sessions; however, the OCAMs are completely free to grant the right to reimbursement for additional sessions. Concerning organizations already offering packages of psychological consultations in their covers (package of soft medicine, alternative, etc.), they are not required to respect this new commitment – unless they wish to the contrary.
A first evaluation of the measure is planned for the end of 2021. A questionnaire sent to all the complementary organizations will make it possible to estimate the number of beneficiaries but also the real cost for the OCAMs. According to this assessment, the device could possibly be extended beyond 2021.