NIn a statement published on its website, ADSE states that the changes to the tables and prices of the free and agreed regimes were designed taking into account the need to “stop the occurrence of situations” that “damage the good performance” of this health subsystem, ” billing abuses” and also — especially in the areas of obstetrics and clinical psychology — respond to the satisfaction of beneficiaries who had difficulty finding an “adequate and sufficient response” for these two health care services in the agreed network.
Thus, with regard to psychology consultations, the maximum reimbursement value by ADSE increases from 9.33 to 14.40 euros, under the free regime, with 24 consultations per year being allowed, with no need to present a medical prescription. .
Under the agreed regime, ADSE continues to contribute 80% (and the beneficiary the remaining 20%), with the amount supported by the public servants’ health subsystem rising from 12.50 to 18 euros, starting today. The beneficiary’s copayment increases by 1.10 euros, for a total of 3.60 euros.
In the case of births (agreed regime), the distribution of costs remains the same, with 90% of the price being borne by ADSE and 10% by the beneficiary.
According to the new table, the copayment for a eutocic birth will be 235.87 euros, a dystocic birth 261.07 euros, a cesarean section 345.59 euros, adding 40 euros for each twin.
The copayment values, the same information states, include fees for doctors (neonatologists, obstetrician, assistant and anesthetist), nursing and support staff, as well as hospitalization in a private and semi-private room (three days for the cesarean section and two days for other situations), medicines and medicinal products, any consumable materials, cardio-fetal monitoring center, room and recovery floor and all surgical and medical acts that may occur during births.
In the table that comes into force today, diapers for incontinence are now limited to 120 units per month, for a total of 1,440 diapers per year, with the beneficiary being paid the amount of 0.88 euros per unit. These new rules on diapers arise as a result of “invoicing abuse”, says ADSE.
The part of the table relating to the transport of patients free of charge and intraoperative prostheses in accordance with the agreement is expected to come into force in June.
Read Also: ADSE updates transport and intraoperative prosthetics tables in June
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