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My First Trip to the ER in France

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Last month, I went on a four-hour hike through the snow in Chambéry, France. I put on my oversized jacket, layered up in every way, and put on my best wool socks. Equipped with a pair of leather, wool-lined boots, I thought this was going to be a walk in the park (or the woods). What I didn’t account for was the snow melting as soon as it touched my boots and my feet sitting wet for hours in the cold. The next night I discovered a small open wound had appeared by my toenail. By the next morning it was undoubtedly infected. 

Instead of immediately booking a doctor’s appointment, as I had just seen my doctor the day before the hike, I thought it would be fine if I tried to treat the wound myself. Given the title of this article, you can probably guess that wasn’t the best idea. 

By day two I was miserable, by the end of the week, I was in severe pain. No number of Manuka honey presses, green clay masks, red-light sessions, or bleach baths was healing me. So by the time I finally came to my senses on Sunday night, I realized my only option was to go to the hospital to get immediate care, only four days before my international flight to go home for the holidays. 

My French friends (pretty much family), advised I go early, so I arrived at the ER in my town at about 8:20am on Monday morning. There were 4 people waiting to be seen ahead of me. I approached the window to address the intake nurse. When she called me forward, I explained my injury. She took my carte vitale and told me she would return it after I was seen to complete payment. The carte vitale is the social healthcare card in France. It tracks healthcare visits and prescription fills, facilitating reimbursement when eligible. As a language assistant for the French public school system, I was provided one, first digitally, and eventually in card form once all my paperwork was processed. After I answered a handful of questions, I took a seat in a waiting chair. 

I was called back after about 15 minutes, this time met by a male nurse and a female assistant. Both looked relieved when they realized that I spoke French. I explained my situation and when I showed them my foot, they were immediately compassionate. They gave me a wristband to be processed as a patient and told me the doctor would call me back shortly. I returned to the waiting room for about 30 minutes. Soon enough, I was called into another room. There, a friendly young doctor of about my age explained that she would be doing an immediate procedure to remove as much of the infection as possible and to cut back the side of my ingrown toenail. 

I should probably preface this by saying that not only was this my first trip to the ER in France, but it was my first trip to the ER — ever. I took a deep breath and lay back on the operating table. We started with just local anesthesia, but the pain of the infection was quite intense, so another nurse was called in to give me laughing gas. Soon enough the procedure was over and I was able to sit up to receive my care instructions. 

I received my paperwork documenting the procedure and prescriptions to fill at the pharmacy. The doctor spoke slowly and I asked for clarification for the one word that was outside of my vocabulary. Limping back to the intake nurse to see what the damage was, she asked if I had a mutuelle, an additional private healthcare insurance to complement the social system. I replied no. She looked disappointed by the news, so I braced myself for the worst. Then she said, “That’ll be 19.98 euros,” the equivalent of about twenty dollars. Cue my sigh of relief. 

My prescriptions at the pharmacy came to another 30 euros, making my total expenditure about 50 euros. As an American, these numbers were simply astounding. I have never been so grateful for the French healthcare system. 

I won’t fool you and say it was all blue skies and rainbows from there. The following days, the pain returned and I was put on an antibiotic that contained pork and gluten — both of which I am allergic to. Passing through Paris with my suitcase and post-op foot was also not the most fun I’ve ever had. By the time I made it back to the States, I visited a doctor and received another antibiotic for $150. I guess that’s the difference between French and American healthcare, about 200%. 

My toe is fully on the mend and you can bet I’m watching my nails for any signs of ingrowth like a hawk. What a memory made! Though I’d be glad to have missed out on this experience altogether, I’m quite proud to have proven my French proficiency equal to the occasion. Have you ever gone to the ER or sought healthcare while in France? We’d love to hear about your experience. Cheers to firsts (and hopefully lasts)!

Photo taken by yours truly on the hike that started it all. Was the view worth it?

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How Healthcare for Expats in France Really Works

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We often get asked questions about healthcare for expats in France. This is especially true for our older audience — retirees hoping to move abroad, folks over 50 who decide to make a life for themselves in Paris or elsewhere — they want to make sure they’ll have coverage.

It’s no surprise that Americans are concerned about this as our healthcare system is one of the most complicated, expensive, and challenging ones in the world (I said what I said). For many, healthcare is one of the biggest unknowns when moving to France. 

The good news is that France consistently ranks among the best in the world for quality and accessibility of care. I have had nothing but good experiences with healthcare in France (okay, maybe I’ll admit the one dentist I saw wasn’t the best), and I found it easy to navigate once I got the hang of it. 

We’ve already written about our experiences with osteopaths and chiropractors, how to get a numéro provisoire to get your carte vitale and sign up for a mutuelle, and the differences between the CSS and top-up insurance, but I wanted to create a deep dive to hopefully help quell some of your worries.

While the system may seem intimidating at first, healthcare for expats in France is surprisingly affordable and reliable once you understand how it works.

The Basics of French Healthcare

France operates on a universal healthcare system called the PUMA (Protection Universelle Maladie). This means that every legal resident — yes, including legal expats — is entitled to coverage. When you go to the doctor or a hospital, the state pays a percentage of your medical costs and you’re responsible for the rest.

The golden ticket to benefiting from this system is the carte vitale. This small green health insurance card is tied to your French social security number, and when you hand it over at the end of appointments or at pharmacies your reimbursement is processed automatically. 

Once you arrive, securing this card is one of the first big steps toward fully integrating into life in France.

Who’s Eligible and When

Generally anyone with legal residence in France can access the system. Non-EU expats (like Americans) typically have to wait three months after their arrival before they can apply. 

Students, salaried workers, and retirees each have slightly different processes:

While you wait for approval, we typically suggest you stick to the private health insurance you were required to have for your visa application. Cigna Global has great options for expats, as does AXA.

What’s Covered and What Isn’t

One of the best surprises about healthcare for expats in France in my opinion is just how much is included. Doctor’s visits, specialist appointments, hospital stays, prescriptions, and maternity care all fall under the state system. Most GP visits cost around 25 €, and the government reimburses about 70% of that (color me surprised at my first appointment when I only owed 7.50 €!). Hospital stays are reimbursed at 80%, and chronic conditions are covered 100%.

The biggest gap is in dental care, eye care (including glasses and contact lenses), and certain specialists. I personally found the cost to be nominal coming from the US, but after some encouragement from my mother-in-law, who was choquée that I didn’t have top-up insurance to cover it, I did end up signing up for a mutuelle to help cover the costs (more on that later).

One thing to note if you’re still waiting on your carte vitale — save your receipts. You’ll be required to pay up front, but as soon as you receive your card, you can submit your feuilles de soins for reimbursement later. And yes, I can confirm they actually do reimburse you.

The Role of the Mutuelle

A mutuelle is France’s version of supplemental private insurance, or “top-up” insurance. You can think of it as the add-on that fills any gaps left by the state. A typical mutuelle covers the remaining 30% of GP visits, plus higher percentages of dental and eye care.

Don’t let the word “private” fool you, it’s still very affordable especially coming from the US. You can expect to pay anywhere from 30 € to 100 € per month, depending on the coverage you choose. I wear glasses and contact lenses so I decided to get a plan somewhere in the middle and paid around 45 € per month. Most, if not all, of my appointments were covered and my glasses and lenses were very inexpensive.

For any of our salarié readers, if you’re employed in France your company is legally required to provide a mutuelle, and it’s usually one with very good coverage. Freelancers, students, visitors, and retirees need to shop around for themselves. I like Harmonie Mutuelle myself.

Tips for Using the System

Once you’re set up with your carte vitale and mutuelle (if you choose), daily life within the French healthcare system is very straightforward:

  • Finding a doctor: USE DOCTOLIB. It’s the easiest way for expats to find a doctor, especially if you haven’t made French friends yet who can recommend one. You can even set filters for providers who speak English. If you’re in the Paris area, I loved my team at Ipso.
  • Appointments: Remember to bring your carte vitale so you are reimbursed automatically. Otherwise, save your receipts to submit later.
  • Pharmacies: You’ll also need your carte vitale to pick up prescriptions. Another thing to mention: don’t be afraid to ask your pharmacist for advice on medications. I’ve found that they are incredibly helpful and knowledgeable and they served as an invaluable resource for me.
  • Emergencies: Don’t call 911 and expect to receive help. Instead, dial 15 for the SAMU (medical emergency line that can connect you to ambulances).

The one caveat about the French healthcare system that I feel called to share is that not all French doctors are well-trained in bedside manner. I do believe this is changing as more time goes on, but like many things, don’t expect to receive the same exact experience as you would in the US. 

The care is just as good, don’t get me wrong, but you likely won’t be coddled in the same way you would in America. Honestly, this is good advice to heed when it comes to adjusting to life in France as a whole (just saying).

Healthcare for expats in France may seem intimidating at first glance, but once you take care of the necessary paperwork, it will quickly become one of the more reassuring aspects of life there. With universal coverage, reasonable costs, and a mutuelle to handle all of the extras, feel confident that if something happens, you’ll be well cared for.

Photo by Annie Spratt on Unsplash

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An Expat Discussion of CSS vs Mutuelle

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A note from the authors: In these articles, we (Molli — MS and Gracie — GB) have a conversation about a topic that’s familiar to both of us. In addition to providing information, our aim is to explore it from two different angles and give you a more in-depth view of the complexities of French life and the expat experience.  To get the most benefit, make sure you read our previous articles explaining CSS and mutuelles.

GB: Since moving to France, I’ve been both impressed and mystified by the French healthcare system. For a long time, I assumed everyone’s carte vitale was a magical debit card that paid all their medical expenses. Eventually, I learned that this isn’t the case and that many French people also have a mutuelle which acts as additional health insurance. My American perspective is to assume health care plans are linked to employers, so I figured a mutuelle had to come from a full-time job at a French company, and since I arrived in France on a specifically non-working visa, none of these options felt accessible to me. What were your first impressions of the French healthcare system, Molli? Did you have someone to help you avoid my misconceptions?

MS: I had a similar perspective as you! I think that in the U.S. there’s this big narrative around the fact that yes, health care is free in most other countries, but that it means low-quality care, long wait times, and old-fashioned hospitals and healthcare centers. I was also shocked to find out that the “free” health care so bragged about here isn’t actually free.

The first time I had to go to the doctor or hospital was when I was still an au pair. I cut my thumb on some broken glass and when the cut got infected my host dad took me to the hospital. I was pleasantly surprised at the normal wait times, friendly doctor, and standard hospital equipment that I was used to seeing in the US Yet another stereotype bit the dust that day. 

That said, one stereotype did come true that day, and it was the fact that health care here is extremely affordable albeit not free. You definitely don’t have to worry about going bankrupt if you end up in the emergency room and you don’t have a carte vitale, which I didn’t at the time. I was on some special au pair insurance that my host family had set me up with. If you’re wondering what a carte vitale is, think of it as a healthcare card similar to the insurance cards in the US. You use it at the doctor’s office, pharmacy when you pick up prescription drugs, and at the hospital. It also has your French social security number on it, as well as your name and picture.

I actually didn’t get my first carte vitale until I opened my auto-entreprise three years after I had been living in France. Interestingly enough, I should have been given one automatically when I began the intensive French language program I began after I decided to stop nannying, as all students are part of France’s social security system (which includes the carte vitale). But, in true French bureaucratic fashion, halfway into the school year I still wasn’t issued one. Luckily, I decided to start my auto-entreprise while I was still a student. 

I also had never heard of the concept of a mutuelle, and naively thought that I could go to any sort of doctor or specialist for free. I have since learned that if you have to go to the dentist, eye doctor, or physical therapist and you don’t have this extra coverage, things can get really expensive. Gracie, do you have extra coverage now that you understand the system better? And, speaking of which, when and how did you start to wrap your head around how everything works?

GB: Yes, I have extra coverage through complementaire sante sociale (CSS) in addition to a carte vitale. Having both of those together means the French government pays for most of my healthcare which makes me feel amazing and lucky. That said, it did take about a year and a half of filing paperwork and waiting to get the whole thing in place. And to qualify for a CSS, you have to be making very little money so I’m not sure if it will be a permanent solution, especially since you have to reapply each year. As with all French bureaucracy, they don’t make it easy. 

I started to wrap my head around how everything works after being in France for about two years.  I’d always assumed that I had to be a French citizen or have a more permanent visa (at the time all I had was a long-term visitor visa), but that wasn’t correct. France is actually fairly lenient about including immigrants in its healthcare system, and all you have to do is prove that you’re living in France in a “stable and regular manner.” This means you do not have to be born in France, married in France, or even working in France to register. It does mean you do have to have spent at least three months in the country and have a valid titre de séjour. 

This was one of those classic –– why didn’t anyone tell me this –– revelations. From there, I learned more from the assurance maladie office which told me I could apply for a permanent number and a carte vitale after I was PACSed and had a VPF visa. My primary care physician was also extremely helpful and advised me to apply for the CSS in the first place.

What about you — were there any specific moments or people who illuminated this process for you? And once you were in the French system, what made you decide to get additional coverage?

MS: It seems like I’ve had to just figure out everything as I go ever since I arrived in France. In all seriousness, when I was an au pair, my host family was very helpful, but almost too helpful because my host parents took care of almost everything for me, including a lot of paperwork. Once I became a student and was no longer living under their wing, a lot of things came as a shock and there was a massive learning curve!

I was really hesitant to get a mutuelle because up until very recently I had the mentality of “I’m healthy, I’m young, I’ll never have to go to the hospital, and I don’t want to spend the money on something I’ll never use.” And, until I was 26 and still under my parent’s insurance back in the States, I saved my yearly dentist and eye doctor appointments for when I went home to visit. 

My French mother-in-law actually pushed me to finally get a mutuelle. Since I’m turning 30 this year, it was about time, and ultimately I’m happy I took the plunge into the world of paying for my own healthcare. I pay around 30 € per month, and most of my prescription drugs are covered as well as the dentist and the ophthalmologist (I wear glasses and contacts). I have to admit, there’s something so sweet about going to the pharmacy and picking up medicine for free!

My last question for you about the CSS is, do you have the same coverage as someone like me who has a mutuelle? Or, are there things that I have access to and you don’t? 

GB: I’m pretty sure my CSS has the same coverage as a mutuelle, if not more. Although I haven’t taken it to every possible doctor, the documentation says it reimburses most glasses, prosthetics, and hearing aids, as well as all visits to the doctor, dentist, and hospital. I wear insoles and have been meaning to see my podiatrist about those, and I’m assuming that’s covered as well. I also have lofty ambitions to work with a kinesiologist and would love it if that was reimbursed since I know it’s only partially covered by the normal medical system. 

My admittedly American approach is to show up to any doctor, assume it will cost hundreds of euros, and be pleasantly surprised that it’s significantly cheaper than in the US. That said, the medical system here is much more transparent about costs –– all doctors post their fees on their website and in their offices, and they will explicitly tell you how much a procedure is and if you’ll be covered when discussing it with you. My dentist wanted to x-ray my teeth and told me it would only be partially reimbursed –– the x-rays cost 50 € and I’d get back 60%. The total cost was laughably small, especially since I used to pay $300 to have my teeth cleaned. That said, I’m grateful she had the conversation with me and wish the American medical system had the same transparency.

We hope this has been a helpful discussion of our experience with the French medical system. Feel free to comment with any questions or health insurance adventures of your own.

Photo by Marcelo Leal on Unsplash

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How to Get a Complémentaire Santé Solidaire (CSS)

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After I successfully enrolled in France’s health insurance system and got my temporary social security number or numéro provisoire, I went to see many doctors. At the beginning of the appointment, they would look at my certificate of registration and ask if I had a complementaire. I’d say no, because I didn’t, and I also had no idea what that term meant.

Then they’d ask if I had a mutuelle, and I would say no again. I knew that was additional health insurance offered by French businesses, but I didn’t have a French job. I didn’t even have a working visa. I was already thrilled to be enrolled in government health care, wasn’t that enough?

But they were asking because it wasn’t. Assurance maladie works in tiers of reimbursement, and only fully reimburses its users for a select few medical visits. For other expenses, they might cover a small percentage of the cost, which is why most French people have a mutuelle as well. After six months of being disappointed by the meager refunds trickling into my bank account, my general practitioner kindly explained all this to me. She also told me I could get a mutuelle without being employed by a French company, but advised that I apply for a complémentaire santé solidaire or CSS. And so my health insurance journey continued.

What Is a Complémentaire Santé Solidaire?

A complémentaire santé solidaire or CSS is an additional insurance that covers your medical costs at the doctor, dentist, and hospital. It also covers most glasses, prosthetics, and hearing aids.

Who Qualifies?

In order to qualify for a CSS, you must have already enrolled in the health care system and be a regular resident of France. In my reading, this means you must have a long-term visa as well as other documents tying you to a fixed address here.
Note: Even if you have a temporary social security number, numéro provisoire, you can still apply for a CSS.

Beyond residency, you qualify based on your income or resources, which include salary, government aid and donations, commercial sales of objects, and gambling gains. Depending on your annual total, you can either qualify for full government aid or you’ll pay less than 1 € per person per day. I was given full aid so I’m not sure what the annual payment would be. It seems safe to assume it’d be under 365 € annually or 30 € monthly, which is equivalent to the cheapest monthly mutuelle.

As you can see below, your income must be quite small in order to qualify:

How Do You Apply?

To apply you fill out a form with your personal and financial information, as well as information about the rest of your household and any dependents. Since Fred and I are PACSed, he’s considered part of my foyer, and his income was included in the calculations.

As I mentioned in the list of requirements, you’re also asked to declare any additional government aid you’re receiving such as unemployment or pension. After quite a few boxes pertaining to income sources, there is a deeply puzzling flowchart.

In a very convoluted way, all it’s asking is if you want to have your CSS directly with assurance maladie or through a mutuelle company.

Note: You also need to include your titre de séjour with the application, as this is proof that you’re a current French resident.

How Long Does It Take?

Great question. The assurance maladie website says the application will be processed in two months, which I rounded up to three.

How Long Is It Valid For?

Since the complémentaire is contingent on your income and “need” you must renew your request each year by sending proof of income, as well as your tax documents.

What Happens Next?

  • The short answer: Go to the doctor and get reimbursed.
  • The long answer: Now I can go back to the dentist and not have to worry about how much she’s charging to take X-rays of my teeth. Actually, doctors in France are always upfront about costs, and they must be listed on the doctor’s website so you usually know exactly how much you’re paying before you walk in. In the case of my dentist, she explained that assurance maladie would only cover eighty percent of the cost of the 50 € x-rays, and wanted to make sure I was okay with that. The bill was laughably small compared to my dentist back in New York where I paid $300 for a cleaning.

Photo was taken in the tastefully appointed waiting room of my knee doctor.

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carte vitale

How to Get a Numéro Provisoire or How to Sign up for Assurance Maladie

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For the first year after I arrived in France, every time I went to the pharmacy or doctor, they’d ask for my carte vitale. This is the health insurance card every French person has which allows them to be reimbursed for medical expenses, and each time I politely explained I didn’t have one, the person checking me out would be shocked. To be paying out of pocket for my medical costs was unheard of, even though they were fractions of what I was used to in the U.S.

It took me longer than it could’ve to realize I also qualified for medical insurance or assurance maladie. After going through the process, the first document I received was a temporary social security number or numéro provisoire. If you’re in France on a carte de séjour visiteur, this is the only number you’ll be assigned. However, if you are here on a talent visa or vie privée visa, you’ll be eligible for a permanent social security number, as well as a carte vitale.

Who Qualifies?

Anyone living in France in a “stable and regular manner” qualifies to be covered by France’s healthcare system. This means you do not have to be born in France, married in France, or even working in France to register. However, it means you do have to have spent at least three months in the country and have a valid titre de séjour.

How do I Register?

To register you need to send copies of the following documents to the closest health insurance office. You can look up which one here.

Required Documents:

  • National Identity Card or passport or residence permit, as well as any documentation of your civil status.
  • Extract of birth certificate with filiation or full copy of your birth certificate
  • Completed “Demande d’ouverture des droits d’assurance maladie.” (The second page of the form also lists the necessary documents to include.)

In my case, I sent copies of my passport and current titre de séjour, as well as the récépissé of my PACS — all documents which showed I was a ‘permanent’ resident in France. I also included a long-form copy of my birth certificate which had an apostille and had been translated into French, as well as a letter d’hébergement saying I lived with Fred. Luckily, I was doing this process soon after being PACSed and had all these documents on hand. Proving you live in France usually all boils down to the same set.

Why is it Taking so Long?

  • The Short Answer: Assurance Maladie is a single government health agency that serves the entire country of France. Unsurprisingly, it can take them a long time to process documents, especially since you’re required to mail in your application.
  • The Long Answer: There are many reasons why an application can be deemed incomplete –– perhaps you sent an abbreviated version of your birth certificate, perhaps you forgot to sign a certain form, perhaps your dossier is inexplicably missing. This was the case for my first attempt, and after waiting three months and without a word from the health insurance office, I went back and discovered they had no record of my ever having filed for a numéro provisoire. Whenever possible, try to keep track of who you’re speaking to, their name and contact info, and any trace that could be helpful in tracking down your file. In my case, I simply resubmitted everything and waited a few more months. As you can see, it’s always worth it to follow up and be on top of these processes.

Bonus Question: What’s the difference between a temporary and permanent number?

Your temporary number allows you to be reimbursed for expenses, assuming to keep the form the doctor or pharmacy fills out, as well as any prescriptions, and mail them to assurance maladie. The reimbursement is done directly to your French bank account on file, though the entire process can take up to a month.

With a permanent number, you qualify for a carte vitale which acts as a debit card and means the French government is paying the upfront costs, or at least the percentage of costs covered by the health care system.  You can create an online account on Ameli (the French government’s healthcare site) which means you no longer have to mail completed forms and proof of doctor visits to be reimbursed. That said, as I’ll talk about in a future article, being reimbursed doesn’t mean that one hundred percent of the costs are covered.

If, like me, and you’ve assumed that you don’t qualify for healthcare because you’re not French, I hope this article is helpful. As you can see, the process of applying is relatively straightforward and worth it from a financial sense and for the mental relief of being “covered.”

Photo is of my new card when it finally arrived!

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flying during lockdown

Flying During Lockdown

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While many of my planned trips this year evaporated in the spring, there were still some trips I chose to take for business and personal reasons.  During a brief window in the summer when PCR tests weren’t required, I went to visit family and friends in the States.  Inside Europe I managed short trips to Croatia, Mallorca, and Andorra.  I did all this on my US passport, despite the alleged “American ban” in Europe, and even without my French carte de séjour.  But I still had a final business trip on the calendar for 2020: Salzburg in November.

As you do when traveling in Europe these days, I was checking the ReOpen EU site regularly, to see what new regulations were in place.  I don’t remember exactly when I found out I was going to need to take the dreaded PCR test, but when I did, I immediately made an appointment at a lab in the 11th.  In early October the appointments were at least 2 weeks out and I needed a test that was done fewer than 72 hours before my arrival in Austria, in early November.  I managed to get an appointment for the right day and time and I showed up to a virtually empty clinic.

COVID-19 Testing

This was to be my third COVID-19 test.  The first had been at my doctor’s request during lockdown, when I described the flu-like symptoms I had earlier in the year.  The second had been before a summer trip to Croatia, when I thought they might ask for a test even though I was coming from France, not the US.  But those had been blood tests.  The PCR test was “invasive,” I had heard, but I hadn’t really read much more about it.

When I came to the clinic I was ushered right to a receptionist who verified my appointment and asked for my Carte Vitale.  Since the summer the French government had started fully covering the cost of Covid testing so I wasn’t asked for any money out of pocket.  After a few minutes I was handed a printout and some stickers which would ostensibly go to the lab with my swab.

“Personne suivante,” came a calm voice from behind a mostly closed door.  I came in and sat down in the chair that she beckoned me towards.  She told me I would need to remove my mask, which I did.  She then asked if I had done this before.  I shook my head and she told me to sit back and relax and that it would not take long.

I assumed the pose that I normally do at my dentist’s.  Relaxed, head back, remembering that the person who is doing this does this all the time, professionally, and is not interested in hurting me.  For those of you who are unfamiliar with the PCR test, it involves sending a swab about three inches into your nose to grab some samples of upper respiratory mucus.  As you might guess, this is not a pleasant feeling.

This is not so much a question of pain as unpleasantness.  Your nerves in this area sound an alarm: what is this thing doing here?  When she had inserted the probe the entire way in she actually moved it around a bit, ostensibly to make sure she collected enough of a sample.  She saw me tighten up and after withdrawing it she waited a beat before asking if I was ready for the “next one.”

Then I realized she meant the other nostril.  Okay, I know what to expect this time.  I braced myself and a few moments later it was over.  I thanked her, got my stuff, and headed home.  I got the results by email the next day, which I then printed out so I could present it in Austria when I landed.

Arriving in Austria

As I said, the trip was originally planned for Salzburg, and had the trip occurred one week before that would have been fine.  But in the days leading up to the trip Austria announced a lockdown and this led to many hotels and Airbnbs closing their doors (as the government promised to make them mostly whole if they complied).  Not wanting to take a risk of being in Salzburg without a place to stay, I decided to improvise and go to another location where I knew I could stay, outside Vienna, close to where my colleague on this trip actually lives.  But there was an additional wrinkle.  Austria had asked for a 10-day quarantine on visitors, even those with a negative test.  I decided to chance it.  My trip was scheduled for 7 days and if they made me stay an additional 3 days in Austria, I wouldn’t fight them.  Though, my business involved me working in the same room as my colleague, so if they actually planned to enforce this quarantine, my trip would be pointless.

The flight was about 80% full and during the flight we filled out contact tracing paperwork (which they collected) as well as an “Entry and Transit Declaration” (which they did not collect).  This document asked for:

  • Name, Nationality, Date, and Country of Birth
  • Flight Details
  • Stays in the previous 10 days
  • Address in Austria for the next 10 days
  • Contact details

I was asked to sign and date this form, next to a declaration that said, “I hereby confirm that I will self-quarantine at home or in suitable accommodation for a period of ten days, that I will cover the costs of any such accommodation and that I will not leave home or this accommodation for the duration of the quarantine.”  The flight attendants said to keep this form on us and that we might be asked for it at anytime.  I considered that curious, as if the form were true, the only place I could be asked for it would be inside an isolated accommodation.

At the very bottom of the document it said, “The details provided here will be sent to the health authorities of the province where you will be staying for the next ten days and, at the end of this time, destroyed.”  So, this form was supposed to be turned into someone, not carried with me inside an isolated accommodation in case a police officer stopped by, who couldn’t possibly know I was staying there unless I had turned it in in the first place.

No matter, the main concern for the Austrians for those of us arriving was a valid PCR test.  They had military personnel, not customs agents, looking at our passport and PCR test.  Because of the perfunctory manner in which the soldier dealing with me looked at my paperwork, I realized he was looking for two things: a name match, and a valid 72-hour window.  That meant that anyone who wanted to forge up an official-looking test could easily do so.  There was no electronic scanner to verify that this was an actual lab which had administered an actual test.  It was a simple check of paperwork using the technology of 1920, not 2020.  He handed back my paperwork and my passport.

I then proceeded to the passport window.  Surely, I’ll be checked, I thought.  Vienna had just had a terrorist attack the previous week.  But no, the lady at the window was busy on her phone and just waved me through.  The Austrians didn’t care what my purpose was in their country or if I even had a valid purpose to be there.  They only worried if I had a valid PCR test, which I could easily have forged, it seems.  As has been the case for most of this year, I was watching biosecurity theater, and not even good theater at that.

“Lockdown” in Austria

A friend picked me up at the airport and we headed back to his place to have lunch.  As we walked into his apartment building I marveled at the people not wearing masks.  “Is there no mask mandate?” I queried.   “Not outdoors, that’s weird!” he said.  Indeed it is, I thought to myself, but felt like a kid on Christmas day just because I wouldn’t have to wear a mask outdoors all week.  We had had an outdoor mask mandate in France for some months now.

Later in the week I was walking around Vienna with another friend when I realized that pretty much all the shops were open and a lot of restaurants were offering takeaway service.  I tried to explain that in France “lockdown” meant I couldn’t leave my house without a permissible reason, that I could be stopped and asked to justify myself at any time, and all this was to take place within 1km of my house, outside of particular extenuating circumstances (although, just as in late spring, the French were not taking this seriously at all).  He wrinkled his nose.  “We had something like this back in the spring, but not now.”  While it seems that since my visit Austria has been put into a much stricter lockdown, I was happy to take the opportunity to, among other things, get my hair cut while I was there, as I didn’t know when I would have the opportunity again in France.

Coming Home

When I came back home to France I presented my passport at the border.  The agent scanned it and after some time my linked carte de séjour showed up digitally on his screen and he waved me through.  No tests, no quarantine, and not even any paperwork pretending to enforce either.

So, traveling during lockdown?  If you’re worried about how to do it, don’t (the authorities clearly have no idea what they’re doing).  Just have your paperwork in order and be ready to be patient and smile.

Photo by Ashim D’Silva on Unsplash

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Getting My French Carte Vitale and Going to the Doctor…Finally

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It felt futile. I knew the French didn’t operate this way, but I was feeling worn out and was reverting to American habits.  I was writing, in French, on a post-it note, the following message:

“I am very happy to send another yet another check to cover my health insurance charges, but I still have not received my Carte Vitale.”

I knew as I sealed the envelope that some French functionary processing my cheque would see this note, laugh scornfully, then peel it off and place it delicately into the circular file.

So you can imagine my surprise when, one week later, I received a letter in the mail letting me know the only thing missing to process my Carte Vitale was a photo and my signature, after I had verified some information they had on me.  It is one of those times I was quite happy to be wrong.

This was the only part of my paperwork processing that had gone sideways as I left visitor status and transitioned into my profession libérale life.  But, since I’m not a frequenter of doctors anyway, it simply remained a slight irritation.  When four months had passed without any sign of my Carte Vitale, I made a copy of my translated birth certificate, as well as a copy of the original, and sent it to RSI with a pleasant cover letter.  No reply.  Another four months passed.  That’s when the wry (but polite) post-it note was written, which just goes to show you that every now and then an unexpected tactic might just work.

* * *

The visit to the doctor felt like an interstitial in an Inspector Clousseau skit.  I had crowdsourced a good doctor from my Paris network, one who had a decent command of English, though I made the appointment in French.  I made the mistake of not asking how to find the place (surely an address is good enough?) and when I walked into the vestibule of the apartment building that was the address for my doctor, I searched in vain for signage that would indicate my desired destination.

Not quite willing to admit defeat yet, I decided to climb the stairs (surely the doors will be marked?).  But by the time I reached the 3rd floor (American 4th) I realized that this was a fool’s way to figure things out.

Humbled, I turned around and went all the way back down the stairs.  Thankfully, on the ground floor, a resident was having her door locksmithed and I asked if she knew where the “medecin” was (on a side note, “doctor” is one of those words in French that doesn’t change ending whether you put a “le” or “la” in front of it).  She responded insouciantly (as if she gets this all the time) that “all the doctors are on the fifth floor.”

Bingo.

I took the elevator up to the fifth floor, found her office, and checked in, roughly ten minutes after my original appointment time.  Ten minutes after that, I heard a gentle, “Monsieur Heiner, S.V.P” from the hallway and went in.

Her room was cheery and welcoming and full of books.  I felt like I was in a comfy study, not a doctor’s office.  She took out a clean sheet of paper, wrote my name down at the top, drew a straight and clean black line under it, then looked up at me, smiled, and asked how she could help me.

“Puis-je parle avec vous en anglais?” I queried.  She smiled down her glasses at me.  “Yes, of course.”  “I just don’t have the vocabulary to speak well about my health in French.”  She nodded.

Ten minutes later she was asking for my Carte Vitale and 40 €.  The carte goes into a card reader just like a chip-and-pin card, but with no pin.  “Cash or cheque?” she asked.  “Oh, you don’t take bank card?”  “Non,” she gave the slightest of pouts and shook her head.  “Is this the case for all medical appointments?” I asked.  “Non, it is a choice,” she said.  I had just enough cash on me: “You cleaned me out,” I laughed.

On the way out she handed me a form which designated her as my “medecin traitant” which in American parlance is “primary care physician.”  Getting this form to La Ram/RSI would make sure I got properly reimbursed.

I was off to the lab after that for some testing and I thought I had understood her directions about how to get there (it was in the same structure, just down a different hallway) and seven minutes and a few dead ends later I was in front of the receptionist at the lab.  Twenty minutes and roughly ten glasses of water later, I was prepared for my lab work.  When it came time to draw my blood, the nurse gazed at all the vials which had been set aside for me (around 11) and asked if there was a reason I needed all the tests.  I responded in French that I hadn’t been to a general doctor for 2-3 years and I figured why not check on everything?  We both laughed.

I went back to the waiting room and five minutes later the receptionist called me.  A swipe of my Carte Vitale and 80€ on my bank card later, and I was done.  I went home, dropped the form for my new “medecin traitant” in the mail, and went back to my day.

Two weeks later, to the day, an envelope arrived in my mailbox.  I had completely forgotten that I had some money coming back.  There was a check for 15 € against the 40 € I had paid for the visit, as if even 40 € was “too much” (as an aside here I’ve mentioned in the past that you can acquire a “mutuelle” policy that tops up even this copay so you are 100% reimbursed all the time, but I don’t go to the doctor enough to add that extra cost to my budget).

My first encounter with the French medical system: easy, painless, friendly, efficient, and inexpensive.  Against the roughly 700 € a year I pay to cover my national health insurance, not too bad.

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