Osteo & Chiro

“We’re not covered by the French insurance system.”

I was only slightly surprised when my osteopath said this to me at the end of our visit.  As someone who has spent most of his life outside of a single-payer healthcare system, and has confessed that he only goes to the doctor occasionally, I expect to always pay a little something when I have medical needs in France.

Part of my lower spine had been troubling me for several weeks and my exercise regimen wasn’t helping it to heal – but stopping exercise, even for just a couple weeks, was not an option I was willing to consider.  In a past life, upon feeling this way, I would have immediately gone to my chiropractor in the US.  Those visits were covered by my US insurance of the time.  But I never had insurance in a post-Obamacare America.  I left the US in 2013, before the changes to the insurance system began, and as such, have no idea whether chiropractic care is still covered in the way it might have ben back then.  But whatever might be the policies of the US insurance companies, it seemed that chiropractors really didn’t have a presence in France in general, and in Paris in particular, and so I made an appointment with “the next best thing,” an osteopath.

What’s the difference?

The osteopath who saw me took a few minutes to quickly parse the two disciplines.  “It’s a vast oversimplification, but you might say that chiros are more exclusively spinally focused, whereas in addition to the spine we are concerned with respiratory and digestive issues.  We also won’t see our patients as frequently.”  She went on to tell me that the founder of chiropractic was actually a student of the founder of osteopathy for a short 6 weeks.  However divergent their paths are now, both disciplines are a reaction to “traditional” treatments of the time in which they were invented, at the end of the 1800s.

In the end, because of my travel schedule last month, I double-dipped.  The osteopath I saw in Paris made some helpful adjustments just 2 days before a trip I made stateside, and while I was in America I had 4 adjustments over a 2 week period with a chiropractor, including some time on a traction table.  On all these visits on both sides of the Atlantic I paid cash (70€ for my French visit, and $50USD for each of my American visits), as I have no US insurance, and as I said, French insurance does not cover osteopathy.  But, some mutuelle plans do.  Would I finally be motivated to get one of those “top up” plans that the French are so attached to?  Not yet.  But seeing both the osteo and chiro helped tremendously, and my back feels a lot better now.  I also managed to learn more about a field I didn’t know about and what the French system will pay for.  So, the pain was worth it, if only to remind me to be grateful that I live in a country in which I can easily see a doctor when I have a problem, and not pay an exorbitant amount.

Getting my Carte Vitale and going to the doctor…finally

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 liberale 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 5th floor.”

Bingo.

I took the elevator up to the 5th 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 7 minutes and a few dead ends later I was in front of the receptionist at the lab.  Twenty minutes and roughly 10 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.