France — dépassements d'honoraires, secteur 1 and 2, and the OPTAM

What it entitles you to, beyond money

• Fees set "avec tact et mesure"A professional obligation enforceable through the Ordre des médecins, not merely a guideline. A dépassement far outside the local norm for the same act is the paradigm case.
• A written estimate before treatment above the regulated thresholdWhere one was required and not given, say so: it is a breach independent of whether the fee itself was excessive.
• Conciliation through the CPAMThe caisse primaire d'assurance maladie operates a conciliation service for fee disputes, which is free and often effective without going to the Ordre.

Where to take it next

1. 01Write to the practitioner asking for the fee note and the basis of the dépassementAsk which act was billed, at what conventional tariff, and what the dépassement represents. Ask for the estimate if one should have been given.Claim direct·typically 21 days
2. 02Conciliation at the CPAMFree conciliation service for fee disputes between patients and practitioners.Alternative dispute resolution·typically 60 days·official page
3. 03Conseil départemental de l'Ordre des médecinsThe Ordre enforces the "tact et mesure" obligation and can require a practitioner to justify a fee. Complaints are free.Regulator·typically 120 days
4. 04Défenseur des droitsWhere the dispute involves access to care or a public service failure rather than a purely private fee question.Ombudsman·typically 150 days