Question 16365 — maternity health insurance

Summary

Ms. Marie-Agnès Poussier-Winsback draws the attention of the Minister of Health, Families, Autonomy and Disabled People to the difficulties in reimbursing psychological consultations encountered by victims of terrorist acts when their practitioner is not approved. Victims of terrorist acts present deep and lasting trauma requiring specialized psychological monitoring, often provided by practitioners trained in specific therapeutic approaches such as EMDR. However, these specialists are not always approved, particularly in certain areas where the provision of trauma care remains limited. When a victim initiates or wishes to resume follow-up with such a practitioner, they encounter a refusal of reimbursement under common law from health insurance, for the sole reason that the professional is not not conventional. The exceptional route, which previously allowed reimbursement on paid invoices, is no longer accessible under the same conditions. The victim is thus forced either to change practitioner, implying resuming the entirety of a painful follow-up with a new professional, or to request an exemption from an exceptional commission, a long, exhausting procedure accompanied by a documentary requirement. disproportionate. This situation is all the more paradoxical as victims of terrorist acts have already gone through a cumbersome administrative process to obtain recognition in this capacity. Forcing them to justify themselves again to their health insurance fund in order to access basic psychological care constitutes an additional burden that is difficult to bear. Furthermore, ambiguity surrounds the organization competent: the victims are referred to the CPAM or the CNMSS, which further adds to the confusion and the feeling of abandonment felt by these victims. Regardless of the fund requested, the response remains the same: the practitioner's agreement is required. She asks him if the Government plans to introduce a derogatory and simplified right to reimbursement for victims of terrorist acts consulting a specialized psychologist. non-agreed, if a clarification of the respective powers of the CPAM and the CNMSS with regard to these victims is envisaged in order to guarantee a single and identified contact person, and if an instruction could be sent to health insurance organizations in order to recognize the continuity of therapeutic monitoring as a criterion in its own right in the examination of requests for exceptional care, thus avoiding victims having to interrupt an ongoing care pathway.

Machine translation from French. The official text remains authoritative.

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