Who receives the bill, and who pays it

The two systems, one sentence each

• ✓Tiers garant: the practice sends you the bill. You pay it, send it to your insurer, and the insurer reimburses whatever exceeds your deductible and co-payment. This is the usual case with doctors in private practice.
• ✓Tiers payant: the provider bills your insurer directly. You receive only a copy and a statement of what remains yours to pay. This is the usual case in hospitals and pharmacies.
• ✓In both cases you are entitled to a copy of the bill. It lists the services, their code and their price: it is the only document that lets you check what you were charged for.

What getting it wrong costs

Under tiers garant the debt is yours towards the practice, not towards the insurer. Waiting for reimbursement before paying invites a reminder — and then fees. You pay first, the insurer reimburses afterwards: two independent movements.

The opposite mistake costs more: paying the bill and forgetting to send it to your insurer. The right to reimbursement does not vanish the following month, but a late submission gets queried, mislaid and argued over. A bill paid and never submitted is money left on the table.

So send every bill in as soon as it is paid, even if you think you are still inside your deductible: the insurer keeps the running total, and it can only count what it receives.

Reading the statement without losing your temper

• ✓The statement shows the amount billed, what is charged to the deductible, what falls under the co-payment, and what the insurer pays.
• ✓«Not covered» does not always mean «refused»: it can mean the service is not in the basic catalogue, or that a prescription is missing.
• ✓It also shows how much of your deductible is used up. That figure tells you, in October, whether it is worth postponing an examination to January — or, on the contrary, bringing it forward.
• ✓An error is disputed in writing with the insurer, with a copy of the bill. It happens often, and it is almost always settled without conflict.