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L'Assurance Maladie Denial

I am an American citizen living in France with a long-stay French visa. My application for a Carte Vitale has been refused several times (after carefully filing all required documents). I now have a deadline to supply a document from the US embassy that does not exist. I also contacted the CRA and received no response.聽 聽

Is arbitrary denial a common occurrence with LAssurance Maladie and are health insurance lawyers available? Any advice is greatly appreciated.

Thank you.

See also

There is no need to post the same question again. Please be patient and wait for someone to answer you.

1 member reacted to this post

Hi, what exactly have you supplied? Birth certificate, marriage certificate etc??

I was asked several times for documents already submitted and most recently, demand for a US embassy-issued marriage certificate with my parents name on it.聽 No such document exists, confirmed and forwarded by an official email.


Submission:

Cover letters

Cerfa request form

Medical certificate

Passport

Visa

Birth certificate

Marriage certificate (EN/FR officially translated)

Proof of living in France

Bank statement with IBAN

Notarized sworn statement of truth and accuracy off all submitted documents

Usually it is the birth certificate or extract that must show the parents聽 information (filiation).


I don't understand the question. The information you supplied is not used to obtain a Carte Vitale. It is used to get on the national health system (PUMa, etc.). Once you are accepted (ie, receive the attestation des droits), getting the Carte Vitale is straightforward.


I see nothing on the CERFA form (N掳 15763*02) for the ouverture des droits that mentions either marriage or a bank statement or a sworn statement!!


Just what have you applied for?

Ok, so I had a similar problem as my birth certificate was a "short one" as in it didn't show my parents names. I supplied them with the "long version" clearly stating both parents names. This was accepted immediately.

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聽 聽 Ok, so I had a similar problem as my birth certificate was a "short one" as in it didn't show my parents names. I supplied them with the "long version" clearly stating both parents names. This was accepted immediately.
聽 聽

聽 聽 -@sharoncook2004


Yes, officials don't like the A5 ones, they have always have to be A4 full-size ones.

@AARO health


My sentiments exactly!聽


She submitted all the necessary documents in the first filing then came three more requests (and responses) seemingly out of the blue.


Her notarized statement of truth was my idea as the tone of correspondence suggested she is a fraud.


Her documents are聽 complete and in good order. I need a fresh set of eyes to fairly evaluate my case.聽 聽

The deadline for the latest (impossible) request is approaching.


Any advice would be greatly appreciated!

@mrice30

Who is the she and her in your response? Whom so you suspect of fraud? The S1106 is submitted to your local CPAM and may be processed by the departmental CPAM.



If there are problems with processing, you can go to the local CPAM for help. All the documents you provided should have been scanned into your record, so they can be viewed by any agent at the local CPAM.聽 That way you can have a direct conversation.



Re. the embassy document, maybe what is being requested is an apostille. To my knowledge, some country embassies/consulates can issue apostilles, but the US does not, probably because of the organization of vital statistics by state. In this case, the apostille for a marriage might have to be obtained from the state of marriage, though I don't know if these contain filiation info.



See:





But, again, you might be better off making an appt at the local CPAM to go over the record and documents of the application.

1 member reacted to this post

OK, thanks I鈥檒l make an appointment.聽 To be clear, I don鈥檛 suspect fraud, quite the opposite.聽 The coordinator seems suspicious of my wife by denying her birth and marriage certificates as truthful.聽 I thought a sworn statement would help, apparently not.

You didn't mention it, but is your wife American? If so, it seems strange your US birth certificate extract was accepted and not your wife's. You say that both your wife's birth and marriage certificates are treated with suspicion, but isn't there only one marriage certificate?


Since the reform in 2016 (PUMA), each individual is supposed to have his/her own health coverage registration. This was intended to remove coverage delays following life changes such as transition from minor to major or divorces, etc. Is it correct that BOTH your registrations are being held up?


Social security code L160-5


Article L160-5

Version en vigueur depuis le 25 d茅cembre 2016


Toute personne qui d茅clare aupr猫s d'une caisse primaire d'assurance maladie, dans des conditions fix茅es par d茅cret, ne pas b茅n茅ficier de la prise en charge des frais de sant茅 mentionn茅e 脿 l'article L. 160-1 b茅n茅ficie de cette prise en charge aupr猫s de cette caisse d猫s qu'elle justifie de son identit茅 et de sa r茅sidence stable et r茅guli猫re.

@mrice30


One last question.聽 I just received a notice that my wife鈥檚 file was sent to Caisse Nationale d'Assurance Vieillesse for approval.聽 I am not looking for a pension, just a Carte Vitale for a long stay visa expat.聽 Is this the correct location for approval?

Thank you

@mrice30


Normally ur supposed to send it to the assurance maladie but u still sent it to a social office so it should work. Im not 100% sure tho

@mrice30

Is there some missing part of the story? You first wrote that YOU were denied. Then it turned out your wife was denied. Now your wife's case has been referred to the CNAV.


There is a scenario in which the CNAV's involvement would make sense, which is if your wife were entitled to a French pension. It doesn't take much. One trimestre of work could create eligibility, even though the amount of the pension would聽 be minuscule.


That pension would make her exempt from any premium (cotisation)聽 for the PUMA coverage.


So is it possible that the CPAM is verifying your wife's pension status with the CNAV?


Social security code

Article L380-2


Les personnes mentionn茅es 脿 l'article L. 160-1 sont redevables d'une cotisation annuelle lorsqu'elles remplissent les conditions suivantes :

. . .


2掳 Elles n'ont per莽u ni pension de retraite, ni rente, ni aucun montant d'allocation de ch么mage au cours de l'ann茅e consid茅r茅e. Il en est de m锚me, lorsqu'elles sont mari茅es ou li茅es 脿 un partenaire par un pacte civil de solidarit茅, pour l'autre membre du couple.


This says the other half of a couple is also exempt from the cotisation in this case.

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Sorry for the confusion, now I understand. My wife started the post and I continued.聽 Oops, poor grammer on my part.

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