The administrative procedures that a person affected by a heart rhythm disorder or heart incident have to undertake include, in some cases, those linked to chronic conditions. Chronic conditions may be exonerated, i.e. all medical expenses are fully covered.There are 29 recognized chronic conditions, which are oddly known as “ALD 30”. These include heart failure, severe heart valve disease, severe congenital heart disease and infarction (heart attack). Those who have had a prosthetic heart valve fitted for a heart rhythm disorder are also eligible for a chronic condition exoneration.
Having your chronic condition recognized
To benefit from 100% health coverage, you need to have your illness recognized as a chronic condition (Affection longue durée – ALD) by French Social Security. This begins with an appointment with your registered primary care physician (médecin traitant), who will fill out a treatment protocol detailing your overall health, any medication you are taking and how long you will need to take it, as well as any planned changes. Once it has been signed by your registered primary care physician, the document will be sent to the French National Health Insurance Fund (CPAM). They will study it, and in certain cases, they may ask a consulting physician from the French Social Security for an additional exam. The processing time is generally several weeks. If the CPAM refuses, it is possible to lodge an appeal and request a second medical examination.
Prosthetic heart valves fitted to treat a heart rhythm disorder must be recognized under the prosthetics listed by French Social Security in order to be reimbursed. For several years now, the remote monitoring of these prosthetics, particularly in the case of heart failure, has been covered financially.
ALD 31 and 32
Beyond the 29 conditions discussed in this article, the ALD protocol may also take others into account, such as a condition not included on the list, known as “ALD 31”. This applies to a serious, progressive or debilitating condition which requires treatment for more than six months, leading to expensive care costs. It may also be one or several conditions leading to a debilitating pathological state (known as “ALD 32”), requiring continuous treatment for more than six months.
Health coverage for chronic conditions
When a health condition is recognized by the CPAM, health coverage is relatively straightforward. Your health insurance card (Carte Vitale) is updated as soon as it is inserted into a dedicated terminal, often found in pharmacies. All healthcare is then covered, from consultations to medication, exams, hospitalizations, surgical procedures, etc. A few costs will remain to be borne by the patient such as surcharge fees, hospital fees and one-euro flat fees, although these can also be covered by your private health insurance.
Other financial help available
Once the chronic condition has been recognized by the CPAM, other help and rights can be claimed, such as the Adult Disability Allowance (Allocation Adulte Handicapé – AAH). It can be requested if the chronic condition reduces the person’s ability to work. There is also the Disability Compensation Benefit (Prestation de Compensation du Handicap – PCH), which covers expenses related to any assistance the person needs, as well as any adjustments to their home. The chronic condition also makes it possible to benefit from long-term sick leave and gives access to the AERAS convention (see box).
AERAS, being able to borrow regardless
In France, the AERAS Convention scheme allows people suffering from serious health conditions to access loans, particularly mortgages and insurance. Companies, as well as banks, are committed to offering alternative solutions for people whose application is refused for health reasons, in particular by pledging a portfolio of transferable securities or a mortgage on another property.
In any case, it is possible and highly recommended to contact associations helping people suffering from heart rhythm disorders (see box), which are particularly helpful when it comes to these practical matters.
Dedicated associations
A certain number of specialized associations support people suffering from heart issues, as well as their loved ones. Among them is the AMRYC, the Association des Maladies héréditaires du Rythme Cardiaque, and the Alliance du coeur, which brings together various associations across France. More specialized associations include the, Association des porteurs de dispositifs électriques cardiaques (APODEC), the l’Association pour les patients insuffisants cardiaques et leurs proches (ASPIC), and Coeur des Mamans Priorité Prévention, not forgetting the Association vie et coeur avec insuffisance cardiaque (AVEC), created for patients and their loved ones.
