{"id":25371,"date":"2024-10-07T10:00:00","date_gmt":"2024-10-07T08:00:00","guid":{"rendered":"https:\/\/carexpat.com\/blog\/?p=25371"},"modified":"2024-10-22T14:23:01","modified_gmt":"2024-10-22T12:23:01","slug":"entente-prealable-assurance-sante-internationale","status":"publish","type":"post","link":"https:\/\/carexpat.com\/blog\/entente-prealable-assurance-sante-internationale\/","title":{"rendered":"Qu&rsquo;est-ce qu&rsquo;une entente pr\u00e9alable ? Comment \u00e7a fonctionne ?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">L&rsquo;entente pr\u00e9alable est une proc\u00e9dure importante pour obtenir l&rsquo;accord de prise en charge d&rsquo;un assureur avant de recevoir certains soins. Cela permet d&rsquo;\u00e9viter des frais impr\u00e9vus et permet de connaitre le niveau de couverture des actes m\u00e9dicaux par votre assurance avant leur r\u00e9alisation, qu&rsquo;ils soient courants ou sp\u00e9cifiques.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cette validation&nbsp;pr\u00e9alable&nbsp;est particuli\u00e8rement utilis\u00e9e pour des soins qui s&rsquo;\u00e9talent sur plusieurs s\u00e9ances, comme les traitements de kin\u00e9sith\u00e9rapie ou d&rsquo;orthophonie. Ces soins n\u00e9cessitent souvent une autorisation lorsque le nombre de s\u00e9ances d\u00e9passe un certain seuil. Elle s&rsquo;applique \u00e9galement aux frais de sant\u00e9 \u00e9lev\u00e9s, comme les proth\u00e8ses dentaires ou les hospitalisations.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pour les expatri\u00e9s, l&rsquo;entente pr\u00e9alable est tout aussi cruciale. Chaque <a href=\"https:\/\/carexpat.com\/blog\/ma-sante-a-l-etranger-expatriation\/\" target=\"_blank\" rel=\"noreferrer noopener\">contrat d\u2019assurance internationale<\/a> d\u00e9termine les soins soumis \u00e0 cette proc\u00e9dure, comme les hospitalisations ou les frais m\u00e9dicaux \u00e9lev\u00e9s. Le respect de cette proc\u00e9dure permet aux fran\u00e7ais \u00e0 l\u2019\u00e9tranger d&rsquo;obtenir une couverture efficace et certaine.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pourquoi une entente pr\u00e9alable est-elle n\u00e9cessaire ?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Elle permet \u00e0 votre organisme d\u2019assurance de v\u00e9rifier si les soins envisag\u00e9s sont m\u00e9dicalement justifi\u00e9s et s\u2019ils respectent les crit\u00e8res de prise en charge. Cette demande concerne des soins sp\u00e9cifiques tels que :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Les actes en s\u00e9rie (exemple de 10 s\u00e9ances de masso-kin\u00e9sith\u00e9rapie prescrites par un m\u00e9decin),<\/li>\n\n\n\n<li>Traitements orthodontiques,<\/li>\n\n\n\n<li>S\u00e9ances de masso-kin\u00e9sith\u00e9rapie au-del\u00e0 d\u2019un certain seuil,<\/li>\n\n\n\n<li>Certains m\u00e9dicaments co\u00fbteux ou exp\u00e9rimentaux,<\/li>\n\n\n\n<li>Appareillages m\u00e9dicaux et proth\u00e8ses,<\/li>\n\n\n\n<li>Transports m\u00e9dicaux longs (plus de 150 km) ou en s\u00e9rie (ex. transports r\u00e9p\u00e9t\u00e9s sur plusieurs mois).<\/li>\n\n\n\n<li>Frais et proth\u00e8ses dentaires.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Cas particuliers \u00e0 l\u2019\u00e9tranger<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Lors d&rsquo;une expatriation, l&rsquo;entente pr\u00e9alable permet une prise en charge fluide des soins m\u00e9dicaux \u00e0 l&rsquo;\u00e9tranger. En effet, les syst\u00e8mes de sant\u00e9 et les co\u00fbts m\u00e9dicaux peuvent varier consid\u00e9rablement d&rsquo;un pays \u00e0 l&rsquo;autre. Cela rend la validation pr\u00e9alable par l&rsquo;assureur important pour anticiper les d\u00e9penses et garantir un remboursement optimal.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Hospitalisation, grossesse et traitements lourds<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dans le cadre de soins sp\u00e9cifiques tels que l&rsquo;hospitalisation, le suivi de grossesse, ou les traitements lourds comme la dialyse ou le traitement du cancer, l&rsquo;entente pr\u00e9alable&nbsp; vous permettra de conna\u00eetre le montant de la prise en charge avant d\u2019engager des frais. Cette transparence&nbsp; \u00e9vite les surprises financi\u00e8res dans des situations m\u00e9dicales d\u00e9licates, surtout \u00e0 l&rsquo;\u00e9tranger o\u00f9 les frais peuvent \u00eatre \u00e9lev\u00e9s\u200b.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Avantages pour l&rsquo;assur\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Connaissance du montant de la prise en charge : Gr\u00e2ce \u00e0 l&rsquo;entente pr\u00e9alable, vous connaissez \u00e0 l&rsquo;avance quel montant sera pris en charge par votre assurance et le montant qui pourrait \u00e9ventuellement rester \u00e0 votre charge. Cela est particuli\u00e8rement utile dans des pays o\u00f9 les co\u00fbts m\u00e9dicaux peuvent rapidement s&rsquo;accumuler, garantissant ainsi une tranquillit\u00e9 d\u2019esprit avant m\u00eame de commencer les soins.<\/li>\n\n\n\n<li>Traitement rapide des remboursements : Lorsque l&rsquo;entente pr\u00e9alable est obtenue, le traitement des remboursements est g\u00e9n\u00e9ralement plus rapide. Cela permet de limiter le d\u00e9lai entre le r\u00e8glement des frais m\u00e9dicaux et leur remboursement. Ce qui est important afin d&rsquo;\u00e9viter un impact financier prolong\u00e9, surtout lors de d\u00e9penses importantes telles que des hospitalisations. Dans certains cas, l&rsquo;assureur peut m\u00eame directement r\u00e9gler le professionnel de sant\u00e9&nbsp; et vous \u00e9viter ainsi toute avance de frais.&nbsp;<\/li>\n\n\n\n<li>Alerte sur les surfacturations : Le M\u00e9decin Conseil de l\u2019assureur joue \u00e9galement un r\u00f4le de protection pour l&rsquo;assur\u00e9. En analysant les devis m\u00e9dicaux, il peut alerter l\u2019assur\u00e9 sur une \u00e9ventuelle surfacturation. Ce ph\u00e9nom\u00e8ne est en effet parfois observ\u00e9 dans certains pays. Cette vigilance renforce la s\u00e9curit\u00e9 financi\u00e8re de l\u2019assur\u00e9, tout en garantissant que les tarifs pratiqu\u00e9s restent justes et align\u00e9s sur les standards locaux.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9lais et gestion de l\u2019entente pr\u00e9alable<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Pour que l&rsquo;entente pr\u00e9alable soit valide, il est imp\u00e9ratif d&rsquo;envoyer la demande \u00e0 l&rsquo;assureur au moins deux semaines avant la date pr\u00e9vue des soins. Cela permet \u00e0 l\u2019assureur de v\u00e9rifier les documents, de consulter les m\u00e9decins experts, et de donner une r\u00e9ponse avant le d\u00e9but des soins. En cas d&rsquo;urgence, des proc\u00e9dures sp\u00e9ciales permettent de demander une entente rapide, mais cela doit \u00eatre justifi\u00e9 par un rapport m\u00e9dical d\u00e9taill\u00e9.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Que se passe-t-il si l\u2019assur\u00e9 oublie de faire une demande d\u2019entente pr\u00e9alable ?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Chaque assureur applique ses propres r\u00e8gles en cas d&rsquo;oubli de la demande d\u2019entente pr\u00e9alable. Cela peut aller d\u2019une r\u00e9duction de la couverture (par exemple, un remboursement \u00e0 80 % au lieu de 100 %) \u00e0 un refus total de prise en charge. Il est donc essentiel de respecter cette proc\u00e9dure pour \u00e9viter toute mauvaise surprise financi\u00e8re. Les contrats d\u2019assurance mentionnent g\u00e9n\u00e9ralement ces p\u00e9nalit\u00e9s et rappellent l\u2019importance de soumettre la demande dans les d\u00e9lais.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Que faire si vous n\u2019avez pas le temps de faire la demande ?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/carexpat.com\/blog\/accident-en-voyage-que-faire\/\">En cas d&rsquo;urgence, comme une hospitalisation<\/a> ou des examens co\u00fbteux, l\u2019assureur peut accepter de renoncer \u00e0 l&rsquo;entente pr\u00e9alable \u00e0 condition que vous fournissiez les justificatifs n\u00e9cessaires (rapport m\u00e9dical, r\u00e9sultats d&rsquo;examens, etc.). Cela permet de prouver qu&rsquo;il s\u2019agissait bien d\u2019une situation d\u2019urgence et d&rsquo;obtenir une prise en charge r\u00e9troactive. Dans tous les cas, en cas d\u2019hospitalisation urgente, il est indispensable de contacter le service de prise en charge de l\u2019assureur d\u00e8s que possible. Celui-ci pourra directement prendre en charge les frais aupr\u00e8s de l\u2019h\u00f4pital, \u00e9vitant ainsi d&rsquo;avancer les sommes parfois importantes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>L&rsquo;entente pr\u00e9alable est une proc\u00e9dure importante pour obtenir l&rsquo;accord de prise en charge d&rsquo;un assureur avant de recevoir certains soins. Cela permet d&rsquo;\u00e9viter des frais impr\u00e9vus et permet de connaitre le niveau de couverture des actes m\u00e9dicaux par votre assurance avant leur r\u00e9alisation, qu&rsquo;ils soient courants ou sp\u00e9cifiques. Cette validation&nbsp;pr\u00e9alable&nbsp;est particuli\u00e8rement utilis\u00e9e pour des soins [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":25372,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[10,110],"tags":[101,128],"class_list":["post-25371","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-conversion","category-conversion-a-forte-valeur-ajoutee","tag-expat","tag-ma-sante-a-letranger"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Assurance sant\u00e9 internationale : focus sur l&#039;entente pr\u00e9alable.<\/title>\n<meta name=\"description\" content=\"Tout comprendre sur l&#039;entente pr\u00e9alable dans le cadre d&#039;une assurance sant\u00e9 internationale lors d&#039;une expatriation \u00e0 l&#039;\u00e9tranger.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carexpat.com\/blog\/entente-prealable-assurance-sante-internationale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Assurance sant\u00e9 internationale : focus sur l&#039;entente pr\u00e9alable.\" \/>\n<meta property=\"og:description\" content=\"Tout comprendre sur l&#039;entente pr\u00e9alable dans le cadre d&#039;une assurance sant\u00e9 internationale lors d&#039;une expatriation \u00e0 l&#039;\u00e9tranger.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/carexpat.com\/blog\/entente-prealable-assurance-sante-internationale\/\" \/>\n<meta property=\"og:site_name\" content=\"carexpat.com\/blog\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/carexpat.com\/\" \/>\n<meta property=\"article:published_time\" content=\"2024-10-07T08:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-10-22T12:23:01+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/i0.wp.com\/carexpat.com\/blog\/wp-content\/uploads\/2024\/10\/pexels-delcho-dichev-114220-1129615-scaled.jpg?fit=2560%2C1707&ssl=1\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1707\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Margaux DUPRAT\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@Carexpat_fr\" \/>\n<meta name=\"twitter:site\" content=\"@Carexpat_fr\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Margaux DUPRAT\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/carexpat.com\\\/blog\\\/entente-prealable-assurance-sante-internationale\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/carexpat.com\\\/blog\\\/entente-prealable-assurance-sante-internationale\\\/\"},\"author\":{\"name\":\"Margaux DUPRAT\",\"@id\":\"https:\\\/\\\/carexpat.com\\\/blog\\\/#\\\/schema\\\/person\\\/5aa3b26d55ac4039eed5b43779fa2b1c\"},\"headline\":\"Qu&rsquo;est-ce qu&rsquo;une entente pr\u00e9alable ? 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