Glossary
Prior authorisation (entente préalable)
Approval requested in advance from a scheme (Social Security, CFE or an insurer) before certain costly, rare or extended procedures, on which cover is conditional.
Prior authorisation — also called prior agreement — covers a list of procedures and care defined by French Health Insurance (Assurance Maladie): certain long-distance medical transport, spa treatments, physiotherapy sessions beyond a threshold, orthodontics, or certain medical devices. The fund has 15 days to respond from receipt of the request; no response within that period counts as approval.
The same principle applies, in similar forms, to supplementary insurers and to CFE: certain costly procedures or a scheduled hospital stay may require approval before they take place, otherwise reimbursement may be refused or reduced. Checking this requirement before scheduled care, rather than after, avoids a bad surprise on reimbursement.
Example
Before starting orthodontic treatment or a spa course, a request for prior authorisation must be sent to the fund (or the insurer) and its approval awaited — starting the care without this step can lead to a refused reimbursement.
Also searched as: prior agreement · advance authorisation