Glossary
Actual costs (frais réels)
The amount actually billed by the healthcare provider or facility for a treatment, before any reimbursement — as distinct from the negotiated rate used as the official calculation basis.
Actual costs correspond to the sum genuinely paid for a consultation, a procedure, or a hospital stay — as opposed to the negotiated rate (or reimbursement basis), which is the reference amount used by French Social Security and by CFE to calculate their reimbursements, regardless of the price actually billed.
The gap between actual costs and the reimbursement basis can be significant, particularly in the case of fee overruns or care received abroad, where the prices charged often bear no relation to French rates. A benefit expressed “as a % of actual costs” (rather than a % of the reimbursement basis) therefore potentially reimburses far more, within the limits of the policy’s coverage caps.
Example
A consultation billed at €80 when the negotiated rate is €30: a benefit calculated on the reimbursement basis will only cover a fraction of that €80, unlike a benefit expressed in actual costs.
Also searched as: costs incurred · real cost of care