A Serious Injury, CPAM and the French Medical System

One of those things that I worried about, but hoped would never happen, came to pass this week.  I have a partial tear of a ligament in my knee, which means I'm in a thigh-to-calf splint for the next 3 weeks (potentially a month and a half . . . or an additional month and a half?  There was a small language difficulty).  The worst part - I live in small rural town and I cannot drive.

Well, the pain may actually be the worst part because it doesn't appear to be customary to prescribe strong painkillers the first visit, even for a serious injury (not even Tramadol, which is what I prefer because it isn't as strong and is an opioid, but non-narcotic).  This would potentially be ok, since I was given a prescription dose of a painkiller similar to Tylenol, a prescription dose of Naproxen Sodium and a pain relieving cream . . . except I'm allergic to soy, which I told the doctor (in French), yet I was prescribed a soy-containing pain cream.  Unlike in the US, you apparently cannot just call your doctor and tell them that there's a problem with your prescription or that your pain is not even remotely well-controlled.  You can try, but you'll be told by the receptionist that the doctor is too busy to return a call and you'll have to make an appointment.  Are. You. Freaking. Kidding. Me?!?!  The doctors here will make a house visit to ensure you have your required note for missing a day of work, even for a cold, but not return a phone call.  Not even to correct their own mistake.  Incredible.

Now that I know that, I've changed my mind about continuing to see a doctor in the town 20 minutes away who speaks the best English because, as I also learned, they won't make a 20 minute drive for the house calls.  I learned this when I tried to contact the recommended nurse for my DAILY injection.  This is another interesting difference from the US.  I've had limbs splinted or immobilized before and never had an injection required.  After having it prescribed in France, I looked up why this might be.  It's because they've studied the risk of a clot and it's near zero if you don't have at least 3 risk factors (I don't), so it's been determined that prophylactic treatment is not recommended.  The French all took it as gospel that I would need this treatment (but of course you need the injection!) and joked that Americans are simply content to let natural selection take its course for the poor tiny percentage of the population that could be impacted by this.

I'm guessing it also has something to do with the fact that a daily house visit from the nurse isn't so objectionable when the combination of your socialized health care and extra mutuelle coverage is footing the bill.  Can you imagine the cost of a nurse coming to your home for three weeks to administer a daily injection in the US? 😨  Not only would people not agree to pay for it, the for-profit insurance in the US would surely refuse.

So, outside of the apparent reluctance to prescribe anything remotely suitable for the pain caused by a torn ligament, French doctors have no qualms about prescribing you the entire remainder of the pharmacy stock.  This is what I left the pharmacy with:

There's also no need for silly bottles.  If you were prescribed 14 pills, they just sell you the full box of 16.  Presumably nobody cares since they're not paying out-of-pocket.  Of course, if you're not French, then you've probably also encountered the most incompetent branch of the French government well before you've needed any medical care.

In direct contrast to my experience of getting my work permit issued in a week and my visa arriving promptly, plus the prefecture finding me an appointment before my visa expiration, CPAM seems to delight in it's ability to be completely dysfunctional.  First, they incorrectly told my human resources department that I was not eligible for a social number (or Carte Vitale) until I'd been in the country for 3 months.  My immigration attorneys assured me that this was not true with the visa type that I have, plus they sent the link to the French government website that proved this.

It's unclear whether the next problem was CPAM or my co-worker, but somehow this issue never progressed further until I complained to PB that I'd been in the country for nearly 3 months, paying high social taxes and for a mutuelle policy that I couldn't use, with no Carte Vitale to show for it.  He followed up with my co-worker, who possibly never tried to clarify with CPAM about my visa type.  My dossier was finally sent over and, several weeks later, PB followed up again.  CPAM informed us that they'd received no such dossier.  My co-worker forwarded the proof that we'd filed.  CPAM then miraculously found my file, which had been assigned to somebody who was out on leave of some sort.  It seems that CPAM was content to leave my file waiting on a desk until whenever the person returned, but they were finally persuaded to do something with it.

PB laughed a bit while telling me that I was having my first experience with TRUE French bureaucracy.  Apparently, the French just accept this as the way things are here, which could be why so many of them are in favor of politicians who want to fire a significant number of civil servants!  Finally, in early January, I was issued my "temporary" social number and told that a bill of rights would be mailed to me.  The mutuelle insisted that my temporary number could not be used for registering with them.  Fine, I'll continue to wait.

Well, this became a problem when I injured my knee.  Even though I should have been covered from the day I arrived, because my human resources folks didn't persist and file until December, I'm told I have coverage as of December 22.  But, without a Carte Vitale, I have to pay upfront and hope that the French government will actually reimburse me.

The cost in France for an uninsured "urgent care" visit to a doctor?  Twenty-three Euro.  Yes, that's the entire cost.  The pharmacy, on the other hand, set me back over two hundred Euro, but that was for the entire stack of medication and the knee splint.

So, financially, the lack of proof of insurance has not been so terrible.  Of course, I have no idea where to send my "factures" or invoices, in order to be reimbursed.  The CPAM has quit responding to my employer when an update is requested as well (I should have pushed for my US HQ to include this in the services that the immigration attorneys were hired for - they seem able to persuade the government to actually do its job).  I will say that PB has made it his personal mission this week to resolve the issue and has our HR staff working on it studiously.  My understanding is that they will help me get reimbursed and to register with the mutuelle, regardless of my lack of Carte Vitale.

My fears before this experience centered more around what I would do if I were seriously injured in a country where I don't have any long-term friendships yet and no family to call on.  As it turns out, I was worried about something that hasn't really happened yet.  Le Américaine has helped a lot with buying my groceries for the week, driving me to the doctor and taking me back and forth to work.  Alexis, who is back in the area, brought me an ice pack and is going to help with my furniture assembly.  Another co-worker has also offered to pick up groceries for me or help with any other errands.  A new friend offered to accompany me if I needed surgery, so I'd have an interpreter.  On the other hand, PB had a brief moment of acting like I'd injured myself during the WORST POSSIBLE TIME (our CEO visited this week) just to inconvenience him, but then he recalled that I just received a large set of knives as my 5 year service gift 😈 . . . er, I mean he recalled that he generally likes me and should be more concerned that I'm injured than about the poor timing of the injury.

I have learned that there are a lot of things that are a bit of a challenge when you can't bend one knee.  Like getting up from any sitting position without something to grab on to.  On the other hand, my left leg is going to have quads of steel and I'll be able to swing my lower body around using my arms like a gymnast!  My poor right quad is having a time of it though as I pulled it trying to swing my sock around and catch my foot in it like a net.  You know, socks are overrated anyway.  As are shoes.  I posed this question on my FB, but fuzzy blue slippers are proper work attire, right?

To my relief (and surely that of PB), I managed to wrangle a sock and (untied) shoe onto my foot prior to our CEO's arrival and have not yet had to wear fuzzy slippers in public.  Which I'm pretty sure a French person would view as sufficient public humiliation to justify a home visit and a doctor's note to skip work.😊

Obtaining a French Residency Card and Renting a Home in France

Obtaining a French Residency Card

I've read horror stories about prefecture appointments and the difficulty involved in getting a Carte de Séjour, so I was expecting an unpleasant experience.  In my case, I was pleasantly surprised; however, this may have been because my documents were prepared by immigration attorneys and I had a French-speaking assistant who came with me.

The start to the appointment was rather ominous because the man looked at my documentation and muttered about never seeing a "European Blue Card" application before, that he didn't know what was required for my dossier and that he hoped we were prepared to be at the prefecture for a LONG time (all in French, of course).  I came across the same lack of knowledge about a European Blue Card at the consulate - it appears that not many people take advantage of this visa, even though it's one of the easiest ways to immigrate to France from a non-EU country.  Of course, you have to meet the educational or work experience requirements, plus a salary requirement, but then you're entitled to the same benefits as a resident and have a path to permanent residency.

Moulin Rouge, 2009

Fortunately, the prefecture official came back quickly with the binder for the European Blue Card (aka "passeport talent") and was able to confirm that I had all of the required documents and French translations.  Ironically, my original documents were barely glanced at.  All they really cared about were the colored copies that were stamped by the official translator and the translations.  Since I'll have my new address within 8 days of the appointment, they also issued my card with my new address so I didn't have to return to change it.

The official was actually extremely nice and seemed pleasantly surprised that I understood most of the French and was able to give my address and other information in French.  So, I am now in possession of my temporary card (through May 2017) with my permanent one on the way!  I officially have the legal right to live and work in France for the next four years! 😊

I might be homesick occasionally, but if I'd ever made a bucket list, living in France would have been on it.  Ten years ago, I was on my first trip to Europe and I'd been to Paris earlier in the trip, but was returning to the city for one day before I went home.  I remember feeling completely at home, which hadn't been the case for the rest of my trip.  I thought it was just the familiarity because I'd been there before, but when I went to London the next day to fly out, I didn't feel the same, despite speaking nearly the same language as the Brits!  When I returned in 2009, Paris was the only city that I visited for a second time "just because" - I returned to Barcelona and Rome because I'd missed large parts of both cities due to missing a flight (Barcelona) and being extremely ill (Rome).  There wasn't anything in particular that I went back to Paris for though, other than because I really loved France.

Paris 2009 with a truly awful hair cut!

TIP: If you don't have utilities in your name, an attestation of insurance coverage is adequate proof of address (along with your rental contract) for the prefecture.  This also worked when opening my French bank account.

Renting a House in France

There are so many new things about life here (the measurement system being metric, the language, the culture) that at times it can be overwhelming.  I was really not enthusiastic about moving because I knew it was likely that I'd have to do a move-in "inventory" and sign a contract that was all in French.  I also knew that I'd have to figure out how to obtain utilities in French.

I'm very fortunate that I have the general manager that I do!  Clearly, it's not part of his job responsibilities to help me with my house (which falls squarely into the "personal" arena in France), but he did it anyway.  It would have taken me hours to understand everything that was being said, try to make sure the contract reflected what we agreed on and I probably would have been so distracted trying to translate that I would have missed things (which was my experience when viewing houses initially).  PB was able to quickly communicate with the owners, was meticulous about noticing everything and made sure that certain things would be done before I moved in and that they were noted in the contract (like a holder for the shower head).

If you do not speak fluent French and you know ANYONE who does, enlist their help!  The tenant is responsible for basically any damage that is not noted on the move-in report (and not normal wear-and-tear).  PB also told me to take photos of everything.  The couple I'm renting from seem like very nice people, but PB was insistent that I needed to be cautious to protect myself.

I accidentally took a photo of them while photographing chips in the paint.  The infamous PB is to the right and appears to be inspecting my fireplace.

I'd read of other ex-pats having trouble getting utilities turned on in their name (or needing the phone number of the prior occupant to switch the phone over); however, I had no difficulties.  What is strange is that the owners were able to provide my info to the electric and water company without me ever speaking to the companies myself and the bills will apparently be in my name now; this would not happen in the US!  (UPDATE: I received a form to sign and confirm)  Most of the sites for internet service asked for the prior phone number, but I was able to select an option to use my address instead.  After comparing offers, the offer from Orange was the best for my area.  Orange's site was all in French, but I understand enough that I was able to order service (and it was supposed to be on by the 15th, then I received a 2nd message for the 21st - that turned out to be for my TV service though).  The owners indicated that I should contact the local mayor's office to determine what to do about trash pickup - usually the website for the commune will have that info, but the one for my town is useless in that regard.  It did inform me of the rate for my tax d'habitation next year though!

For those who don't know, tax d'habitation is a tax that renters pay, which I believe is a percentage of the rent.  It is based on where you live on January 1, but is not due until later in the year (the bill at my current house arrived in November, due in December).  This is on top of the tax that the property owner pays (which is likely passed down to the renter as well through the rent price)!