Dépassements d'Honoraires (Extra Billing) in France

One of the most distinctive and controversial aspects of French healthcare is the system of dépassements d'honoraires, whereby doctors in Sector 2 (secteur 2) are permitted to charge fees above the standard tariff set by the Assurance Maladie. While Sector 1 doctors adhere to the official tariff (e.g., €26.50 for a GP consultation), Sector 2 specialists may charge significantly more, with the excess amount only partially reimbursed or not reimbursed at all by the basic public insurance.

In practice, specialist consultations can range from €50 to €150 or more in major cities like Paris, compared to the official tariff of €30–€55 depending on the specialty. The average dépassement rate across all Sector 2 physicians is approximately 56% above the official tariff. Some specialties, such as surgery and ophthalmology, see particularly high extra billing, with patients sometimes paying double or triple the official rates.

To address this, the OPTAM and OPTAM-CO agreements incentivise Sector 2 doctors to moderate their extra billing in exchange for higher reimbursement rates from the Assurance Maladie. A good mutuelle (complementary insurance) is essential for managing these costs, as many mutuelles offer partial or full coverage of dépassements up to a certain percentage of the official tariff.