The article in brief
Urological consultations can be carried out without a prescription, but this has an impact on the reimbursement of healthcare costs in France.
- Visit without prescription is legal but reduces the reimbursement to only 30% of a reduced base
- Le coordinated pathway via the general practitioner guarantees reimbursement of 70% of the base rate.
- The emergencies are an exception where the financial penalty does not apply
- Your mutual can partially, but rarely, compensate for off-course penalties
As a practising urologist for over 15 years, I receive this question from my patients on a daily basis: can you go to the urologist without a prescription? ? The answer is simple: yes, you can consult a urology specialist without a prior medical prescription. On the other hand, this decision will have major implications for your reimbursement. I remember a patient who, suffering from urgent urinary problems, came directly to see me without going through his GP. He was surprised to learn that his reimbursement would be significantly reduced. I'm going to explain in detail how this system works and what your options are.
Seeing a urologist with or without a prescription: what are the differences?
When you need to see a urinary tract specialist, you have two options. The first is to follow the coordinated care pathway, where your GP will issue you with a prescription to see a urologist. The second option allows you to go directly to the specialist without going through this stage.
The coordinated care pathway: the recommended route
In my practice, I find that patients referred by their GP generally receive more comprehensive care. The coordinated care pathway involves an initial consultation with your GP, who assesses your situation and refers you to the urologist with a prescription. There are several advantages to this approach:
- A better rate of reimbursement by the Assurance Maladie (70% of the base)
- A more complete medical file when you see the urologist
- Coordination of care between healthcare professionals
Direct consultation without a prescription: an option worth knowing about
You can make an appointment with a urologist quickly without a prescription from your GP. I have often seen patients with urgent problems such as severe urinary tract infections who could not wait for an appointment with their GP. This option is perfectly legal, but you should be aware that it will affect your level of reimbursement.
Emergency situations: exceptions to the standard route
In certain circumstances, such as acute urinary retention or severe back pain suggesting kidney stones, urgency takes precedence over the traditional route. In these cases, the financial penalty for not having a prescription does not apply. In fact, I recently treated a patient suffering from a renal colic attack who came directly to my surgery, and there was no impact on the cost of his treatment.
The price and reimbursement of urological consultations
The cost of a urological consultation and its reimbursement vary according to a number of factors: the doctor's area of practice, the context of your consultation (with or without a prescription) and your supplementary cover. Here is a table summarising the fees charged:
| Type of consultation | Sector 1 | Sector 2 OPTAM | Sector 2 non-OPTAM |
|---|---|---|---|
| One-off notice | 50€ | 50 + moderate overruns | 50 + variable overruns |
| Regular monitoring | 30€ | 30 + moderate overruns | 23 + variable overruns |
Reimbursement according to the care pathway
The level of reimbursement depends directly on your compliance with the coordinated healthcare pathway. With a prescription from your GPFor a consultation in sector 1, you will be reimbursed €70% of the basic fee after deduction of a €1 fixed contribution. For example, for a consultation costing €30 in sector 1, you will be reimbursed €20 by the Assurance Maladie.
On the other hand, if you consult without a prescription, reimbursement will fall to €30% from a base that is itself reduced to €25 for a sector 1 or 2 OPTAM doctor. In other words, you will be reimbursed just €6.50 for the same consultation. That's why I always encourage my new patients to check whether a prescription is required for their consultation.
The impact of your supplementary health insurance
Your mutual insurance company plays an essential role in covering the remaining costs. It generally covers the co-payment (the part not reimbursed by Social Security) as part of the care package. However, the penalties for consulting a doctor without a prescription are not usually covered by complementary health insurance.
I've noticed that patients with good mutual insurance are less reluctant to consult a doctor directly. However, even with excellent cover, the "contrats responsables" cap reimbursements to non-OPTAM doctors at 100% of the conventional tariff.
Optimal preparation for your visit to the urologist
To make the most of your urological consultation, whether with or without a prescription, good preparation is essential. In my years of practice, I have found that the most effective consultations are those where the patient arrives well prepared.
Please bring the following documents to your appointment:
- Your prescription if you have one
- Your previous test results (blood tests, PSA, ultrasound scans)
- Minutes of previous events
- List of your current medicines
- Carte Vitale and health insurance card
One practical tip I always give: don't empty your bladder just before the consultation. In many cases, I have to carry out a physical examination or ultrasound which requires a relatively full bladder. Also, take a few minutes before your appointment to note down the evolution of your symptoms in chronological order.
Ultimately, you are perfectly entitled to consult a urologist without a prescription, but this will have a significant impact on your reimbursement. Unless you have a medical emergency, going through your GP is still the most cost-effective option. Whatever your decision, you should know that we urologists are here to welcome you and treat you in the best possible conditions.
Sources : wiki urology | urology department
