Preferred provider networks (France)
Agreements between supplementary health insurers and opticians, dentists or hearing-aid providers, who accept capped prices in exchange for patient volume; a 2014 law allowed mutual insurers to reimburse better within the network.
In areas where prices are unregulated and out-of-pocket costs high, glasses, dental, hearing aids, supplementary health insurers are not mere payers: they can influence prices. Preferred provider networks are the tool of this purchasing power. A platform, often shared by several insurers, selects professionals who accept capped prices, quality commitments and direct billing; in return, insureds are steered toward them. For a long time, French mutual insurers could not vary reimbursements depending on whether the insured used the network, unlike insurance companies and provident institutions. Law no. 2014-57 of 27 January 2014, known as the Le Roux law, lifted this ban and regulated networks: open membership for professionals meeting objective criteria for glasses and hearing aids, no closed networks for opticians, and the insured's free choice of professional preserved. Networks divide opinion: insurers see cost control and a fight against abuse, professional unions an attack on free choice and pressure on quality. The so-called 100 percent health reform, by creating a basket with no out-of-pocket cost, has removed part of their rationale.
Hypothetical case: an insured needs progressive glasses priced at 700 euros at an out-of-network optician, reimbursed 350 euros. At an optician in the mutual's network, the same pair costs 480 euros and the enhanced reimbursement leaves 30 euros to pay, with no upfront payment.
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