Direct billing (third-party payment)

In the classic model, the patient pays the health professional, then is reimbursed by the national health insurance and the supplementary insurer. Direct billing removes this advance: the provider is paid directly by the payers, and the patient pays at most the share left to them. It exists at two levels. For the compulsory share, it is automatic in several cases: beneficiaries of solidarity supplementary health cover, work accidents and occupational diseases, maternity care, long-term conditions. For the supplementary share, it rests on agreements between supplementary insurers and providers, often organized through shared platforms, and it is systematic in pharmacies and common with opticians and in provider networks. The generalization of direct billing, voted in 2016, was scaled back to an optional scheme for the supplementary share, in the face of opposition from many doctors, who feared administrative burden and payment delays. For supplementary insurers, direct billing is at once a service insureds expect, a way to contain costs through provider networks, and a point of vulnerability: direct flows to providers require checks against billing for fictitious services.