The major reform set to take effect in December secures funding from the AM up to the PLV. But certain specialized needs will require exceeding this ceiling. The remaining funding balance is a point of vigilance for the administrative logistics of our coordination.
Anticipating the Balance and Transparency
The optimistic scenario is that the amount of the balance is considerably reduced. This makes the intervention of the Departmental Compensation Fund for Handicap (FDCH) more effective. Social Workers can approach the file with more serenity. My former PMR expertise allows me to facilitate the understanding of the clinical justifications provided by the specialist doctor for the overrun.
The pessimistic scenario is the financial surprise for the beneficiary. We must be uncompromising: zero out-of-pocket is not unlimited. If the beneficiary chooses an option beyond the PLV without prior verification, the balance will be their responsibility. Social Workers have a critical role in verifying complementary coverage. My role is to coordinate administrative action so that the complementary aid request is launched simultaneously with the Prior Agreement (AP) request to avoid delaying delivery.