Claw Toe Surgery: Cost, Reimbursement, and Sick Leave
Dr. Julien Lopez performs your claw toe operation at a standard sector 2 price, covered by social security and your insurance depending on your chosen plan.
The specialist in foot and ankle pathologies receives you in one of his offices in Cannes or Nice to understand the origins of your condition, the causes of your pain, and guide you toward suitable treatments. Depending on the severity of the claw toe and your discomfort, surgical intervention may be justified.
The orthopedic surgeon accompanies you through consultations at every stage of your care journey, from the appointment with the anesthetist to the percutaneous surgery of your claw toes and throughout your recovery.
Reimbursement for Claw Toe Surgery
What is the reimbursement for claw toe surgery? Following the diagnosis of the condition, the orthopedic specialist explains the principle of the surgery, the duration of recovery, as well as the cost and reimbursement of this minimally invasive surgical procedure.
Claw toes, also known as toe claws or hammer toes, are characterized by a deformation of the plantar extremities. This condition is visible as the toes bend downward, creating an illusion of "claws." Hammer toes, on the other hand, are a plantar pathology where the toes bend downward and then upward.
During your initial consultation, Dr. Julien Lopez assesses the extent of the deformity through a clinical examination and the results of prescribed additional medical imaging.
Subsequently, based on your discomfort, the severity of the claw toes, and your functional expectations, non-surgical treatments or a surgical procedure may be proposed. If surgery is scheduled, the procedure and post-operative care will be explained in detail.
When the need for surgery is established, the surgeon will always recommend percutaneous surgery for your claw toes whenever possible. Less invasive, it is performed through incisions of a few millimeters, assisted by medical imaging. The surgeon uses specialized tools such as percutaneous scalpels and specific drills.
This surgical technique offers advantages over conventional surgery:
- Local or regional anesthesia, less burdensome than general anesthesia.
- Ambulatory, allowing the patient to return home quickly.
- Reduced post-operative pain.
- Faster recovery compared to open surgeries.
The fees and reimbursements for the surgical procedure are provided in a quote that will be given to you by the specialist in foot and ankle pathologies before the surgical intervention.
The standard fees applied by the surgeon are sector 2. In this sector, they can apply additional fees on top of the "controlled" amounts set by the CPAM, which refers to the Primary Health Insurance Fund. The CPAM uses standard rates.
Practitioners in sector 1 must adhere to the price schedules set by the CPAM for their consultations and surgeries. Patients are reimbursed 100% by social security when these professionals provide their care.
Professionals in sector 3, on the other hand, are free to determine the fees for their consultations.
Dr. Julien Lopez is sector 2; he accepts the "Carte Vitale" (health insurance card) and may request additional fees that are not reimbursed by the CPAM but by insurance (partially or in full).
The cost of consultations with Dr. Julien Lopez ranges from 70 to 100 euros, whether it's for the initial surgical consultation, follow-up consultations, or video consultations.
He accepts payments in cash, by check, and by credit card.
But what is the actual cost of claw toe surgery? To determine the real out-of-pocket cost for a patient, you need to send the quote provided by the secretary to your insurance company. After the insurance company's response, the secretary will be able to inform you about the remaining costs.
First and foremost, for a reimbursement to take place, the surgery must be "necessary." Indeed, significant discomfort and debilitating or disabling pain must be confirmed by the orthopedic specialist for the patient to hope for reimbursement. Otherwise, it will be considered as having an "esthetic purpose" and will not be subject to any reimbursement.
Dr. Julien Lopez is sector 2, which means that prices imposed by the CPAM are reimbursed at 100%. The additional fees requested by the orthopedic specialist are indicated in a quote and sent by the patient to their mutual insurance company. Depending on the policy subscribed, the insurance company will be able to reimburse all or part of the requested additional fees.
On average, after the CPAM and mutual insurance coverage, the cost of claw toe surgery is around 300 euros borne by the patient.
Following the Surgery of the Second Claw Toe: Necessary Sick Leave
For example, in the case of surgery for the second claw toe, sick leave is often required. It allows for a smooth recovery.
After the percutaneous surgery of your claw toes or hammer toes, the specialist in foot and ankle pathologies prescribes sick leave. The duration varies from a few days to several weeks, depending on several factors:
- The degree of your condition's severity before the intervention.
- The surgical procedures performed and their significance.
- The estimated duration of your recovery.
- The means of transportation used to get to your workplace (no driving for 10 days and no prolonged walking for 2 weeks).
- The nature of your professional activity (no physical exertion for 2 months).
- The operated side, previous medical history, and associated diseases.
Indeed, if you have to walk a long distance to get to work, if your job is physically demanding or requires driving, sick leave may be extended. Conversely, if you have a desk job close to your home, the surgeon may decide to grant you a shorter sick leave period.
Depending on your company's social convention and your salary amount, the compensation you receive during your sick leave will vary.
The surgical operation for claw toes performed by Dr. Julien Lopez is fully covered by the CPAM for the conventional part. The additional fees and their reimbursement are determined after sending the quote to the mutual insurance company. The average out-of-pocket cost for this type of operation is around 300 euros.