Appealing Non-Provision of Medical Services (Right)

From All Rights (Kol-Zchut) (www.kolzchut.org.il)

הקדמה:

Health plan policyholders whose request to receive care has been rejected may appeal the health plan's decision
Appeals may even be submitted for non-provision of medical services or medications that are not included in the healthcare basket
Those submitting an appeal may do so with the assistance of an attorney, aid organization and/or legal representative

Forms:


When necessary, health plan policyholders are entitled to receive the medical services included in the healthcare basket in accordance with the rules and conditions established in the National Health Insurance Law. When a health plan refuses to provide a service or medical treatment, the decision may be appealed to the following bodies:

  • Health plan policyholders whose request for service has been rejected by the district doctor, who claim that the service is included in the basket, may submit a complaint to their health plan's ombudsman.
  • Patients for whom a request has been rejected for a service they claim is in the healthcare basket may submit a complaint to the National Health Insurance Law ombudsman.
  • Policyholders who require a service not included in the healthcare basket may contact their health plan's exceptions committee with a request to approve the required treatment ex gratia.

Who is Eligible?

All health plan policyholders.

How to Claim It?

Appealing Non-Provision of Services for Treatments Included in the Healthcare Basket

  • For more information on submitting an appeal to the health plan's ombudsman, click here.
  • For more information on submitting an appeal to the National Health Insurance Law ombudsman, click here.

Appealing Non-Provision of Services for Treatments Not Included in the Healthcare Basket

  • For cases in which the service, treatment or medication is not included in the healthcare basket, patients should contact their health plan's exceptions committee. For more information, click here.

Please Note

  • Policyholders planning on utilizing the assistance of an attorney or legal representative when submitting a request to an exceptions committee must inform the committee of this.
  • There is no hierarchy of the different bodies to which appeals may be submitted. Nonetheless, it is recommended to first contact the body responsible for handling complaints within the health plan, and only if that request is denied should an appeal be submitted to the National Health Insurance Law ombudsman.
  • When appealing to these different bodies, claimants may be assisted by the various volunteer organizations that help patients in such situations. See here for more details.

Court Rulings

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies

Laws and Regulations

Credits