Appeals and complaints

Appeals and Complaints Regarding Medical Services
Received and/or Not Rendered

Someone who is insured and claims that he/she was deprived of his/her rights or harmed by a health plan (kupat cholim) employee or affiliate may submit a complaint to one of the following bodies:


1. Health Plan/Medical Institution Public Complaints Commissioner (Ombudsman) – In every medical institution there must b­­­­­e an appointed complaints commissioner who manages complaints against the institution. Click here to send a complaint regarding receipt of services to the relevant health plan e-mail address (Hebrew).


2. Health Ministry Complaints Commissioner (Ombudsman)

      • According to the law, the Minister of Health appoints a commissioner whose job is to deal with complaints against the health plans, against anyone who provides services on behalf of the health plans (ie: doctor 
      • or paramedical profession), and against any of their employees or any individual working on their behalf. The sole condition is that the complaint must be related to the fulfilling of professional duties according to the National Health Insurance Law.
      • According to the amendment to National Health Insurance Law, beginning from January 2006, the commissioner has the authority to enforce his/her decisions on the health plans. Accordingly, the insured whose complaint was found   to be justified is not required to turn to the Labor Court in order to claim his/her rights.
      • For the commissioner’s website, Click here (Hebrew).


3. Court Petition

      • The Labor Court is the only court with the authority to judge in every case between an insured individual or an individual who claims to be insured and the Minister of Heath/the manager/the institution/the health plan who provides services according to the law.

 

      • As part of the Labor Court proceedings, it is possible to receive “temporary assistance”, meaning a temporary court order instructing the health plan to temporarily fund a specific treatment until the court reaches a verdict in the case and clarifies if there is or is not a right for funding of the treatment.  

 

4. Exceptions Committee

  •  In some cases, it is possible to refer to an Appeals Committee or an Exceptions Committee which acts in the framework of the health plan/medical institution in order to appeal a decision to not fund a specific medicine or service.
  • For more information regarding the judicial review of health plans and exceptions committees, click here for the Dolev Foundation's English-language website.

 

For more information on actions taken by The Society for Patients Rights in Israel to propose health-related legislation, submissions to Knesset members and cases brought to the Supreme Court, click here.

 

Click here to see the legal verdict which determined that when a public authority (the Public Complaints Commissioner) possesses information, he/she must allow public study of the information and cannot claim that the information is not found according to the requested format or that the request requires unreasonable resources (Hebrew).

 

Note:  For additional details and addresses, see Appendix F to The Society for Patients Rights in Israel’s document concerning rights of the insured (Hebrew).

 

Translated by The Shira Pransky Project