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Health insurance conciliator: how do we use it?

Verified 17 avril 2020 - Directorate for Legal and Administrative Information (Prime Minister)

The health insurance conciliator examines disputes between users and health insurance funds. He shall act as mediator. It can also help users in the practice of the route of care (choice of the treating doctor, coordination of care).

All users of the general health insurance scheme may refer the matter to the conciliator.

Enter conciliator

You can contact the conciliator if you are in one of the following cases:

  • You feel that you have been denied care
  • Your complaint concerns your relationship with a doctor. For example, you are unable to appoint a doctor or have difficulty getting an appointment with a specialist doctor in a timely manner.

Why seize the conciliator?

You can contact the conciliator only if:

  • You are not satisfied with the caisse's answer
  • You have not received a reply from your caisse

  FYI : the conciliator does not prevent you from appealing to the Advocate..

Write to the conciliator and mail to your health insurance fund. Some caisses offer to send the complaint to the conciliator by email or provide a telephone welcome. For more information, contact your caisse.

Who shall I contact

  FYI : an acknowledgement of receipt is always sent to the user.

The conciliator is considering your request. He shall perform the duties of Ombudsman: it is not intended to settle a dispute, but it establishes or restores communication between the caisse and you. He can explain the decision under appeal. He may also propose to the credit union a decision that would end the dispute.

  FYI : conciliation does not replace other remedies. She doesn't interrupt the limitation period.. On the other hand, the proceedings before a court put an end to the conciliation proceedings.