Health Insurance Ombudsman: how to use it?

Verified 21 October 2022 - Directorate for Legal and Administrative Information (Prime Minister)

You have filed a claim with your Caisse and you are not satisfied with its answer? It is possible, under certain conditions, to refer the matter to the Ombudsman free of charge. The mediator is the conciliator. In some cases, especially if you have difficulties in declaring a treating doctor, you can contact the Ombudsman directly.

All users of the general sickness insurance scheme may apply to the Ombudsman.

You can contact the Ombudsman if you are in one of the following situations:

  • You feel you're being denied care
  • Your complaint concerns your relationship with a doctor (e.g. you are unable to appoint a treating doctor or you have difficulties in getting an appointment with a specialist doctor within a satisfactory time frame)
  • You want to highlight a malfunction of your Caisse (examples: opening hours, quality of reception, processing time)
  • The cash register's answer doesn't satisfy you
  • You have not received a response from your fund


Referring to the Ombudsman does not prevent you from appealing to the Defender of Rights.

You must write to the mediator and send your mail to your health insurance fund.

Please note

An acknowledgement of receipt of your mail is always sent to you.

Some cash registers:

  • Offer to send the complaint to the Ombudsman by email 
  • Provide a telephone reception or by appointment

For more information, contact your cash register.

Who shall I contact


CPAM posts a questionnaire Difficulties in accessing a attending physician to be attached to the mail if you cannot appoint a attending physician.

The mediator considers your request: it is not intended to settle a dispute, but it establishes or re-establishes a communication between the caisse and you.

It may:

  • Explain the contested decision
  • Accompany you to find a solution acceptable to you and your Caisse
  • Seek to find a compromise, whether in your dealings with your fund or with your doctor.


conciliation is not a substitute for other remedies. It does not interrupt the limitation period.

On the other hand, the proceedings before a court end the conciliation procedure.