Appealing an Insurance Company's Denial to Cover Costs for Medical Treatment Outside Israel

The appeal is submitted in two stages.

1. Sending the form and the accompanying documents:
   You have to print out the registration form for considering the appeal to the Appeals Committee for Health Services Received outside Israel (Hebrew) and include in it the following details:
   • The disease from which the appellants suffer.
   • The requested treatment abroad.
   • The name of the medical institution that provides the requested treatment.
   • Why receiving the approval for treatment abroad is justified according to the terms of the regulations.

   The form should be filled out clearly, ensuring that all the fields are filled out and specifying the names of treating or consulting physicians who recommend receiving the treatment abroad.
   It is important to fill in a current email address, in order to receive instructions regarding the continuation of the appeal process.

   Additional documents to be attached to the form:

   • The written response of the HMO, in which it refuses to finance the requested service abroad.
   • Appeal letter against the HMO’s decision.
   • Medical recommendation regarding the need to carry out the treatment abroad.
   • Medical confidentiality waiver (Hebrew).
   The documents should be sent to the Director regarding the Regulations of the State Health Insurance Law in one of the following two ways:
   • Email: [email protected]
   • Fax: 02-5655954.
2. Sending additional medical documents according to the instructions received by e-mail.
   More details can be obtained from the committee coordinator by phone: 02-5080729.

1. The coordinator of the appeals committees in the Health Directorate forwards the letter of  appeal to the HMO for obtaining its response.
2. The coordinator of the appeals committees forwards the HMO response to the applicants.
3. The applicants send to the coordinator of the committees their response to the HMO's reply.
4. The materials will be forwarded to the Director General of the Ministry of Health (or someone authorized by him), to check whether the two required conditions are met (the ones which are listed in the section on the conditions for receiving the service), so that the requested medical service is considered a health service that can be received abroad.
5. If both conditions are met in fact, the Director orders that the appeal be forwarded to the Appeals Committee for Health Services outside of Israel:
   • The Appeals Committee consists of three physicians, who practice in the medical field discussed in the appeal
   • The members of the committee are appointed by the Director.
     Clarification regarding the identity of the committee members:
     In order to ensure a fair hearing, the regulations state that a physician who treated the insured persons regarding whom the hearing is being held, and who gave a medical opinion to the insured persons or the HMO in their case, is not to participate in the committee's hearing.
6. The committee holds its hearings without summoning the parties, it is satisfied, for the purpose of making a decision, with the written materials brought before it.
   • The committee is authorized to obligate the HMO to finance a health service abroad in the amount not exceeding $250,000.
   • As a part of its deliberations, the committee discusses the eligibility of the appellants to receive the funding of the required health service abroad, according to the two conditions for eligibility (which are detailed in the section on the conditions for receiving the service).
   The committee sends its reasoned decision - accepting or rejecting the appeal - by email to the email address entered in the form.

The working procedures of the appeal committee were determined in the Health Directorate of the Ministry of Health circular numbered 73/2002 (Hebrew) dated 12/17/2002.

More information can be found in the following documents (Hebrew):

• State Health Insurance Law Regulations (Health Services Received Outside of Israel), 5755 - 1995.
• General Directorate Circular No. 07/2006 - Financing of Organ Transplants Outside of Israel.