Submit a complaint about health services you that your HMO (kupat holim) provided

You can submit complaints about:

• eligibility for medications
• examinations
• treatments

You can also submit complaints about additional health services (Sha"ban) offered by the HMOs.

Complaints about staff behavior and malpractice can be submitted to The Medical Professions Ombudsman, according to the Patients’ Rights Law.

Who can submit a complaint

• Any HMO member can submit a complaint
• If you are not legally eligible to receive healthcare services, you'll receive a reply from the Ombudsman's office and will be referred to the appropriate authorities, if possible.

How to apply and what you need

1. Prepare:
   • a letter detailing the complaint
   • medical documents regarding the health issue and recommended treatment
   • copies of the correspondence — we recommend including copies of all correspondence with the HMOs on the subject of the complaint
   • personal details, such as full name, ID number, address, postal code, telephone number, the name of the HMO of the person submitting the complaint, and a fax number and email address, if available
     
     Also:
      
   • if your complaint is about payment for services, copies of receipts. You may be required to send original receipts later
   • if the complaint has to do with the emergency department, a copy of the discharge document from the emergency department
   • if you are being represented, power of attorney
   • if you are representing a someone else, a waiver of medical confidentiality
   • if your complaint regards someone who has died, a copy of an inheritance order or probate order
      
2. Submit the complaint online attaching your documents.

You may be asked to provided additional documents.

The service is provided free of charge

Handling of the complaint

1. Once the complaint has been received, it will be reviewed to establish if:
   • the Ombudsman has the legal authority to investigate
   • if there are grounds for the complaint
      
2. The complaint will either be passed on to arbitrating attorneys, or the applicant will receive one of the following responses:
   • there are no grounds for the complaint
   • the complaint is outside the ombudsman's authority
   • a request for additional information
     
     Complaints are investigated in cooperation with the complainant, the subjects of the complaint, and the relevant professional officials.
     
     The Ombudsman is authorized to require the agency or the employees who are the subject of the complaint, or any others, respond to questions and produce any document or report that, in the Ombudsman’s opinion, may help in the clarification of the complaint.
      
3. The Ombudsman will rule and notify the complainants and the subjects of the complaint:
   • The Ombudsman will determine whether the HMO is required to provide the requested service to the complainant as part of the health-services basket or as part of complementary insurance. If necessary, the decision may be enforced and the cost of the medical service may be refunded to the complainants.
   • When the Ombudsman rules that an HMO was required to provide a service that was withheld from the complainant, who consequently paid for private treatment, this sometimes helps in receiving a reimbursement from the HMO. If the HMO refuses to issue the refund, the Ombudsman’s decision can help sue for compensation for funds spent on private treatment from the regional labor court.
   • If the Ombudsman rules that the complaint has no grounds, you can still take the case to the regional labor court, which is authorized to judge claims against HMOs to provide health services that are included in the health-services basket.
   • Handling time depends on the complexity of the complaint, and the level of investigation required. In many cases, an answer is received within a few days of submitting the complaint, or within several months. In complicated and complex cases, it could take longer. Urgent cases are fast tracked depending on the circumstances.