A complaint is a formal tool to protect your health insurance rights.When an insurance fund (e.g. NHIF or private health fund) refuses to cover an expense or delays payment, you can file an administrative complaint.This applies to both compulsory insurances andadditional.Here's how to do it - step by step.
When do you have the right to file a complaint?
They can file a complaint when the following situations are present:
- The health fund refuses to cover a service approved by regulation;
- Delayed payment of already recognized costs;
- Refusal due to "lack of grounds", despite valid documents;
- Unfounded request for additional payment by the medical facility;
- Administrative error processing documents.
Where is the appeal filed?
| Институция | Кога се подава? |
| Районна здравноосигурителна каса | При отказ или забавяне от страна на НЗОК. |
| Централно управление на НЗОК | При нерешен проблем със здравни разходи от районната каса. |
| КЗЛД/Омбудсман | При нарушени права, неправомерна обработка на лични данни. |
| Комисия за финансов надзор (КФН) | При спор с частен здравен фонд. |
| Съд (административен) | Когато жалбата не е уважена от горните органи. |
What should the complaint contain?
The complaint must be clear, specific and supported by documents.It includes:
- Your personal data – three names, social security number, address for correspondence;
- Data on the institution or person against whom the complaint is directed;
- Description of health care expense problem - date, location, type of service;
- A specific request - for example: "to recognize the expenditure of BGN 240.";
- Attached evidence - epicrisis, invoices, opinions;
- Signature and date.
You can download a complaint form from the website of the National Health Insurance Fund or the FSC, or submit the complaint in free text.
How can you file a complaint?
| Метод | Подробности |
| На място | В деловодството на РЗОК, НЗОК или съответния орган. |
| По пощата | С препоръчано писмо с обратна разписка. |
| Онлайн | Чрез електронен подпис в портала на НЗОК или КФН. |
| По имейл | До официалния имейл адрес на институцията (не винаги е допустимо). |
In what period is the appeal considered?
- 14 days– standard deadline for a response from the RHOC or NHOC;
- 1 month– in more complex cases, the deadline can be extended;
- 6 months– maximum term for an administrative procedure under the ZAP.
If you do not receive a response within the specified time, you can file a report of inaction or file a legal appeal.
How to increasethemthe chances of the appeal being upheld?
- Applyall documents, which prove the case;
- Describespecifically what right has been violatedand why;
- Use itofficialandclear language, no emotional expressions;
- If necessary, searchassistance from a lawyeror patient organization.
More information on international health insurance can be found atthis link!
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A complaint is a formal tool to protect your health insurance rights.When an insurance fund (e.g. NHIF or private health fund) refuses to cover an expense or delays payment, you can file an administrative complaint.This applies to both compulsory insurances andadditional.Here's how to do it - step by step.
When do you have the right to file a complaint?
They can file a complaint when the following situations are present:
- The health fund refuses to cover a service approved by regulation;
- Delayed payment of already recognized costs;
- Refusal due to "lack of grounds", despite valid documents;
- Unfounded request for additional payment by the medical facility;
- Administrative error processing documents.
Where is the appeal filed?
| Институция | Кога се подава? |
| Районна здравноосигурителна каса | При отказ или забавяне от страна на НЗОК. |
| Централно управление на НЗОК | При нерешен проблем със здравни разходи от районната каса. |
| КЗЛД/Омбудсман | При нарушени права, неправомерна обработка на лични данни. |
| Комисия за финансов надзор (КФН) | При спор с частен здравен фонд. |
| Съд (административен) | Когато жалбата не е уважена от горните органи. |
What should the complaint contain?
The complaint must be clear, specific and supported by documents.It includes:
- Your personal data – three names, social security number, address for correspondence;
- Data on the institution or person against whom the complaint is directed;
- Description of health care expense problem - date, location, type of service;
- A specific request - for example: "to recognize the expenditure of BGN 240.";
- Attached evidence - epicrisis, invoices, opinions;
- Signature and date.
You can download a complaint form from the website of the National Health Insurance Fund or the FSC, or submit the complaint in free text.
How can you file a complaint?
| Метод | Подробности |
| На място | В деловодството на РЗОК, НЗОК или съответния орган. |
| По пощата | С препоръчано писмо с обратна разписка. |
| Онлайн | Чрез електронен подпис в портала на НЗОК или КФН. |
| По имейл | До официалния имейл адрес на институцията (не винаги е допустимо). |
In what period is the appeal considered?
- 14 days– standard deadline for a response from the RHOC or NHOC;
- 1 month– in more complex cases, the deadline can be extended;
- 6 months– maximum term for an administrative procedure under the ZAP.
If you do not receive a response within the specified time, you can file a report of inaction or file a legal appeal.
How to increasethemthe chances of the appeal being upheld?
- Applyall documents, which prove the case;
- Describespecifically what right has been violatedand why;
- Use itofficialandclear language, no emotional expressions;
- If necessary, searchassistance from a lawyeror patient organization.
More information on international health insurance can be found atthis link!