Appealing a refusal of coverage for scheduled treatment

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The following applies if you intend to seek treatment in another EU/EEA country or Switzerland. For certain types of care, you must be issued a certificate of prior authorization (S2 certificate) by your French health insurance fund. Without this document, your treatment will not be covered.

Your authorization (S2 certificate) will be granted if the following conditions are met:

You will receive notice of prior authorization or refusal of coverage from your health insurance fund within 14 days of receipt of your application. If you receive no response within this timeframe, your application has been approved.

To appeal a denial of an S2 certificate application, you may:

  1. Appeal to your health insurance fund's arbitration board (Commission de Recours Amiable/ CRA)
  2. If the arbitration board upholds the denial, you may appeal to the court of Social Security Affairs (Tribunal des affaires de sécurité sociale/ TASS).

If you application has been denied on medical grounds, you must first ask your health insurance fund to conduct a medical assessment. To contest your health insurance fund's application of the conclusions of the medical assessment, you may appeal first to your health insurance fund's board of arbitration (Commission de recours amiable/ CRA) and then to the Court of Social Security affairs.