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.

You wish to appeal a denial of an S2 certificate application

Appealing an administrative decision

You must first apply to your health insurance fund's arbitration board (“Commission de recours amiable”/ CRA) (list of health insurance funds – CPAM).

If your appeal is denied, you can then bring proceedings before the court of social security affairs (“Tribunal des affaires de sécurité sociale”/ Tass).

As a last resort, you can appeal before the court of appeals (“Cour d'appel") and/or the Court of Cassation (“Cour de cassation”).

Appealing a medical decision

You must first apply to your health insurance fund (CPAM) for an expert medical assessment.

To dispute how your health insurance fund (CPAM) applies the expert's findings, you can appeal to your CPAM's arbitration board (“Commission de recours amiable”/ CRA) within a 2-month deadline following notice of the decision you wish to dispute.

You may then choose to bring proceedings before the court of social security affairs (“Tribunal des affaires de sécurité sociale”/ Tass) within a 2-month deadline following notice of the arbitration board's decision. As a general rule, the Tass with jurisdiction is the one that is local to your place of residence. It is located at the same address as your local court known as the “Tribunal de Grande Instance”/ TGI. You will need to submit your application by registered letter to the secretary of the Tass whose address appears on the notice of the arbitration board (CRA)'s decision that you are appealing, or drop it off at the Tass' administrative office (“secretariat”), within a 2-month deadline:

As a last resort, you can appeal to the court of appeals (“Cour d'appel”) and/or to the Court of cassation (“Cour de cassation”). If your decision from the Tass is handed down “en dernier ressort” (this is the case for disputes involving an amount less than €4,000) you can apply to the Court of cassation (“Cour de cassation”) within a 2-month deadline following the date of notice from the Court of Social Security Affairs (Tass).

If the decision from the Tass is handed down “en premier ressort” (this is the case for disputes involving an amount above €4,000 or when the amount is undetermined), you can appeal before the Social division of the Court of Appeals (“chambre sociale de la cour d'appel”) within a 1-month deadline following notice from the Tass. If you are not satisfied with the decision from the Court of Appeals, you can then apply to the Court of Cassation (“Cour de cassation”) within a 2-month deadline following notice from the Court of Appeals.

The French Justice Ministry's website lists contact information to help you find the courts to which to apply by entering the name of the town in which the fund that denied your S2 form is located.