13. French Health System - Complaints
If you have a complaint about charges, reimbursements or access to health, in the first instance you should contact your local Caisse.
For non-active persons it is the Caisse Primaire d’Assurance Maladie (CPAM) and for those who are self-employed the Régime Social des Indépendants.
If you have a complaint against refusal by your Caisse for affiliation or reibursements then you can appeal to a body called the Commission de Recours Amiable.
You need to appeal with two months of formal notification of the decision that you wish to contest. The CRA should make their own decision within one month of having received all necessary documents. In the event there is no news within a month then the case is considered to have been rejected.
There is also an ombudsman system through an official and ‘independent’ Conciliateur.
The decision of the Conciliateur is non-binding on both sides, but as a general rule, their recommendations are respected.
You can contact the Conciliateur through your local Caisse or RSI.
Other than the CRA or conciliateur, you can go to the main independent ombudsman, called the Défenseur des droits. They are equally empowered to receive complaints.
Beyond all of this you will need to take your complaint to a specialist tribunal called Tribunal des affaires de sécurité sociale (TASS).
If you have a complaint about medical treatment then, in the first instance, you should take it up with service concerned, failing which you can make a formal complaint to a conciliation body called Commissions régionales de conciliation et d'indemnisation des accidents médicaux, des affections iatrogènes et des infections nosocomiales (CRCI). These regional boards have the power to award compensation payments.
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