How to File a Complaint Against Your Health Insurance Provider

How to File a Complaint Against a Health Insurance Company in Germany Treatment denied? Response delayed? Here are your legal steps to reclaim your rights.

1. Understand Your Rights First In Germany, every insured person (whether in GKV or PKV) has the right to appeal against insurance company decisions, according to Sozialgesetzbuch V (SGB V).

Cases where you can complain:

• Refusal to cover treatment or surgery → Yes

• Delay in response to your medical request beyond 3 weeks → Yes

• Unprofessional behavior from staff → Yes

• Refusal to approve alternative treatment → Yes

• Incorrect or duplicate invoices → Yes

2. First Step: Internal Objection (Widerspruch)

• Must be filed within one month of receiving the rejection notice

• Sent in writing to the insurance company by post or fax (preferably registered mail – Einschreiben)

Simple template for objection:

Subject: Objection to decision dated [date]  

Dear Sir or Madam,  

I hereby object to your decision dated [date], in which you denied [describe decision].  

I request a re-examination and a detailed explanation.  

Sincerely,  
[Your full name]  
[Insurance number]  
[Signature]  

3. If No Response or Objection Rejected

• Next step: file an official complaint depending on insurance type

For GKV:

• Medical Service (MD) for medical issues

• Supervisory authority of the insurance fund:

  • AOK → State Ministry of Health

  • TK, DAK, Barmer → Federal Insurance Office

For PKV:

• Complaint to BaFin (Federal Financial Supervisory Authority): www.bafin.de

4. Free Support for Filing Complaints

• UPD – Patientenberatung: free and neutral advice, Tel. 0800 011 77 22

• Sozialverband Deutschland (SoVD): legal support for members at symbolic fees

• Verbraucherzentrale: templates, advice, complaint review at low cost

• Specialized lawyer in social law: if case escalates, may be covered by legal insurance

Summary