# My health insurer will not pay a bill Your health insurer has not paid a bill, or not paid it in full. This guide shows how to first check whether there really is a refusal, what basic insurance covers, and how to proceed if the insurer refuses a benefit: from asking for the reasons, through the ruling, to the objection and the appeal. This guide covers: Compulsory basic health insurance (KVG) and what to do if your health insurer does not pay a bill, or does not pay it in full. Not covered: Supplementary insurance (semi-private, private, dental supplementary, cover abroad and similar), disputes with service providers about the amount of their fee as such, and questions of accident, invalidity or military insurance. ## Your answers - Is this about compulsory basic insurance or about supplementary insurance? (Basic insurance (compulsory) / Supplementary insurance / I don't know) - What is the bill or refusal about? (Medical or hospital treatment / Medicine / Dental treatment / Something else, for example an aid or therapy / I don't know) - How is the bill settled? (The insurer pays the doctor or the hospital directly (tiers payant) / I receive the bill and have to submit it (tiers garant) / I don't know) - Did the treatment need the insurer's approval in advance (a cost guarantee)? (Yes / No / I don't know) - How far have you got in the procedure with the insurer? (I received a refusal, but no ruling / I received a ruling / My objection was decided by an objection decision / I don't know) ## Deadline You can file an objection against a ruling of your health insurer within 30 days, with the body that issued the ruling. What matters is the notice of legal remedies at the end of the ruling. The time limit begins on the day after service. If the last day falls on a Saturday, Sunday or public holiday, it ends on the next working day, and the time limit stands still over Easter, in summer and over Christmas. In health insurance, you can file the objection in writing, or raise it orally if you attend in person; if oral, the insurer records it in a statement, which you or your representative sign. The objection must state what you are asking for, and briefly give reasons why. It is in time if you submit it, or hand it to the post office, at the latest on the last day. *Applies if: How far have you got in the procedure with the insurer? → I received a ruling / I received a refusal, but no ruling / I don't know* Sources: [ATSG · Art. 52](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_52), [ATSV · Art. 10](https://www.fedlex.admin.ch/eli/cc/2002/569/de#art_10), [ATSG · Art. 38](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_38), [ATSG · Art. 39](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_39) You can appeal against the objection decision to the cantonal insurance court within 30 days of service. The court of the canton where you live when you file the appeal has jurisdiction. Here too, the time limit stands still over Easter, in summer and over Christmas, and if the last day falls on a Saturday, Sunday or public holiday, it ends on the next working day. The appeal must briefly describe the facts, contain a request and be reasoned; if something is missing, the court will give you a time limit to correct it. The court establishes the facts itself and is not bound by your requests. It can even amend the decision to your disadvantage, but must first give you the opportunity to comment or to withdraw the appeal. *Applies if: How far have you got in the procedure with the insurer? → My objection was decided by an objection decision / I don't know* Sources: [ATSG · Art. 56](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_56), [ATSG · Art. 58](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_58), [ATSG · Art. 60](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_60) ## Watch out If your bill concerns dental treatment, basic insurance only covers this as an exception: if a serious, unavoidable disease of the chewing apparatus makes the treatment necessary, if a serious general disease or its consequences require or make necessary the dental treatment, or if an accident has damaged the chewing apparatus. Ordinary dental treatment, including for tooth decay or gum disease, is generally not covered. So check whether one of these exceptions applies, and have this confirmed in writing by the treating dentist before you file an objection. *Applies if: What is the bill or refusal about? → Dental treatment* Sources: [KVG · Art. 31](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_31) If you choose the written form, the objection must bear your signature. An ordinary email does not meet this requirement and does not preserve the time limit, even if it arrives in time; there is no further time limit to correct this after the deadline, because the missing signature is treated as deliberate. It is different if you simply forgot to sign a letter: the insurer must then give you a time limit to add it. As long as the objection time limit is still running, you can remedy the defect by submitting a signed version. So use the post, hand it in personally, or raise the objection orally instead by attending in person. *Applies if: How far have you got in the procedure with the insurer? → I received a ruling / I received a refusal, but no ruling / I don't know* Sources: [ATSG · Art. 52](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_52), [ATSV · Art. 10](https://www.fedlex.admin.ch/eli/cc/2002/569/de#art_10), [BGE 142 V 152, E. 4.6](https://mcp.opencaselaw.ch/entscheid/bge_BGE_142_V_152#e-4-6) Your right to an outstanding benefit lapses after five years, calculated from the end of the month in which the benefit would have fallen due. Under tiers garant, this time limit for your reimbursement begins when the service provider's bill reaches you. So do not wait too long to assert your claim, even if you are still in discussion with the insurer. Submit the bill to the insurer in good time. Sources: [ATSG · Art. 24](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_24), [BGE 139 V 244, E. 3](https://mcp.opencaselaw.ch/entscheid/bge_BGE_139_V_244#e-3) ## What to do **1.** If you received the bill yourself and have not yet submitted it, do so with all the details to your insurer for reimbursement. Keep a copy. If the insurer is missing information, for example on the diagnosis or the treatment, it can request this from the service provider; that delays processing, but is not yet a refusal. Only once the insurer tells you that it will not pay, or not pay in full, is there a genuine refusal, and the following steps apply. *Applies if: How is the bill settled? → I receive the bill and have to submit it (tiers garant)* Sources: [KVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_42) **2.** If your insurer pays the service provider directly, the service provider must still send you a copy of the bill that goes to the insurer, without being asked. Check this copy: are the treatment, the date and the amount correct? Your insurer will bill you for your cost-sharing. If you receive a bill for a service that the insurer does not cover, first clarify with the insurer why it has not paid before you pay it yourself. *Applies if: How is the bill settled? → The insurer pays the doctor or the hospital directly (tiers payant)* Sources: [KVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_42) **3.** If the insurer refuses a benefit or pays less than expected, first ask in writing for the reasons. Benefits under basic insurance are usually dealt with informally under the law, even where a substantial amount is at stake. If you do not agree with this informal notice, you have the right to ask for a formal ruling. Ask for this in writing, and as soon as possible. A ruling contains a statement of reasons, to the extent it does not fully grant your request, and a notice of legal remedies. Only against this ruling can you file an objection. *Applies if: How far have you got in the procedure with the insurer? → I received a refusal, but no ruling / I don't know* Sources: [ATSG · Art. 51](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_51), [KVG · Art. 80](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_80), [ATSG · Art. 49](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_49), [BGE 133 V 188, E. 3.3](https://mcp.opencaselaw.ch/entscheid/bge_BGE_133_V_188#e-3-3) ## The law Before you assume there has been a refusal, check what the bill actually says. Often it is not a refusal at all, but your own cost-sharing: the deductible, a fixed annual amount you bear yourself first, and then the co-payment of 10 percent of the further costs. This is provided for by law and is not the insurer refusing benefits. Also check the billing system: under tiers payant, the insurer pays the doctor or the hospital directly, and you only receive a copy of the bill for your records. Under tiers garant, you receive the bill yourself and initially owe the money to the service provider; the insurer only reimburses you once you submit the bill to it. A bill that has not yet been submitted, or not yet processed, is therefore not yet a refusal. Submit the complete, understandable bill and wait for the insurer's reply before you consider further steps. Sources: [KVG · Art. 64](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_64), [KVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_42) Basic insurance only covers what the law names as a benefit: in particular medical treatment and treatment ordered by a doctor, hospital stays in the general ward, prescribed medicines and tests, and a contribution towards certain other costs. Every benefit must also be effective, appropriate and cost-efficient. For medical treatment, a presumption applies in your favour: treatment by a doctor is regarded as covered as long as it is not expressly excluded by a list. If the insurer disputes in an individual case that medical treatment was effective, appropriate or cost-efficient, you can ask for a ruling on it. For services from other service providers, and for preventive care and dental treatment, it is the other way round: they are only covered if they are expressly listed. Sources: [KVG · Art. 24](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_24), [KVG · Art. 25](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_25), [KVG · Art. 32](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_32), [KVG · Art. 31](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_31), [KVG · Art. 33](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_33) The law expressly makes some benefits subject to the insurer's prior approval, a cost guarantee. This applies, for example, to a medicine from the Specialities List that is used outside its approved product information or limitation: here, basic insurance only covers the costs with a special guarantee, after consulting the medical adviser. If the application is complete, the insurer must decide within two weeks, and if it refuses, it must give reasons to the treating person and to you. If such approval was needed for your treatment and was not obtained or was refused, ask for the written reasons and have it checked whether the legal requirements would have been met. *Applies if: Did the treatment need the insurer's approval in advance (a cost guarantee)? → Yes / I don't know* Sources: [KVV · Art. 71a](https://www.fedlex.admin.ch/eli/cc/1995/3867_3867_3867/de#art_71a), [KVV · Art. 71d](https://www.fedlex.admin.ch/eli/cc/1995/3867_3867_3867/de#art_71d) ## Costs The objection procedure with the insurer is free of charge; however, you are generally not compensated for your own time and effort. Appeal proceedings before the cantonal insurance court are also, in principle, free of charge for disputes over benefits, unless the court finds that you acted wantonly or recklessly. If you win in court, you are entitled to reimbursement of your party costs. The right to be represented by a lawyer is guaranteed; if your circumstances justify it, you will be granted free legal representation if you need it. Sources: [ATSG · Art. 52](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_52), [ATSG · Art. 61](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_61) ## Advice If this is about supplementary insurance, for example for a semi-private or private hospital ward, dental care, complementary medicine, glasses or cover abroad, this guide does not apply to you. Supplementary insurance is a private contract under the Insurance Contract Act (VVG), not the Health Insurance Act (KVG). Different time limits apply, along with a different procedure for a refusal and different dispute resolution. There is a separate guide for supplementary insurance. If your bill concerns basic insurance in part and supplementary insurance in part, what is said here still applies to the basic-insurance part. *Applies if: Is this about compulsory basic insurance or about supplementary insurance? → Supplementary insurance / I don't know* Get personal advice if a larger amount is at stake, if the insurer refuses ongoing or recurring treatment, if medical questions about effectiveness or necessity are in dispute, if you have received a ruling and the time limit is already running, or if it is unclear whether this concerns basic insurance or supplementary insurance. Because the time limits are short, do not wait in that case. ## Help Free help is available from the Health Insurance Ombudsman's Office: it advises and mediates on unclear points and disputes with your insurer, independently and free of charge for you, financed by contributions from all Swiss health insurers. Many cantons also offer free legal information, and the cantonal insurance courts publish information about the appeal procedure on their websites. ## Sources - [KVG · Art. 64](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_64) - [KVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_42) - [KVG · Art. 24](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_24) - [KVG · Art. 25](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_25) - [KVG · Art. 32](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_32) - [KVG · Art. 31](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_31) - [KVG · Art. 80](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_80) - [KVV · Art. 71a](https://www.fedlex.admin.ch/eli/cc/1995/3867_3867_3867/de#art_71a) - [KVV · Art. 71d](https://www.fedlex.admin.ch/eli/cc/1995/3867_3867_3867/de#art_71d) - [ATSG · Art. 51](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_51) - [ATSG · Art. 49](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_49) - [ATSG · Art. 52](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_52) - [ATSG · Art. 38](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_38) - [ATSG · Art. 39](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_39) - [ATSG · Art. 56](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_56) - [ATSG · Art. 58](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_58) - [ATSG · Art. 60](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_60) - [ATSG · Art. 61](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_61) - [ATSG · Art. 24](https://www.fedlex.admin.ch/eli/cc/2002/510/de#art_24) - [ATSV · Art. 10](https://www.fedlex.admin.ch/eli/cc/2002/569/de#art_10) - [BGE 133 V 188, E. 3.3](https://mcp.opencaselaw.ch/entscheid/bge_BGE_133_V_188#e-3-3) - [BGE 139 V 244, E. 3](https://mcp.opencaselaw.ch/entscheid/bge_BGE_139_V_244#e-3) - [BGE 142 V 152, E. 4.6](https://mcp.opencaselaw.ch/entscheid/bge_BGE_142_V_152#e-4-6) - [KVG · Art. 33](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de#art_33) ## Official information - [Health Insurance Ombudsman's Office](https://www.om-kv.ch/de/) - [Federal Office of Public Health: health insurance benefits](https://www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife.html) - [priminfo: information on health insurance](https://www.priminfo.admin.ch/) --- Statute texts checked on 28 September 2026. General legal information. It does not replace individual advice. https://swisslaw.io/en/health/refused-bill/ · swisslaw.io, health.refused-bill, 2026-09-28 · CC BY 4.0