CNAS Health Insurance Denied in Romania: Appeal

The Casa Națională de Asigurări de Sănătate (CNAS) manages Romania's public health insurance system, paying for medical services at contracted hospitals, clinics, and pharmacies across the country. When CNAS or your county health insurance house (CJAS) denies coverage, reimbursement, or drug compensation, you have up to 30 days to file a formal challenge. Acting within this window is critical.

How CNAS Coverage Works

Every Romanian who pays health insurance contributions (contribuție la asigurările sociale de sănătate, or CASS) through their employer or independently is entitled to CNAS benefits. Your insurance status — whether you are an asigurat — is verified through the Romanian national health card (cardul național de sănătate) and the national e-health records system (SIUI/RNCB).

CNAS reimburses providers according to agreed tariffs and protocols. Patients access services by:

1. Registering with a medic de familie (family physician/GP) on CNAS's list
2. Obtaining a bilet de trimitere (referral) from the GP for specialist care or diagnostics
3. Attending a contracted facility (furnizor aflat în relație contractuală cu CNAS)
4. Using a compensated prescription (prescripție compensată) for drugs on the national list

Failures at any of these steps are the most common sources of CNAS denial.

The Most Frequent CNAS Denial Reasons

Inactive insured status (asigurat inactiv): If contributions have not been paid — by you or your employer — your CNAS entitlement is suspended. This is especially common for:

• Freelancers (PFA — persoană fizică autorizată) who missed quarterly contribution payments
• Recently unemployed people transitioning between employer-covered and self-covered status
• Those who recently moved to Romania or changed employment status

Check your current status at the CNAS national portal or via the Ghișeul.ro platform. If your status is inactive due to administrative error or processing delay, correcting this is step one before filing any other appeal.

Missing or expired bilet de trimitere: The referral from your medic de familie is required for most specialist visits and diagnostic tests. It is valid for 90 days. If you attended a specialist after the referral expired, or without one entirely, CNAS will not cover the cost.

Non-contracted provider: Not all hospitals and clinics in Romania are contracted with CNAS. Private clinics in particular often operate outside the CNAS system. Before any non-emergency treatment, confirm the provider has a current CNAS contract (contract cu CJAS) for the specific service you need. Contracts must be renewed annually and lists are published on each CJAS website.

Drug reimbursement denied: Drugs are compensated (100% or 90% reimbursed) only if they appear on the Lista medicamentelor compensate și gratuite and if the prescription meets clinical protocol requirements. Common denial reasons: the drug is prescribed outside the approved indication, the patient is not registered under the correct chronic disease programme (program național de sănătate), or the prescribing physician submitted an incorrect ICD-10 code.

Overstepping CNAS volume limits: CNAS contracts specify the number of services a facility can provide per month. If a provider has reached its contractual limit for the month (often the case in high-demand specialties), CNAS will not reimburse services beyond that threshold — even if clinically performed.

Filing a Contestație: The Formal Appeal

Deadline: 30 Days

You have 30 calendar days from the date you received the written denial or the date the CNAS decision was communicated to you. Missing this deadline forfeits your right to an administrative contestație — you would have to proceed directly to court, which is more complicated and expensive.

Where to File

• If the decision was issued by your CJAS (county health insurance house): file with the same CJAS, addressed to the director
• If the decision was issued by CNAS centrally: file with CNAS Headquarters (Calea Călărașilor 248 Bl. S19, Sector 3, București)
• In Bucharest: the Casa de Asigurări de Sănătate a Municipiului București (CASMB) handles Bucharest insured individuals

How to Submit

Send by registered post with acknowledgement of receipt (scrisoare recomandată cu confirmare de primire) and keep the postal receipt and acknowledgement. You can also submit in person at the CJAS office and request a date-stamped copy.

Content of the Contestație

Your written contestație should include:

• Your full name, CNP (Cod Numeric Personal — your 13-digit national ID number), and address
• Your CNAS card number and insurance registration details
• Reference number and date of the CNAS/CJAS decision you are challenging
• A clear statement that you contest the decision and the specific grounds:
  • Your contributions are current (attach recent CASS payment confirmation — adeverință de asigurat from your employer or the ANAF fiscal attestation if self-employed)
  • You had a valid bilet de trimitere (attach a copy)
  • The provider was contracted (attach evidence from the CJAS website)
  • The drug meets the compensated list criteria (attach clinical protocol documentation from your physician)
• All supporting documents attached as copies

CJAS Response

The CJAS or CNAS has 30 days to resolve your contestație and issue a new administrative decision (decizie). They may approve your claim, modify it, or uphold the original denial.

Administrative Court — Next Step

If the contestație is rejected, you can file an acțiune în contencios administrativ under Legea nr. 554/2004 before the competent Tribunal (secția de contencios administrativ și fiscal). You typically have 6 months from the date of the CJAS/CNAS rejection of your contestație to file in court.

Legal representation by an attorney (avocat) is effectively required at this level. The court examines whether CNAS/CJAS applied the law correctly — not whether the treatment was clinically appropriate.

Practical Tips

• Check your asigurat status first: Visit the CNAS portal (cnas.ro) or Ghișeul.ro to confirm your insurance is active before spending time on other appeal steps
• Keep all original documents: Your medic de familie can reissue a referral; your CJAS can confirm your contracted status — gather these proactively
• Contact your medic de familie: For drug reimbursement denials, your GP can often correct the prescription coding or refile under the correct chronic disease programme without formal appeal
• CNAS information line: 021 313 9775

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal