Romania Insurance Claim Denied: How to Appeal Through ASF Romania and the Ombudsman

Romania's insurance market operates under both domestic law and EU regulation. Policyholders who face wrongful claim denials have access to the Financial Supervisory Authority, the public health fund, and a growing alternative dispute resolution infrastructure.

Romania's Insurance Regulatory Framework

The Autoritatea de Supraveghere Financiară (ASF) — Romania's Financial Supervisory Authority — regulates the insurance sector under Law No. 237/2015 on the insurance and reinsurance activity. ASF licences insurers, monitors solvency and conduct, and investigates consumer complaints. Key private health and life insurers in Romania include ALLIANZ-TIRIAC Asigurări, Generali Romania, Vienna Insurance Group (through Omniasig), UNIQA Asigurări, BCR Asigurări, and Groupama Asigurări.

The public health system operates through CNAS (Casa Națională de Asigurări de Sănătate) — the National Health Insurance House — which provides mandatory coverage for employed and self-employed persons who pay the health contribution (contribuția de asigurări de sănătate). CNAS contracts with public hospitals and private clinics in its network.

Common Reasons for Denial

• Non-contracted CNAS provider: Treatment at a clinic or hospital outside the CNAS network is not reimbursed; patients must use contracted providers for covered care.
• Contribution arrears: Gaps in social health contribution payments result in loss of CNAS entitlement.
• Private policy exclusions: Romanian private health policies commonly exclude pre-existing conditions for the first year, psychiatric treatment, dental restoration, and oncology drugs not listed on the national compensation list.
• Waiting periods: Maternity, chronic disease management, and specialist care often have 3–12 month waiting periods under private policies.
• Late claim submission: Most Romanian private insurers require claims within 30–90 days of the event; late submissions are rejected.

Step 1: Internal Complaint to the Insurer

Under Romanian law (Law No. 237/2015 and Government Ordinance 50/2010 on insurance contracts), insurers must respond to formal complaints within 30 calendar days.

Submit your written contestație (contestation) to the insurer's customer service or claims department. Include:

• Policy number and denial letter reference
• Medical diagnosis and records (scrisoare medicală, rezultate analize)
• Itemised invoices (facturi)
• Treating doctor's letter explaining clinical necessity
• Specific policy clause you believe supports your claim

Step 2: Complaint to ASF

If the insurer's response is inadequate or you receive no response within 30 days, file a complaint with ASF at its Bucharest headquarters on Splaiul Independenței, or through the online portal at asfromania.ro. ASF can investigate the insurer, demand documentation, and require corrective action.

For CNAS disputes, escalate to the Casa Județeană de Asigurări de Sănătate (CJAS) — the county-level health insurance house — or to CNAS head office in Bucharest.

Step 3: Mediator and Court Action

Romania's insurance industry participates in the Centrul de Mediere al Uniunii Mediatorilor din România for voluntary mediation. The Autoritatea Națională pentru Protecția Consumatorilor (ANPC) can also investigate consumer complaints against insurers.

Court action is taken in the Judecătoria (first instance court) or the Tribunal for larger commercial claims. Romanian courts apply Law No. 237/2015 and the Civil Code (Codul Civil) to insurance disputes.

Practical Tips for Romanian Policyholders

• Check CNAS portal: Verify your insurance status at cnas.ro or through the patient portal; contribution gaps appear here before a denial reaches you.
• 30-day deadline is statutory: If the insurer misses the 30-day response window, this is a violation of Law No. 237/2015; note it explicitly in your ASF complaint.
• ANPC for unfair terms: If the insurer's policy contains unclear or one-sided exclusion clauses, the ANPC can challenge the clause's validity under EU's Unfair Contract Terms Directive.
• Pre-authorisation in writing: Romanian private insurers increasingly require pre-authorisation (acord prealabil) for elective in-patient care; always get this in writing before admission.
• Co-payment disputes: CNAS covers a percentage of costs; disputes about the correct co-payment split between CNAS and the patient should go to CJAS first.
• EHIC cross-border: As an EU member state, Romanian CNAS cards function as the European Health Insurance Card (EHIC) in other EU countries; disputes about cross-border reimbursement go to CNAS.

Fight Back With ClaimBack

If your Romanian insurer or CNAS has denied your health claim, ClaimBack helps you prepare a well-reasoned appeal using ASF standards and Romanian insurance law.

Start your appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Insurance Ombudsman Guide