Refusal of State-funded treatment: how to appeal: what to do under Georgian law

What to do

1. Who refused: the programmes are run by the National Health Agency under the State control of the Ministry of Health (Decree on the 2026 State Health Programmes, Art. 6); the functions of the Social Service Agency relating to health programmes have been transferred to the National Agency (Decree on the National Health Agency, Art. 2); the agency, as a legal entity under public law, is an administrative body, and its refusal is an administrative act (General Administrative Code of Georgia, Art. 2). For a clinic’s refusal, see below.
2. Deadlines come first: an administrative complaint must be filed within 1 month of official notification of the decision (GAC, Art. 180); a missed deadline is restored if there was a valid reason (GAC, Art. 180); the complaint is considered by the body itself, by a superior official within it; an act issued by the head is appealed to the superior body (GAC, Art. 178); the complaint is considered within 1 month (GAC, Art. 183). Silence: within 10 working days the agency must recognise you as a beneficiary and issue the voucher or consent letter, or state in writing the obstacles (Decree No. 474, general rules, Art. 11); failure to decide within the deadline is treated as a refusal (GAC, Art. 177).
3. Court: without an appeal to the body, the court will not accept the claim (APC, Art. 2); a claim to oblige the issue of an act (voucher or consent) must be filed within 1 month of receiving the refusal (APC, Art. 23); if no decision on the complaint is taken within the deadline, the claim must be filed within 1 month after that deadline expires (APC, Art. 22). Urgent treatment: in case of a threat, the court may issue an interim ruling before a claim is filed (APC, Art. 31); emergency care where life is at risk must not be postponed (Law of Georgia on Patients’ Rights, Art. 12).
4. In the complaint, challenge the ground (diagnosis, category, referral); attach to the application a health certificate (form IV-100/a), a copy of the identity document and, if needed, a cost calculation (Decree No. 474, general rules, Art. 11).
5. If a clinic refused the beneficiary: a participating clinic may not refuse a beneficiary a service under the programme (Decree No. 474, general rules, Art. 23); for refusal or delay the clinic pays a fine of three times the cost of the service (Decree No. 474, general rules, Art. 22); file a complaint with the agency.
6. If the service is outside the programmes: apply to the commission of the “Reference Services” programme (Decree No. 474, Art. 4, Annex “Reference Services”). If treatment was paid for privately, there is no automatic reimbursement; harm caused by unlawful acts of a body is compensated by the State (GAC, Art. 208), through a court after the refusal has been annulled.
7. Where to apply: National Health Agency; the superior body (for an act of the director); district (city) court.
8. Documents to prepare: the refusal and the date of its delivery; the application with the receipt stamp; medical opinion; cost calculation; receipts.
9. Pitfalls: writing to the Social Service Agency instead of the National Health Agency; going straight to court without an administrative complaint; waiting indefinitely for a reply, as silence already counts as a refusal.

Be sure to check

• the decision is taken by the National Health Agency; its refusal is an administrative act
• administrative complaint within 1 month, consideration within 1 month, then a claim within 1 month
• in urgent cases, an interim court ruling before a claim is filed; emergency care is provided without waiting
• refusal by a participating clinic is unlawful and fined; for services outside the programmes, the reference commission