A deep dive into Bituach Leumi (Israel National Health Insurance)

Part I: How to feel empowered within a rigid bureaucratic system

True story. A new immigrant called up her kupat cholim (HMO) and said she wanted to know if she could see a different doctor in the same quarter, because she hadn’t liked the manner of this particular doctor. 

The clerk on the other end of the line said, “But you never saw that doctor.” 

“Yes I did,” replied the new immigrant.  After all, she knew what doctors she’d been to in the past month.

“No, you didn’t,” insisted the clerk.  “You have never seen that doctor.”

“I know I saw that doctor,” she repeated.  “I was there. I didn’t forget. I went to that doctor.”

On it went, for 10 minutes, an argument about whether or not the client had seen the doctor, because the clerk didn’t see it on the computer.

It may sound like theater of the absurd but it’s true!  And I’m sure many of you have experienced something similar. Sometimes, when we engage in larger bureaucratic systems, we may end up feeling trapped in an endless loop of confusion or misinformation, and not know how to get out.

Bituach Leumi is certainly no exception. It is actually a remarkable system that offers financial and service support to a large portion of the Israeli population.  Knowing that if I lose my job, need maternity leave, am sick for months on end, or injured on the job, I will not be left out in the cold.

However, accessing those support services can sometimes be daunting and overwhelming, especially when we do not speak the language nor understand many of the cultural nuances we encounter.

That is why we need to be our own best friend in these situations, or better yet, our own advocate.

How do we do that?

Choose your timing.  Obviously, the unexpected occurs. But often, we can choose the day, hour, a specific time when we will interact with a government office. Sundays (in Israel), or the first day of the week, and the first of the month are always notorious for being crowded days, and the clerks might be overwhelmed.  Choose a day in the middle of the month, and ideally, the middle of the week. 

Choose your personal timing as well. If you’re extra tired, or overwhelmed at work, or just recovering from a family crisis, that may not be the best time to confront the ‘system’. 

Write down your unresolved issues.   Not the emotional ones, but rather, related to the system. For example, in Bituach Leumi, you want to understand why your application was denied.  Did you not provide the correct form?  Bring enough evidence of your problem? Write it down and read it out.

Have a native Hebrew speaker write down your questions in Hebrew.  You need to write down the questions for yourself so you can remember what to say. But if you feel like you often encounter situations where the clerk does not understand you at all, and vice versa, have a friend, relative, neighborhood health advocate, write down exactly what to say in Hebrew and give that piece of paper to the clerk in front of you. This will save a great deal of time and mental energy going forward.

Know your stuff.  There’s a beautiful site called kolzchut.org.il, with all the medically related pages translated into English, where you can investigate all your social welfare rights.  You need to know the right questions to ask and call the person on incorrect information.  Which leads to me my next point…

Believe in yourself. This may sound a bit fluffy, but it’s quite real.  To refer to our previous story, our new immigrant lady could have doubted herself after hearing for five minutes that she hadn’t actually seen the doctor.  ‘Maybe I didn’t really have a visit with him? Maybe I made an appointment but then didn’t go?’  We can convince ourselves of anything and when faced with an assured professional in front of us, stating something we know to be true is NOT true, we can begin to doubt ourselves. 

That is the beauty of Israeli culture, the ability to state a guess as a fact without blinking an eye.  I don’t say it facetiously. I envy that confidence and strong conviction in one’s own words.  And the amazing thing is, if you volley back with an example as to how completely wrong their statement was, there is a brief pause, pivot, and on to the next argument!  As if nothing had transpired!  Which is why you need to stand your ground on something that you know to be true.

Remember the person in front of you is a person.  I say this, because when we are in a heated discussion, for example, in the hospital corridor trying to run after the doctor to find out why your father’s surgery has been delayed for the third day in a row, it is hard not to want to throttle the person in front of you.  This is when you want to take a deep breath, remember that the doctor in front of you probably has a partner waiting for them at home, has probably been working straight for the past 12 hours, has little children they haven’t seen, maybe just came from a failed resuscitation and lost a patient.    

You don’t need to know the specifics but you do need to remember that everyone has a story.

When you’ve made a mistake or insulted someone, apologize.  It happens, we blurt things out in anger, or we’re convinced that we sent in a form when it turns out we hadn’t.  It rankles, it’s uncomfortable, especially when we are trying to get our rights acknowledged and the person helping us has been unpleasant and rude.  Doesn’t matter. You are in this for the long haul, both as a person who wants to maintain their self-respect, and someone who needs to continue to advocate for themselves and/or others.  Israel is a small country. You have no idea when that clerk you called less than worthless, ends up in a clothing store next to you, or at your neighbor’s birthday party.  Suck it up, say, “I’m sorry” and then let it go.

Remember.You can do it. You can get results.

What’s your bituach leumi story?

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