Private Hospital Charged More Than SGK Allows? How Patients Can Recover Excess Medical Fees in Türkiye

A patient covered by Türkiye’s Social Security Institution (Sosyal Güvenlik Kurumu – SGK) undergoes surgery at a private hospital.

Before treatment, the hospital says:

“SGK covers part of the treatment, but you need to pay an additional TRY 80,000.”

The patient pays because the operation is necessary.

Weeks later, however, the patient discovers that the hospital was either legally prohibited from charging an additional fee at all or was permitted to charge only a fraction of the amount collected.

Can the patient recover the money?

In many cases, yes.

Private hospitals contracted with SGK do not have unlimited freedom to determine the amount payable by an SGK-insured patient. Additional fees are regulated primarily by Article 73 of Law No. 5510 and the SGK Health Implementation Communiqué (Sağlık Uygulama Tebliği – SUT).

The applicable rules determine:

• whether an additional fee can be collected at all;
• the maximum amount that may be collected;
• which treatments must be provided without additional charges;
• when written patient consent is necessary;
• what documents the hospital must provide;
• whether a separate room or other service may lawfully be charged;
• and how unlawfully collected amounts can be recovered.

The practical difficulty is that patients often receive a single invoice without knowing how much SGK paid, which SUT code was used or what additional-fee percentage the hospital was entitled to apply.

For that reason, excess private-hospital charges are primarily a documentation and calculation dispute.

1. Can a Private Hospital Charge an SGK Patient?

Yes, but only within the boundaries established by SGK legislation.

Article 73 of Law No. 5510 allows certain contracted non-public healthcare providers, including private hospitals and foundation universities, to collect additional fees from general health insurance beneficiaries within the legally established ceiling.

SGK explains that additional fees are calculated by reference to the healthcare service amounts that can be invoiced to SGK. The legislation authorises a ceiling of up to twice the healthcare service amount determined by the Health Services Pricing Commission, while the actual charging rules applicable to the healthcare provider must also be examined.

Therefore, the fact that a hospital is “private” does not mean:

“The hospital can charge whatever price it wishes.”

Where the patient is admitted and treated within the SGK-contracted system, the SUT rules become critical.

2. The Most Important Question: How Much Was the Hospital Legally Allowed to Charge?

The correct calculation normally requires identifying:

1. the medical treatment provided;
2. the applicable SUT code;
3. the amount that may be invoiced to SGK;
4. the hospital’s permitted additional-fee rate;
5. whether the treatment is subject to a special rule;
6. whether the treatment falls within an additional-fee exemption;
7. whether separate items have been charged in addition to a package price.

SGK maintains an Additional Fee Calculation System through which the potential additional amount can be checked based on the hospital, treatment type, medical branch and procedure.

This system can be extremely useful in a refund dispute.

However, for litigation purposes, counsel should not rely exclusively on a general online calculation.

The decisive evidence should normally include:

• the hospital invoice;
• payment receipt;
• medical records;
• MEDULA/SGK transaction information where available;
• SUT procedure codes;
• the amount invoiced to SGK;
• hospital additional-fee documents;
• and, if necessary, an expert calculation.

3. Example: How an Excess Additional Fee May Arise

Assume that the relevant SUT calculation allows the hospital to collect a maximum additional fee of TRY 20,000 from an SGK patient.

The hospital nevertheless collects:

TRY 55,000.

If no other legally chargeable service exists, the potentially unlawful excess would be:

TRY 55,000 – TRY 20,000 = TRY 35,000.

The patient may seek repayment of the TRY 35,000 excess.

But the calculation should not be performed merely by comparing the amount paid with the amount SGK paid.

The SUT classification of the service must first be established.

This distinction is particularly important in surgical procedures, package treatments and inpatient admissions.

4. Some Medical Services Cannot Be Subject to Additional Fees at All

This is one of the strongest categories of refund claims.

SGK currently identifies various healthcare services for which additional fees cannot generally be collected.

These include, subject to the specific SUT exceptions:

• emergency medical services, other than services classified as “green area examination”;
• intensive care services;
• burn treatment;
• cancer treatment, including radiotherapy, chemotherapy and radioisotope treatment;
• healthcare services provided to newborns;
• organ, tissue and stem-cell transplant services;
• surgical procedures relating to congenital anomalies;
• haemodialysis;
• certain cardiovascular surgical procedures;
• certain hearing implant procedures;
• and procedures listed in SUT Annex EK-2/G.

If a private hospital collects an ordinary “hospital difference”, “doctor difference”, “operation fee” or similarly described charge for a service falling within an absolute no-additional-fee category, the patient should investigate the payment immediately.

The description appearing on the invoice does not necessarily determine its legal character.

A hospital cannot necessarily avoid the SUT prohibition merely by renaming an additional fee as a “service fee.”

5. Emergency Treatment Is One of the Most Important Areas

Emergency treatment creates frequent disputes.

Under SGK rules, healthcare provided due to an emergency generally cannot be subject to an additional fee, except for examinations legally classified under the “green area” category.

SGK expressly states that contracted or non-contracted healthcare providers cannot charge participation or additional fees for healthcare falling within the emergency-services rules.

This is especially important where a private hospital demands payment before:

• emergency surgery;
• urgent cardiovascular intervention;
• emergency intensive care;
• or another medically urgent procedure.

The first 24 hours can be particularly important

SGK’s rules state that stabilisation of the patient in emergency services is generally expected within 24 hours.

Emergency interventions performed directly after admission and healthcare provided in emergency observation units within that period cannot ordinarily be subject to additional fees.

If the emergency condition ends and later treatment becomes subject to additional fees, the patient or relative must be informed in writing through the relevant “Notification Form Regarding Termination of the Emergency Condition” before additional fees are charged.

Therefore, in an emergency-fee case, counsel should ask:

Did the hospital issue the required written notification showing that the emergency condition had ended?

If not, this can become significant evidence.

6. A Signed Consent Form Does Not Automatically Make Every Charge Lawful

Private hospitals frequently defend excess-fee claims by saying:

“The patient signed the document and accepted the price.”

This defence should not automatically end the dispute.

SGK requires healthcare providers to obtain the patient’s or relative’s written approval regarding the additional fee before the healthcare service is provided.

Without this prior written approval, the healthcare provider cannot generally wait until after the treatment and then demand an additional amount on a new basis.

But the opposite proposition is equally important:

Written consent does not necessarily legalise a fee exceeding the mandatory SGK limit.

In other words:

Consent is a procedural prerequisite for lawful additional charging; it is not unlimited permission to disregard SUT.

Suppose SUT permits a maximum additional charge of TRY 25,000.

The hospital obtains a signed form stating:

“Patient agrees to pay TRY 100,000.”

The existence of the signature does not necessarily transform the entire TRY 100,000 into a lawful SUT additional fee.

Mandatory pricing restrictions still need to be examined.

7. The Hospital Should Be Asked for the Detailed Additional-Fee Document

Patients should not settle for a credit-card receipt showing only:

“Payment: TRY 75,000.”

SGK rules require contracted private healthcare providers and foundation universities, in qualifying inpatient cases, to provide documentation showing healthcare services supplied and the additional fee collected.

The documentation is intended to identify matters such as:

• the healthcare provider;
• the branch;
• the SGK application number;
• the amount invoiced to SGK;
• the healthcare services subject to additional fees;
• and the amount charged to the patient.

The 2026 SGK Private Healthcare Service Provider Contract also imposes a contractual sanction where the required document showing the healthcare services and additional fee is not provided to the patient within the prescribed period.

Accordingly, one of the first demands in a refund case should be:

“Provide the complete itemised statement showing the SUT codes, amount invoiced to SGK and additional amount collected from the patient.”

8. Patients Should Check Whether SGK Was Charged for the Same Service

A particularly important issue is double charging.

Suppose the hospital:

1. invoices a medical procedure to SGK; and
2. simultaneously collects the entire procedure price from the patient.

That does not automatically mean that every part of the patient payment was unlawful because a permitted additional fee may exist.

However, the hospital cannot simply receive SGK payment and independently charge the patient an unlimited private price for the same covered service.

The legal calculation must determine:

What did SGK finance?

What was invoiced to SGK?

What additional amount could legally be collected?

What did the patient actually pay?

The difference between these figures often establishes the amount recoverable.

9. Medical Materials and Drugs Require Special Attention

Hospitals sometimes present charges as:

• medical material;
• special material;
• surgical equipment;
• implant;
• medication;
• blood product;
• operating-room equipment;
• or consumables.

However, SGK expressly states that separate additional fees cannot be collected for certain medical materials, medicines and blood components where they are already separately billable to SGK or included within relevant SUT treatment pricing.

Therefore, a patient should not accept the statement:

“SGK does not cover the material.”

without verification.

Counsel should request:

• the exact material name;
• barcode or product information;
• SUT code;
• invoice;
• whether SGK was billed;
• and the legal reason why the hospital claims the item was outside SGK coverage.

10. What If the Hospital Says “This Service Is Not Covered by SGK”?

This defence may sometimes be valid.

SGK distinguishes between:

1. additional fees for SGK-covered healthcare, and
2. fees for healthcare that SGK does not finance at all.

SGK states that charges demanded for healthcare services that are not financed by SGK are not technically treated as “additional fees” under the same rule.

This distinction is critical.

Suppose an SGK patient voluntarily purchases a genuinely non-covered treatment.

The hospital may have considerably greater pricing freedom than it would for a standard SGK-funded procedure.

But the hospital should be able to demonstrate that the service was genuinely outside SGK coverage.

A vague statement such as:

“SGK doesn’t pay for this”

should therefore be tested against SUT.

11. What About Private Rooms and Hotel Services?

A patient may have treatment that cannot legally be subject to an additional medical fee but voluntarily request a premium room.

Hotel services have their own rules.

For example, SGK states that contracted healthcare institutions may collect additional hotel-service charges within prescribed limits for qualifying two-bed and single-bed rooms.

The ceiling is linked to the SUT standard-bed tariff: up to 1.5 times that amount in qualifying two-bed rooms and up to three times in qualifying single-bed rooms.

Therefore, the statement:

“Emergency treatment is free, so absolutely nothing can ever be charged”

may also be too broad.

The distinction between medical treatment charges and a genuinely optional hotel/accommodation service should be examined carefully.

12. SGK Complaint Can Lead Directly to Refund Pressure

One of the most practical remedies is a complaint to SGK.

Where an SGK-contracted healthcare provider has collected an additional fee contrary to SGK legislation, SGK can investigate the conduct.

The 2026 SGK Private Healthcare Service Provider Contract contains particularly significant consequences.

Where a healthcare provider is found to have collected an additional fee contrary to SGK legislation, a contractual penalty equal to five times the excess additional fee may be imposed for each patient.

The contract further provides that if the unlawfully collected excess amount is fully repaid to the patient or the patient’s relative within 10 business days following notification of the penalty and SGK is informed accordingly, the sanction can be reduced in accordance with the contractual provision.

Separate fivefold sanction provisions also apply where fees are collected:

• from persons from whom no additional fee may be collected; or
• for healthcare services for which no additional fee may be collected.

This creates powerful institutional pressure on the hospital to make a refund.

13. In Certain Cases SGK Can Deduct the Money From the Hospital

The 2026 SGK contract contains an especially useful mechanism concerning certain prohibited additional fees.

Where an additional fee has unlawfully been collected from a person who should not have been charged and the amount is not fully repaid, the contract provides for the amount to be deducted from the healthcare provider’s receivable by SGK and paid to the relevant person.

Therefore, an SGK complaint is not merely a regulatory complaint with no benefit to the patient.

Depending on the nature of the violation, it may contribute directly to obtaining repayment.

14. Can the Patient Apply to the Consumer Arbitration Committee?

Yes, this is an important recovery route in appropriate private-hospital disputes.

The relationship between a patient and a private hospital may constitute a consumer transaction, and disputes concerning unlawful excess healthcare charges have reached Consumer Arbitration Committees and Consumer Courts.

A particularly useful Court of Cassation decision is:

Court of Cassation, 3rd Civil Chamber, E. 2023/2056, K. 2023/1422, 11 May 2023.

The case specifically concerned a patient who argued that a private hospital had collected more than the permitted SGK additional fee for medical tests.

The patient had sought reimbursement through the Consumer Arbitration Committee.

In the resulting litigation, the Court of Cassation emphasised the need for the merits of the claim to be examined properly. The dispute required consideration of the treatment documents, consent forms, fee-information documents and an expert assessment concerning SUT.

This decision is practically important because it demonstrates the evidentiary framework required in excess-SGK-fee disputes.

It should not, however, be misread as meaning that every payment to a private hospital must automatically be refunded. Whether there was an excess charge still requires a substantive SUT calculation.

15. The 2026 Consumer Arbitration Committee Limit

For applications made in 2026, consumer disputes below TRY 186,000 fall within the monetary jurisdiction of Consumer Arbitration Committees.

The Ministry of Trade states that the TRY 186,000 threshold applies for 2026.

Therefore, if the refund sought is, for example:

TRY 70,000

the Consumer Arbitration Committee will generally be the relevant consumer-law route.

If the dispute is:

TRY 300,000

the claim exceeds the 2026 committee threshold and the appropriate judicial route must be considered, including the procedural requirements applicable to consumer litigation.

Because these thresholds change annually, the amount applicable on the date of the application should always be verified.

16. What Evidence Should Be Submitted With the Refund Claim?

A well-prepared application should ordinarily contain as much of the following as possible:

• hospital invoice;
• credit-card slip;
• bank transfer receipt;
• cash payment receipt;
• treatment records;
• discharge report;
• operation report;
• epicrisis;
• signed consent forms;
• pricing information forms;
• “Hastaya Sunulmuş Olan Hizmetleri ve İlave Ücreti Gösterir Belge”;
• documents showing amounts invoiced to SGK;
• relevant MEDULA information;
• SGK additional-fee calculation;
• correspondence with the hospital;
• WhatsApp messages;
• emails;
• price quotations;
• emergency-admission documents;
• emergency termination notification, if any;
• and the hospital’s written response to the refund demand.

If the hospital holds relevant documents and refuses to produce them, the claim should specifically identify those documents and request that they be obtained during the proceedings.

17. What If the Hospital Did Not Give an Invoice?

The lack of an invoice does not necessarily destroy the claim.

Payment may be established through:

• bank records;
• credit-card records;
• POS receipts;
• hospital accounting records;
• written communications;
• witness evidence where legally admissible;
• and other documentary evidence.

Moreover, absence of the documentation required by SGK may itself become relevant in evaluating the hospital’s compliance.

Patients should therefore preserve screenshots of all payments and communications immediately.

18. A Practical Example

Consider the following scenario.

An SGK-insured patient is admitted to a private hospital.

The hospital performs a covered operation.

The patient pays:

TRY 120,000.

Investigation later establishes that:

• SGK was billed for the operation;
• the relevant SUT rules permitted only TRY 35,000 in additional charges;
• there were no independent non-SGK services worth the difference;
• no premium room had been requested;
• and no other legally chargeable item existed.

Potential excess:

TRY 120,000 – TRY 35,000 = TRY 85,000.

The patient can first issue a written refund demand.

At the same time or thereafter, depending on the circumstances, the patient may:

• complain to SGK;
• request an SGK examination;
• and pursue the consumer-law recovery route.

Because TRY 85,000 is below the 2026 TRY 186,000 Consumer Arbitration Committee threshold, a Consumer Arbitration Committee application would ordinarily be relevant to the monetary refund claim.

19. An Even Stronger Example: ICU Treatment

Assume that a patient spends five days in intensive care.

The private hospital collects:

TRY 250,000

under descriptions including:

• intensive care difference;
• doctor fee;
• monitoring fee;
• nursing fee;
• hospital service difference.

SGK expressly lists intensive care among services for which no additional fee may generally be collected.

The legal analysis should therefore focus not merely on whether the total charge exceeded a percentage.

The first issue is whether the hospital had any legal authority to impose an additional medical fee at all for those services.

If not, the refund claim may encompass the entire unlawfully collected additional amount, subject to determining whether any genuinely separate and legally chargeable services were provided.

20. The Same Applies to Cancer Treatment

Cancer patients should also examine additional charges carefully.

SGK’s current list includes:

• chemotherapy;
• radiotherapy;
• and radioisotope treatment

among the cancer-treatment services for which additional fees cannot generally be collected.

Therefore, where a patient undergoing covered cancer treatment receives a substantial private-hospital invoice, each item should be separated.

The hospital may potentially have charged for something legally distinct from the protected treatment.

But simply describing a payment as:

“oncology package difference”

does not make an unlawful medical additional charge lawful.

21. What Should a Lawyer Ask the Hospital Before Filing the Claim?

A formal demand should ideally require the hospital to disclose:

1. the complete invoice;
2. each treatment and SUT code;
3. amounts invoiced to SGK;
4. the hospital’s permitted additional-fee rate;
5. the legal basis of each payment collected from the patient;
6. the patient’s written prior approval;
7. the SGK additional-fee statement;
8. medical material and medication details;
9. hotel-service charges, if any;
10. the basis for classifying any item as outside SGK coverage;
11. MEDULA-related records;
12. and the precise amount that the hospital maintains was lawfully payable by the patient.

The demand should then request reimbursement of the excess together with applicable legal interest.

22. The Hospital Cannot Solve the Problem Simply by Calling the Payment a “Package”

Another frequent practice is to provide the patient with a single figure:

“Surgery package: TRY 150,000.”

The term “package” has no magical legal effect.

If the patient’s treatment was provided under the SGK system, it may still be necessary to determine:

• what SGK financed;
• what services were included within the SUT package;
• what additional fee could legally be charged;
• whether materials were already included;
• and whether the hospital charged separately for something already included in the package.

The substance of the payment matters more than its commercial label.

23. A Strong Litigation Strategy: Obtain a SUT Expert Calculation

In complicated cases, especially involving:

• surgery;
• implants;
• hospitalisation;
• multiple procedures;
• package prices;
• medication;
• medical materials;
• and intensive treatment,

a proper expert calculation may be essential.

This is consistent with the approach appearing in the Court of Cassation’s E. 2023/2056, K. 2023/1422 decision, where examination of hospital documents and expert analysis concerning SUT was considered necessary to resolve the dispute properly.

A useful expert report should answer:

Which procedure codes apply?

How much was SGK entitled to pay?

What maximum additional fee could be collected?

Which items were included in the package?

Which services could not be charged additionally?

How much did the patient actually pay?

What amount was collected without legal basis?

This converts an emotionally framed complaint—

“The hospital charged me too much”

—into a technically demonstrable monetary claim.

24. A Practical Recovery Roadmap

For an SGK patient who believes that a private hospital charged too much, the following sequence is usually effective.

Step 1 — Collect every payment document

Obtain invoices, card slips, bank receipts and hospital accounting records.

Step 2 — Obtain the complete medical file

Identify exactly what treatment was performed.

Step 3 — Obtain the additional-fee statement

Request the hospital’s detailed SGK/SUT billing information.

Step 4 — Determine the applicable SUT code

The medical description alone may be insufficient.

Step 5 — Determine whether additional fees were prohibited altogether

Check emergency, intensive care, cancer and other protected categories first.

Step 6 — Calculate the lawful maximum

Use the SUT rules and hospital’s applicable additional-fee rate.

Step 7 — Separate legitimate non-SGK services

For example, genuinely optional hotel services should be analysed separately.

Step 8 — Send a formal refund demand

Specify the calculation and request repayment.

Step 9 — File an SGK complaint

Ask SGK to examine the healthcare provider’s charging practice.

Step 10 — Pursue the consumer remedy

For 2026, claims below TRY 186,000 generally fall within the Consumer Arbitration Committee threshold; higher-value disputes require the appropriate judicial route.

25. Why an SGK Complaint and a Refund Claim Should Often Be Used Together

These two mechanisms have different functions.

SGK complaint

Primarily examines whether the healthcare provider violated SGK rules and may result in contractual sanctions and refund pressure.

Consumer claim

Directly seeks repayment of the patient’s money.

Using both mechanisms can be considerably more effective than merely sending informal complaints to the hospital.

This is particularly true because the 2026 SGK contract provides for substantial contractual consequences where unlawful additional charges are established.

26. Conclusion: Paying the Invoice Does Not Necessarily Mean the Charge Was Lawful

An SGK patient should not assume that every amount demanded by a private hospital must legally be paid merely because:

• the patient signed a form;
• the hospital issued an invoice;
• payment was made voluntarily;
• the treatment was performed;
• or the hospital described the amount as a “difference fee.”

Private hospitals participating in the SGK system operate within a detailed regulatory framework.

The decisive question is:

How much was the hospital legally entitled to collect under SUT for the exact healthcare service provided?

If the hospital collected more than the permitted amount—or collected an additional fee for a service for which additional charging was prohibited—the patient may have a legally enforceable refund claim.

In practice, the strongest cases are built by comparing four figures:

1. The SUT value of the treatment

2. The amount invoiced to SGK

3. The maximum additional fee legally chargeable to the patient

4. The amount actually collected by the hospital

Once these figures are established, what initially appears to be an opaque hospital invoice can become a straightforward restitution claim.

And in serious cases involving emergency treatment, intensive care, cancer treatment or substantial excess billing, patients should not limit themselves to negotiating with the hospital.

SGK investigation, Consumer Arbitration Committee proceedings and Consumer Court litigation can provide complementary routes for recovering unlawfully collected medical fees.