A refund including interest has been issued for the overcharged private hospital

A refund including interest has been issued for the overcharged private hospital

The Public Ombudsman Institution (KDK) has issued a recommendation that a private hospital refund 34,638 Turkish Lira, plus legal interest, to a patient who underwent lumbar disc herniation surgery, in violation of the Health Application Regulation.

The patient paid 73,000 Turkish Lira for the surgery, excluding examinations. Upon checking their e-Government account, they noticed a charge of 19,180 Turkish Lira related to the procedure and applied to the KDK for a refund of the excess amount.

The KDK launched an investigation and requested a statement from the private hospital. In a written response, the hospital management claimed that "the patient voluntarily chose to receive private healthcare services and agreed to pay the difference in fees."

The response stated that a refund could not be issued for fees paid with the patient's knowledge and consent.

In a letter sent by the Social Security Institution (SGK) regarding the matter, it was stated that, within the scope of the provisions of the Health Application Circular, the institution paid the hospital 19,180 Turkish Lira for the said surgery.

The letter reminded that, according to the provisions of the circular, the hospital can request a fee up to twice the amount invoiced to the SGK, and noted that the difference of 34,638 Turkish Lira was overcharged.

The letter stated that since the Affiliate University Protocol signed with the hospital does not contain a penalty clause, no penalty can be imposed on the hospital, and therefore, even though it is contrary to the legislation, a refund cannot be made to the patient.

"Disproportionate interference with the right to health"
The Ombudsman's Office, finding the applicant justified, recommended that the hospital pay the citizen the difference of 34,638 Turkish Lira, which was charged in violation of the provisions of the Health Application Circular, along with legal interest to be calculated from the date of payment.

The Ombudsman Institution recommended to the Social Security Institution (SGK) that protective, preventive, and enforcement regulations be implemented in Affiliation Protocols or service purchase agreements with private healthcare providers to ensure compliance with the provisions of the Health Application Circular, in order to prevent similar grievances from occurring. The Ombudsman Institution's decision included the following statements:

"The fact that the hospital where the applicant received healthcare services for herniated disc surgery charged a service fee exceeding the additional fee limit, coupled with the SGK's failure to take any protective measures or apply necessary sanctions, resulted in an excessive and disproportionate burden that put the applicant in an unbearable situation. In this respect, it was assessed that there was a disproportionate interference with the applicant's right to health and the right to protection of bodily integrity." (AA)