Supplement charges retirees pay when using private hospitals The amount paid by the Social Security Institution (SGK) to private hospitals cannot be exceeded by more than twice the SGK rate. When retirees choose private hospitals for faster or more comfortable care, SGK covers part of the treatment fee. Private healthcare providers may ask patients to pay an additional charge beyond the SGK-covered amount. The private hospital surcharge cannot exceed 200% of the fee SGK pays to the private hospital.
What Is the Maximum Amount Payable to Private Health Providers?
The maximum surcharge retirees will pay in private hospitals can be at most twice the amount paid by SGK. This benefit applies not only to retirees but to everyone covered by general health insurance. As private health facilities increase in number, many patients prefer them to avoid waiting and receive faster care. SGK covers part of the private hospital fees. Private hospitals may charge up to two times the SGK-covered amount as an additional fee for people with general health insurance. Separately, retirees are also charged a participation fee; this participation charge is not included in the two-times surcharge calculation.
For example, a retiree seeking a general surgery outpatient visit at a public hospital would pay a participation fee of 6 TL. If the same service is provided at a private facility, SGK covers 30.24 TL for a general surgery consultation. The surcharge a private hospital can collect from you is at most double that amount, i.e. 60.48 TL. In addition, retirees pay a 15 TL participation fee for private hospital consultations. Thus, what costs 6 TL at a state hospital can reach up to 105.72 TL at a private hospital when SGK coverage, the maximum allowable surcharge, and the private participation fee are combined.
How Much Does SGK Cover for Retiree Consultations?
SGK covers part of the consultation fees for patients seen at private hospitals. The covered amount varies by clinic but averages around 30 TL. SGK coverage by specialty is as follows:
- Oral, facial and jaw surgery; orthopedics and traumatology; nephrology; and ENT consultations: SGK covers 25.92 TL,
- Allergy and chest diseases, pulmonology, plastic and aesthetic surgery, and urology consultations: SGK covers 28.08 TL,
- Dermatology, venereology, physical medicine and rehabilitation consultations: SGK covers 27.00 TL,
- Neurosurgery, endocrinology/metabolic diseases, gastroenterology, infectious diseases and microbiology consultations: SGK covers 29.16 TL,
- General surgery, geriatrics and internal medicine consultations: SGK covers 30.24 TL,
- Occupational diseases consultations: SGK covers 24.84 TL,
- Obstetrics and gynecology consultations: SGK covers 33.48 TL,
- Cardiology consultations: SGK covers 36.72 TL,
- Mental health consultations: SGK covers 32.40 TL.
What to Do If You Were Overcharged?
If a private hospital charged you more than allowed, you can request a refund of the excess amount. As noted above, private hospitals may not charge more than twice the fee covered by SGK. After a consultation, surgery or treatment, be sure to ask the private hospital for a detailed invoice of all fees you paid. You can check whether the requested amount is excessive through SGK’s official information portal. By selecting city, hospital, specialty and doctor on the portal, you can learn the allowable additional payment for the service. Compare the portal result with the invoice provided by the hospital to see if you were overcharged. If you were charged in excess, present your invoice to the private hospital and request a refund. If the hospital refuses, you can call Alo 170 or notify the local Social Security Directorate to pursue your rights.
Penalties and Arbitration Committees
Private hospitals that issue excessive invoices face penalties, and those denied refunds can apply to arbitration committees. Consumer arbitration applications can be submitted via e-Government. For private hospitals located in major cities, consumer arbitration can handle claims up to 3610 TL; for district or smaller towns, up to 2400 TL. If a private hospital charges you more and refuses to refund, you can resolve the dispute through a consumer arbitration committee. You can also report a hospital that charges excess amounts to Alo 170 to initiate an inspection and possible sanction. Fines for hospitals range from five to ten times the overcharged amount.
Are Emergency Services Charged a Surcharge?
Private hospital emergency departments do not charge a surcharge for emergency services. While private hospitals may request surcharges for routine outpatient clinic services, emergency care such as wound dressings, injections and immediate interventions are provided without extra charge. However, this free emergency service is limited to 24 hours. Patients who remain in the emergency department longer than 24 hours may be charged additional fees. In that case, we recommend requesting transfer to a public hospital before the 24-hour limit expires. Note that physicians in private hospitals determine whether a patient’s condition is considered an emergency; if the doctor deems the situation non-emergent, a private hospital surcharge may apply.
Deductions from Retirement Pensions
Pension deductions include participation fees for consultations and pharmacy contribution shares. For retirees, the contribution for prescription medications is 10% and is deducted directly from the pension. For active employees the rate is 20%. For example, a retiree pays 5 TL on a 50 TL prescription while a working insured person would pay 10 TL. Another deduction for retirees is the consultation participation fee, which varies by the type of facility:
- State hospitals: 6 TL,
- Second and third-level public hospitals (university hospitals, training and research hospitals): 7 TL,
- Hospitals affiliated with private universities: 8 TL,
- Private health facilities: 15 TL participation fee for retirees.
Prescription contributions are charged separately. For prescriptions with up to three boxes of medication, the contribution is 3 TL; for each additional medication box beyond three, an extra 1 TL is added. For example, a prescription with two medications incurs a 3 TL contribution, while a prescription with ten medications incurs a 10 TL contribution.
How to Check Consultation Participation Fees?
You can query consultation participation fees through the e-Government (e-Devlet) portal. After signing in to e-Devlet, use the relevant service link for your retirement category:
- For retirees under 4A, use the 4A monthly deduction query,
- For retirees under 4B, use the 4B monthly deduction query,
- For retirees under 4C, use the 4C monthly deduction query.
Situations Where Participation Fees Are Not Charged
The Social Security Institution does not require participation fees for certain conditions and extraordinary circumstances. These include:
- Work-related accidents or occupational diseases,
- Health services provided during military exercises,
- Medical care provided during disasters or wartime,
- Chronic illnesses specified by SGK,
- Essential prostheses and life-saving devices,
- Health services related to tissue, organ and stem cell transplants.
Who Is Exempt from Additional Charges?
Law specifies who private hospitals cannot charge an additional fee. According to legislation, recipients of honorary pensions (Law No. 1005), certain veterans or those receiving pensions under Law No. 2330 and Law No. 3713, and those receiving war disability pensions are exempt from private hospital surcharge charges.