Treatment at a Non-Contracted Hospital: Invoices and Reimbursement

Health insurance is easiest to use at contracted hospitals: the hospital obtains approval and bills the insurer directly. But it is not always possible to go to a contracted hospital. A doctor you trust may work at a non-contracted clinic, an emergency may take you to the nearest facility, or your network may not meet your needs. In these cases reimbursement, known in Turkish as ödeme talebi or masraf iadesi, comes into play. Handled correctly it is not complicated; most problems come from a document not collected on the day or from not knowing the policy’s non-contracted conditions in advance.

How reimbursement works

At a non-contracted facility you pay the cost yourself first. You then apply to the insurer with the invoice and medical documents. The insurer reviews them, decides whether the treatment is covered and, if so, pays you an amount calculated under the policy conditions.

One point is essential: costs at a non-contracted facility may not be paid at the same rate as at a contracted one. Many policies apply a different reimbursement rate, different limits or an extra co-payment. Some plans do not cover non-contracted facilities at all, or only in emergencies. This depends entirely on your policy.

Check before treatment

• Does my policy cover non-contracted facilities?
• If so, what reimbursement rate and limits apply?
• Do I need the insurer’s view before a planned procedure?
• Is there a contracted facility nearby for the same treatment?

This quick check can stop a large bill falling mostly on you. We explain why the network matters so much in why the hospital network matters most.

Documents for a reimbursement claim

1. Invoice: In the insured person’s name, original or in an electronic form the insurer accepts.
2. Itemised statement: A line-by-line list of the services behind the total.
3. Doctor’s report or consultation note: Stating the complaint, diagnosis and procedure.
4. Test results: Laboratory and imaging reports.
5. Prescriptions: If you are claiming for medication.
6. Discharge summary (epikriz): For inpatient treatment.
7. Bank details: An account in the insured person’s name.

If you are a foreign resident, make sure the name on the invoice matches exactly the name on your policy and residence permit; spelling differences can slow the review.

Preparing the claim step by step

1. Ask the facility for the invoice and itemised statement during treatment; they can be harder to obtain later.
2. Get a doctor’s report clearly stating diagnosis and procedure.
3. Scan or photograph everything and keep copies.
4. Apply through the channel the insurer specifies: online portal, mobile app or your agency.
5. Follow up any request for extra documents.

The deadline for applying is set out in the policy conditions, so do not delay.

Example

Spending a weekend in Kilyos, a policyholder takes their child with a high fever to the nearest private clinic, which is not contracted. They pay, have the invoice made out in the child’s name and collect the itemised statement and the doctor’s note with the diagnosis. Early the next week they apply through the insurer’s app. The insurer asks for the prescription for the medicines; once added, the review is completed and an amount calculated under the non-contracted conditions is paid.

After payment, and common mistakes

When the insurer pays, it usually sends a notice showing what was paid for each item. Compare it with your invoice; reasons for any shortfall, such as co-payment, non-contracted rate, limit or excluded service, are usually stated. If no reason is given or it seems inconsistent with the policy, ask for an explanation. If your policy covers medication, pharmacy costs can be claimed with the prescription and receipt, under that cover’s conditions.

• Having the invoice issued in another family member’s name
• Claiming with only a total invoice and no itemised statement
• Submitting a report without a diagnosis
• Assuming non-contracted care is paid at the contracted rate
• Not keeping copies

Ailenizin Sigortacısı has worked in insurance since 1996 with several insurers. We can check your reimbursement documents with you and guide you through requests for further information. Compare policies with stronger non-contracted terms on our Maslak health insurance page.

For help with a reimbursement claim, call +90 530 375 89 61 or message us on WhatsApp. English-speaking support is available.