Private health insurance may refuse treatment payment for various reasons. Objection paths are open.
Common Reasons for Refusal
- Pre-existing disease
- Insufficiency of declaration (entry questionnaire)
- Waiting period has not expired
- Aesthetic treatment
- Birth (not covered by the policy)
- Limit exceedance
"Pre-existing" Discussion
- The insurer must prove that the disease started before
- Mere diagnosis after the insurance is not enough
- Traces are sought in medical history
Ojection Ways
- Written objection to the insurer + additional medical report
- Insurance Arbitration Commission
- Consumer arbitration committee / court
- Trade of first instance court
Insurance Arbitration Advantage
- Fast (4-6 months)
- Low fee
- No cost under 5,000 TL
- Decision is final under 250,000 TL
Supreme Court 11. HD
11. HD accepts that the private health insurer must prove the claim of "pre-existing disease" with concrete medical evidence, and that a mere claim is insufficient.
Practical Recommendations
- Report all diseases before the policy (or reason for cancellation)
- Call the insurance and get pre-approval before the treatment
- Keep all reports/invoices
- Quick notification in case of emergency do
Health/insurance law lawyer recommended.