Health Insurance Claims in Türkiye: Documents, Reimbursement and Follow-Up

عناقيد · Dec 20, 2025

Making a health insurance claim in Türkiye

With direct billing, a participating provider seeks payment from the insurer and you pay any applicable share. With reimbursement, you pay first and submit a claim. Neither arrangement guarantees that every service is covered.

1. When reimbursement may apply

An out-of-network hospital or clinic may require full payment before you claim, if the policy allows it. Some services, urgent visits away from your usual network, medicines or diagnostic tests may also use reimbursement. A policy can exclude out-of-network treatment entirely: check before paying where circumstances allow.

2. Why a claim may be refused

Common issues include an excluded service, cosmetic or dental treatment without a benefit, maternity outside its cover or waiting period, or a pre-existing condition subject to an exclusion. Incomplete invoices, reports or evidence of medical need can also delay assessment. Check notification and submission deadlines in your policy and contact the insurer promptly.
Review, 8 October 2026: the original article's examples of 5-, 30- or 60-day deadlines, automatic late rejection and a 7–30 working-day payment period are not universal rules. Ask for the applicable contractual and legal time limits in writing.

3. Prepare the documents

An itemised invoice (fatura): in the patient's name, identifying the provider and tax details, individual services and a verifiable invoice record. A valid electronic invoice need not carry a physical stamp.
A clinical report or discharge summary (epikriz): diagnosis, reason for treatment and the services or tests required.
Relevant laboratory and imaging reports.
Payment evidence, such as a receipt or transaction record.
The insurer's claim form, whether in its app or on paper.
The bank details accepted by the insurer; ask whether a Turkish IBAN is required.

The exact list varies; do not rely on an unsupported percentage of insurers requesting the same documents.

4. Submit the claim step by step

Check out-of-network cover, reimbursement rate and pre-authorisation requirements.
Collect itemised invoices, the medical report and results before leaving the provider.
Make legible copies of every page without cropping identifiers or verification details.
Use the insurer's official app, email or branch channel. Briefly state the reason for the visit, date, services and amount, and supply the requested bank details.
Keep the claim reference and proof of submission.
Respond promptly to requests for more detailed invoices, diagnosis or a translation where required. Ask whether further information affects a deadline.

5. How reimbursement is calculated

The policy may combine a reimbursement percentage, annual limit, deductible and co-payment. The order of calculation matters.
Illustration only: on a TRY 1,000 eligible bill, 70% gives TRY 700. If the policy then subtracts a TRY 100 deductible, the result is TRY 600. A policy applying the deductible first would calculate a different amount. Ask for the actual calculation.

6. How long will it take?

Ask the insurer for its processing time, the date the file became complete and any outstanding documents. An incomplete or disputed claim can take longer than a routine one; keep a record of follow-up and use the insurer's complaint route if needed.

7. Reduce avoidable problems

Confirm reimbursement before planned spending, obtain itemised paperwork and a clinical report, submit a complete file promptly and retain PDF copies. Success depends on eligible cover and evidence, not on paperwork alone.
If you share the insurance category and, optionally, the insurer in the discussion, a tailored list of questions may help. Do not post your policy number, bank details or private health documents publicly.