Application Form for Refund of Additional Fee Charged for Newborns (0-28 Days)

PRESIDENCY OF THE SOCIAL SECURITY INSTITUTION OF THE REPUBLIC OF TURKEY

TO THE PROVINCIAL DIRECTORATE OF SOCIAL SECURITY

(General Health Insurance / Contracted Healthcare Providers Unit)

APPLICANT (PATIENT'S RELATIVE / GUARDIAN):
Name and Surname: ………………………………………
Turkish Republic Identity Number: ………………………………
Address: …………………………………………
Phone/Email: ………………………………

PATIENT (NEWBORN):
Name and Surname: ………………………………………
Turkish Republic Identity Number (if any): ………………………
Date of Birth: …/…/…… (between 0-28 days)

REPRESENTATIVE: Attorney Aydanur NAS
Address: …………………………………………
Tel/Email: ……………………………………

HEALTHCARE PROVIDER (HSP) COMPLAINED AGAINST:
Title: ………………………………………… (Private Hospital / Foundation University Hospital, etc.)
Address: …………………………………………

SUBJECT: Regarding the collection of additional fees/charges contrary to regulations for healthcare services provided to newborns (0-28 days) ; I request a refund of the overcharged amount , an investigation of the transaction within the scope of the Institution's records and the SUT (Healthcare Services Pricing Regulation), the application of contractual/administrative sanctions against the relevant healthcare provider if a violation is found, and written notification to me.

---

EXPLANATIONS

1. On …/…/……, my newborn child, ……………………………, was examined/treated/admitted to the private hospital named ……………………………. The fact that the child was in the neonatal period (0-28 days) is confirmed by the date of birth and the discharge/epicrisis documents.

2. The hospital collected a total of …… TL under the headings of “additional fee/special service fee/difference fee/hotel-companion etc.” within the scope of healthcare services provided to the newborn

   • Invoice/Receipt No: ……………… Date: …/…/……

   • Receipt (POS/payment slip): ………………

   • Items collected (example): ……………………………………

3. However, the Institution's regulation on " Healthcare Services for Which No Additional Fee Will Be Charged " explicitly lists "healthcare services provided to newborns" among the services for which no additional fee can be charged . Therefore, the fee collected for newborns has no legal basis .

4. Furthermore, in cases where SHS claims that an additional fee has been charged, it is necessary to properly prepare a document showing the services provided to the patient/patient's relative and any additional fees , and to obtain informed consent in accordance with the legislation. In the specific case, I was not provided with a clear, understandable, itemized, signed/e-signed document in this regard; or if I was, it was not of a nature that would override the rule that "no additional fee can be charged" for newborn care.

5. For these reasons, it is clear that the fee charged for the newborn is excessive and unfairly collected . I request that your institution investigate the matter and, if the irregularity is found, take action to refund the fee , and also apply the necessary sanctions regarding SHS in accordance with the contract and legal provisions

---

LEGAL REASONS

Law No. 5510, the Health Application Communiqué (SUT) and its annexes, institutional regulations/announcements, legislation on patient rights, general provisions on consumer protection and unjust enrichment, and other relevant legislation.

---

Supreme Court Decisions

• The Supreme Court's 13th Civil Chamber's decision dated May 21, 2015, 2014/47147 E., 2015/16291 K. , states that healthcare services provided to newborns under the SUT (Health Services Pricing Regulation) are within the scope of "no additional fees will be charged," and that in disputes, the nature of the items and whether they were requested should be examined.

• The Supreme Court's 3rd Civil Chamber's decision dated November 16, 2021, 2021/5414 E., 2021/11480 K. , outlines the approach regarding the application of contractual sanctions/penalty clauses when it is determined that an additional fee has been charged to a patient in violation of the Institution's regulations.

  ---

EVIDENCE

• Hospital bill, patient discharge papers/epicrisis, pre-authorization/application records

• Payment receipt/POS slip, bank statement

• Copies of patient files, admission and discharge records

• If applicable, “service and additional fee document”, consent forms, information texts

• Witness and all kinds of legal evidence

---

CONCLUSION AND REQUEST

For the reasons stated and explained above;

1. The process of initiating proceedings for the refund of …… TL collected by the SHS named …………………………… for newborns (0-28 days) is deemed to be an additional fee/charge contrary to regulations .

2. The Institution's records will be examined to determine whether SHS complies with the Institution's regulations and SUT (Health Services Pricing Regulation) , and if non-compliance is found , contractual/administrative sanctions will be applied against SHS .

3. I request to be provided with written information regarding the results of the investigation and the actions taken.

We respectfully request and demand, on behalf of our client, that a decision be made.
Date: …/…/……

Applicant (Guardian/Patient's Relative)
Full Name – Signature

Attorney
Aydanur NAS – Signature

APPENDICES:

1. Invoice/receipt (… pages)

2. Receipt/POS slip (… pages)

3. Epicrisis/discharge certificate (… pages)

4. Other documents (….)