Package Fees at Private Hospitals

1. Introduction: 'Package Fees' and Shocking Additional Costs in Private Hospitals

The package pricing system in private hospitals is attractive to patients who want to know the total cost in advance, especially for births, surgeries, and certain tests. Many people agree to such packages verbally or in writing, trusting the "all-inclusive package fee" claim. However, upon discharge, they may find unexpected charges on their bill, such as "extra cost for medications outside the package, operating room supplies, newborn fees, consultation, emergency room, accompanying person fees, and hotel expenses.".

The critical question here is:
Are additional charges added after a package deal has been agreed upon at private hospitals legally valid?
In other words, are you obligated to pay fees that the hospital subsequently requests "despite the package deal"?

This article the Social Security Institution (SGK) legislation, the Health Application Communiqué (SUT), the Private Hospitals Regulation, Law No. 6502 on Consumer Protection and Supreme Court decisions .

2. What is Package Fee? (Legal and Practical Definition)

2.1. "Package Fee" in Hospital Marketing Language

In everyday life, "package fee" is used, it usually refers to the following:

For a specific procedure (e.g., vaginal delivery, cesarean section, gastric sleeve surgery, cesarean delivery, etc.)
All operations from start to finish are included in a single total price
Reducing cost uncertainty by telling the patient, "You will pay a total of X TL for this procedure . "

For example:

“Normal delivery package: 30,000 TL (all inclusive)”
“Cesarean section + 1 night hospital stay package price: 45,000 TL”
"Gastric sleeve surgery package price: 120,000 TL," for example.

This statement creates the expectation in the patient's mind that "I will not make any payment beyond this fee." And it is precisely this expectation that is legally crucial.

2.2. The Package Concept from the Perspective of SGK and SUT

On the other hand, the Social Security Institution (SGK) also "package price" / "package procedure" based on diagnosis . In the SUT (Health Services Pricing Regulation) appendix lists, some surgeries and treatments are paid for based on package price; which procedures and items are included in this package are determined according to SGK regulations.

In this situation:

SGK pays the hospital a package price .
This package covers specific tests, supplies, hospital stays, and some medications.
According to SUT (Social Security Institution's Tariff), some items can be billed separately, while others are included in the package.

When a hospital issues an invoice to both the Social Security Institution (SGK) and the patient, it cannot charge an additional fee or an "extra charge" for items specified as included in the package according to the SUT (Health Services Pricing Regulation).

3. Pricing System in Private Hospitals: Difference Fee, Additional Fee and Package Fee

3.1. Private Hospitals Contracted with SGK (Social Security Institution)

There are three fundamental concepts in private hospitals contracted with SGK (Social Security Institution):

The amount paid by the institution (SUT price)
- This is the amount paid by the Social Security Institution (SGK) to the healthcare provider.
Additional fee (difference fee)
- This is an additional fee that can be charged to the patient, up to a certain percentage of the SUT (Social Security Institution) price .
- According to the SGK's "Additional Fee" page; no additional fee can be charged for some procedures listed in Annexes 2/B, 2/C, and 2/Ç of the SUT (Health Services Pricing Regulation); these are included in the package price. (For more information, see: https://ferhatkule.av.tr/ozel-hastanelerde-fark-ucreti/)
Services not financed by the institution (outside the scope of SGK)
- These include cosmetic procedures, certain comfort services, and the option of private rooms.
- The fees charged for these services are considered not as "additional charges," but service fees not covered by the Social Security Institution (SGK) .

The Social Security Institution (SGK) has also listed certain services as "health services for which no additional fee will be charged." According to this list:

Emergency situations,
Intensive care,
Burn treatment,
Cancer treatment,
Healthcare services provided to newborns,
Organ transplants, dialysis, certain surgeries

No additional fees may be charged (except for exceptions) .

Therefore, for a patient covered by the Social Security Institution (SGK), healthcare services provided to a newborn baby would in most cases be clearly against the regulations.

3.2. Private Hospitals That Do Not Have a Contract with SGK (Social Security Institution)

In hospitals that do not have a contract with SGK (Social Security Institution):

Since the hospital does not have an agreement with the Social Security Institution (SGK), the patient usually pays the entire cost themselves.
However, this does not mean that the hospital can charge whatever it wants and without limit .
Law No. 6502 on Consumer Protection (TKHK) And Turkish Code of Obligations (TBK);
- Defective service,
- Unfair conditions,
- Unfair price increase and
- It provides protection against ambiguous contract terms that could be interpreted to the detriment of the consumer.

Therefore, even in a hospital that does not have a contract with the Social Security Institution (SGK), "imposing additional charges after the package fee has been agreed upon" is legally debatable and may be deemed invalid in most cases.

4. Legal Nature of the Package Fee: Contract + Consumer Law

4.1. The Package Fee is a Service Agreement

Healthcare services received at a private hospital are legally considered a "service contract" between the patient and the hospital.

A verbal or written agreement is made
Scope of service (type of surgery, method of delivery, length of stay, additional tests),
The amount of the fee and the method of payment are agreed upon.

A package fee is a specific form of pricing in this service agreement : a predetermined, all-encompassing “lump sum”.

Here are the points to note:

The scope of the package must be clearly and in writing
Clearly listing the services that will be excluded from the package,
The patient should be informed about these terms, for example, through an information form, consent form, or contract .

If the scope is unclear, according to the fundamental principle of consumer law, the provision causing the ambiguity shall be interpreted in favor of the consumer.

4.2. Package Fees and Additional Costs from the Perspective of the Turkish Consumer Protection Law

According to the Consumer Protection Law No. 6502:

A person receiving healthcare services from a private hospital is largely a "consumer" .
The hospital "service provider" / "provider" .
The law protects consumers against defective services and unfair contract terms

Example principles:

Information obligation:
- The patient should be clearly informed about the scope of the service they will receive, its cost, and any additional expenses.
The contract terms must be clear and understandable:
- If a package is advertised as "all-inclusive," later stating that "this medication is not included in the package, this test is not included" often constitutes an unfair condition
Unfair terms should not be binding:
- Conditions that are detrimental to the consumer, contrary to the principle of fairness, unexpected, or unpredictable, may often be considered invalid even if written into a contract.

In this respect, "requesting an additional fee without any information and without the patient's consent, despite the package price" would be seriously debatable and largely invalid under both the Turkish Consumer Protection Law, the Turkish Medical Association Law, and health legislation .

5. Health Legislation: Private Hospitals Regulation and SUT Rules

5.1. New Private Hospitals Regulation dated 30.01.2025

The new Private Hospitals Regulation , published in the Official Gazette on January 30, 2025 , completely reorganized the operation of private hospitals. Article 43 of the regulation , titled "Prohibitions," lists many prohibitions that private hospitals must comply with. One of these prohibitions is:

Emergency medical services and related healthcare services that are exempt from additional fees according to relevant legislation cannot be charged additionally in violation of legal provisions.

This means:

According to the Social Security Institution's (SGK) list of "health services for which no additional fees will be charged, " services that are prohibited from having additional fees (such as newborn care, emergency care, intensive care, etc.) cannot be charged extra in private hospitals, even if they are stated as "not included in the package price."
The hospital administrative sanctions and even licensing consequences as a result.

Furthermore, the same regulation clearly states that laboratories/radiology units, etc., from which services are procured cannot charge patients additional fees, and that the hospital and the service provider are jointly responsible.

This also legally prohibits the following situation, which is frequently encountered in practice:

"We had the MRI done at an external center, and they will charge you extra."

According to the regulation, it is forbidden for the institution providing the service to charge the patient an additional fee; that fee must already be indicated in the package or in the hospital's own price list.

5.2. SUT and SGK Regulations: Services for Which No Additional Fee Will Be Charged

The Social Security Institution (SGK) has listed, under the heading "Healthcare Services for Which No Additional Fees Will Be Charged," the healthcare services for which private hospitals cannot charge any additional fees . These include:

Healthcare services provided due to emergency situations,
Intensive care services,
Burn treatment,
Cancer treatment,
Healthcare services provided to newborns,
Organ, tissue and stem cell transplants,
Surgical procedures for congenital anomalies,
Hemodialysis,
Certain cardiovascular surgeries and implant procedures, etc.

Furthermore, the following principles are highlighted on the SGK's "Additional Fee" page:

Healthcare providers are required to inform patients in writing of any additional fees before charging them and obtain written consent
For procedures listed in Annexes 2/B, 2/C, and 2/Ç of the SUT (Social Security Institution's Tariff), no additional fees may be charged for items included in the package price.
Fees charged for procedures not financed by the institution (outside the scope of SGK - Social Security Institution) are not considered additional charges; however, these are also subject to patient information and contract terms .

Extremely important point:
In order for an additional fee to be charged;

Prior notification,
Written consent,
Compliance with the rates set by the legislation is mandatory.

Otherwise, saying "the surgery is finished, this material is outside the package, and you will have to pay this much more" is clearly against the regulations.

6. Supreme Court Practice: Control of Additional Fees, Package Fees, and Excessive Fees

The Supreme Court has long been monitoring the additional fees and treatment charges charged by private hospitals and private healthcare institutions ; in particular:

Exorbitant treatment fees,
Additional charges contrary to the contract,
the patient is not informed, the court makes decisions to protect the patient.

Some key points:

Information and consent are required for the charging of an additional fee:
- The rulings of the 13th Civil Chamber of the Supreme Court of Appeals emphasize that in order for an additional fee to be charged to a patient, it must be explicitly stipulated in the contract and communicated to the patient in advance .
- In healthcare service procurement contracts with the Social Security Institution (SGK), the rate of additional fees that can be charged to the patient is limited, and it is stipulated that any additional fee with written consent before each procedure .
Double billing and unjust enrichment:
- In cases where cancer patients are charged the same fees for services by both the Social Security Institution (SGK) and the patient themselves, the Supreme Court can rule for the refund of the excess fees, based on the contract, the provisions of the Health Services Pricing Regulation (SUT), and the principle of interpretation in favor of the patient
Excessive wage control:
- If the cost of treatment is "far above the usual and reasonable level," there are decisions requiring a reduction in fees based on comparisons with the Turkish Medical Association's Minimum Fee Tariff and similar tariffs, and the refund of the excess amount charged.

In summary,
the Supreme Court tends to protect patients against arbitrary and vague fee practices by private hospitals.
This serves as a serious warning for hospitals that charge additional fees despite the so-called "package fee."

7. In what situations might subsequently incurred additional costs be applicable?

Not every additional charge is automatically illegal. In some cases, a request for an additional fee may be considered reasonable and lawful . Generally, the following conditions must be met simultaneously:

The scope of the package must be clearly defined
- For example, in the contract:
  - “The package includes a normal delivery + 1 night hospital stay + stay in a standard room + basic examinations + standard jaundice screening.”
  - "The following are excluded from the package: neonatal intensive care, additional surgical procedures, advanced imaging, private room, companion fee, exceptional implants, cosmetic procedures..." etc.
The additional service must genuinely be outside the package and justified
- For example, complications developing during childbirth and additional surgery ,
- Unplanned, life-saving intensive care,
- Upon request of the patient or their family;
  - single suite room,
  - luxury hotel services,
  - cosmetic surgery.
Prior notification and written consent of the patient/patient's relative
- According to SGK and SUT regulations, patients must be informed in writing and their consent obtained before any additional fee is charged
- Without this consent, stating "we used this material during the surgery, and it cost this much" is invalid in most cases.
Rates and amounts in accordance with legislation
- In hospitals contracted with SGK (Social Security Institution), additional fees cannot be charged for services that are already exempt from additional fees according to SUT (Health Services Pricing Regulation).
- The additional fee rates that can be charged are also limited by the SUT (Health Services Pricing Regulation) and SGK (Social Security Institution) decisions; any additional fees that contradict these regulations are considered illegal.

When these conditions are met, some additional costs may be legally acceptable. However, in most disputes, especially package birth and package surgery cases, these conditions are found to be missing.

8. Which Additional Costs May Be Considered Unlawful?

The following are examples of additional costs that are frequently encountered in practice and are often likely to be deemed illegal :

8.1. Additional Charges for Items Required in the Package

During presentations or verbal explanations regarding the package price:

"All-inclusive standard maternity package"
"All-inclusive cesarean section package"
"Includes surgery + anesthesia + operating room + 1 night hospital stay," it was stated

later:

The difference in anesthesia,
Operating room usage fee,
Standard laboratory tests,
Routine jaundice screening,
Standard boarding fees

items like these as outside the package and charged separately, this emptying the package price of its contents and is often illegal.

8.2. Requesting Additional Fees for Services for Which No Additional Fee Will Be Charged

In cases listed by SGK (Social Security Institution) as "health services for which no additional fee will be charged"; in particular:

Emergency services,
Intensive care,
Cancer treatment,
Healthcare services provided to newborns,

It is clearly against regulations for a private hospital to charge additional fees under names such as "outside the package," "difference fee," or "newborn fee.".

For example, for a mother covered by the Turkish Social Security Institution (SGK):

The mother may have paid extra due to the maternity package,
However, charging additional fees for newborn examinations and treatments under headings such as "newborn package, newborn hospitalization fee, newborn jaundice package" would in most cases be contrary to the provisions of the Social Security Institution and the Private Hospitals Regulation .

8.3. Additional Costs Incurred Subsequently Without Written Consent

According to the Social Security Institution's (SGK) regulations regarding additional fees, if an additional fee is to be charged at the hospital, this fee is:

Before the service is provided,
The patient should be notified in writing
It must be signed by the patient/patient's relative.

Nevertheless, the following situation is observed in many files:

When a patient is discharged after surgery or childbirth,
"Beyond the package contents, we used these materials, performed these tests, and you need to pay this much extra," they will say
No prior information form or consent can be presented.

In this situation , the contractual and legal basis for subsequently incurred additional costs is weak ; in most lawsuits and complaints, the court may rule for the return of these costs or, if they were never paid, for them not to be paid at all .

8.4. Excessive and Unreasonable Additional Charges

In some cases, it is not the additional expense items themselves but their amount that is legally problematic:

Far above the average market price,
If the fees are exorbitant when compared to the Turkish Medical Association (TTB) or relevant tariffs ,
In the practice of the Supreme Court, these fees are reduced, that is, brought to a reasonable level, and a decision may be made to return the excess amount.

9. Common Scenarios in Practice

9.1. “All-Inclusive Maternity Package” and Newborn Expenses

Scenario:

The mother agrees on an all-inclusive normal delivery package with a private hospital for 30,000 TL
The birth takes place, the baby is healthy; routine checkups and tests are performed.
Upon discharge, the mother is charged additional fees such as a maternity package of 30,000 TL + a newborn package of 18,000 TL + a newborn jaundice screening fee of 2,950 TL

Legal assessment:

For mothers covered by SGK (Social Security Institution), healthcare services provided to newborns are among the services for which no additional fee will be charged according to SUT (Health Services Pricing Regulation).
Article 43/1-ö of the Private Hospitals Regulation explicitly stipulates that "no additional fees may be charged for services for which no additional fees are permitted, in violation of the legislation.".
In a birth package marketed as "all-inclusive," charging an additional fee for the newborn despite the package price, if the scope of the package is not clearly stated or if it is not explicitly indicated that an extra fee will be charged for the newborn, would be a serious violation of the law .

In this case, the patient can both file a complaint with the Social Security Institution (SGK) regarding the "excessive additional fee"and the Consumer Arbitration Board/Court for a refund of the overcharged amounts.

9.2. Surgical Package and “Extra Package Materials” Discussions

Scenario:

The patient is offered a package deal of "100,000 TL including surgery, anesthesia, and a 3-night hospital stay.".
An additional 40,000 TL is demanded, claiming that some implants and materials used during the surgery were "outside the package".

Legal assessment:

If the materials used are among the items listed in the package price according to the SUT (Social Security Institution's Tariff), no additional fee can be charged).
If the package deal does not explicitly state that these materials are outside the package, and the patient has not been specifically informed about this, charging an additional fee for "outside the package" unfair terms and defective performance .
Furthermore, whether the fee is excessive can be checked against the Turkish Medical Association's (TTB) tariff and comparable practices.

10. What Can the Patient Do? Ways to Seek Redress

If you encounter additional charges after paying the package fee, you can follow the roadmap below.

10.1. Gather the Documents First

Be sure to ask the hospital:
- Detailed invoice (item by item),
- If you are covered by SGK (Social Security Institution), you will receive the "Document Showing Health Services Provided to the Patient and Additional Fees (Annex-1/B)".
- The information and consent forms you have signed ,
- “Package agreement” or written package information documents, if any.
Transcribe as much of the oral conversation as possible:
- Email, messages, hospital records, etc.

Without these documents, it becomes difficult to wage a legal battle.

10.2. Written Application to the Hospital's Patient Rights Unit

Most private hospitals a Patient Rights Unit .
If you think the additional costs are unfair;
- a detailed complaint letter ,
- Request a refund for any overcharges.
Request a written response; if necessary, you can also document the dispute with a notarized notice

10.3. Complaint to the Provincial Health Directorate and the Ministry of Health

According to the Private Hospitals Regulation, private hospitals the Ministry of Health and the Provincial Health Directorates .

You can file a complaint with the Provincial Health Directorate regarding unfair additional charges, fees for services that should not be charged, holding patients hostage, and exorbitant fees.
It is also possible to file a complaint via the Ministry's SABİM hotline (Alo 184); these complaints often trigger inspections.

As a result of the administrative investigation, the hospital:

Administrative fine,
Partial or complete suspension of activity,
Repeated violations may result in sanctions, including license revocation.

10.4. Complaint to SGK (Social Security Institution) Regarding "Excessive Additional Fees"

If you are registered with SGK (Turkish Social Security Institution):

According to the procedures stated on the SGK's "Additional Fee" page,
If you believe that the additional fee charged by the hospital is contrary to the SUT (Health Services Pricing Regulation) and the contract,
You can file a complaint about "excessive additional fees" with the SGK Provincial Directorate or social security centers .

SGK (Social Security Institution);

He requests the file from the hospital
It examines the transactions carried out in accordance with SUT regulations,
If "additional fees have been charged for services for which no additional fees should be charged" or "the rate has been exceeded,"
The court may decide to order the refund of any excess additional fees and impose contractual sanctions.

10.5. Consumer Arbitration Board and Consumer Court

The most important legal avenues available to the patient to the Consumer Arbitration Board (THH) and the Consumer Court .

The monetary limit for THH (Turkish Consumer Arbitration Board) applications in 2025 149,000 TL. For disputes below this amount, application to the THH is mandatory; for disputes above this amount, a lawsuit must be filed directly with the Consumer Court.

In the application:

Any additional expense items that you consider excessive/unfair,
All points that conflict with the package price,
The documents you signed and the invoice,
You can elaborate on your claims that you were not informed

THH decisions;

Within certain limits, has the force of a court judgment ,
If the court rules against the hospital, it may have to refund the overcharged amounts.

In cases filed in Consumer Courts, a more comprehensive assessment is made in light of Supreme Court precedents and legislation; if necessary, expert examination is conducted to investigate issues such as excessive fees, package contents, and violations of Social Security Institution regulations.

10.6. What Happens If Enforcement Proceedings Are Initiated for Unjustified Additional Fees?

Some hospitals have issues with patients who don't pay the additional charges that are subsequently incurred:

enforcement proceedings ,
They may even exert pressure by saying, "If you don't pay, we will initiate debt collection proceedings and garnish your salary.".

In this situation:

Carefully review the payment order you received.
to the part of the enforcement proceedings you believe is unfair within the prescribed time limit.
Simultaneously, obtaining a ruling from the Consumer Court or the THH (Turkish Consumer Arbitration Board) stating that the fee in question is unfair would be in your best interest.

Remember, not every requested amount is automatically final and indisputable. Even if enforcement proceedings have been initiated, you have the legal right to defend yourself and object.

11. Frequently Asked Questions (FAQ)

Question 1: I signed for the package deal, can they charge an extra fee later?

Package contents written and clear whereas;
- For genuine additional services not included in the package (e.g., private suite room, optional cosmetic procedures),
- With prior notification and consent, reasonable additional fees may be charged.
However, in packages marketed as "all-inclusive";
- Items such as anesthesia, operating room, standard tests, and newborn examination cannot be listed separately from the package later.
For patients covered by SGK (Social Security Institution), no additional fees or extra charges can be requested for services for which no additional fees are normally charged.

Question 2: A private hospital charged me an extra fee on my newborn baby's bill. Is this legal?

According to the SGK (Social Security Institution) list, no additional fees can be charged for healthcare services provided to newborns (except in some exceptional cases).
The Private Hospitals Regulation also prohibits charging additional fees for services for which no additional fees should be charged, in violation of the legislation.
Therefore, high "newborn package" fees for a newborn covered by the Social Security Institution (SGK) would largely be unlawful.
In such a situation, you have the option of applying to the Social Security Institution (SGK), the Provincial Health Directorate, and the Consumer Rights Arbitration Court/Consumer Court.

Question 3: The hospital says it will not discharge me/my child without payment of additional costs. Is this legal?

Healthcare providers, holding a treated patient or a newborn baby hostage simply because payment has not been made;
- Both patient rights,
- And it is against human dignity.
In such a situation, an immediate to the Provincial Health Directorate and, if necessary, to the prosecutor's office ; furthermore, fee disputes are a matter of consumer law, and resolving them through "collateral" is unacceptable.

Question 4: I paid the extra charges upfront, but later realized they were unfair. Can I get a refund?

Yes. For unfair and illegal additional costs;
- First, you can apply to the hospital for a return request
- If your request is denied, the Consumer Arbitration Board / Consumer Courtto recover the overpayment.
If you are covered by SGK (Social Security Institution), you can also file a complaint with SGK regarding "excessive additional fees".

12. Conclusion: Package fees should protect you and prevent surprise bills

The primary purpose of package pricing in private hospitals is to ensure that patients know the total cost from the outset and avoid surprises . However , numerous cases and complaints indicate that in practice, package pricing has the opposite effect, with patients being charged high additional costs at the time of discharge under the guise of "outside the package."

When we look at the legal framework:

Turkish Consumer Protection Law No. 6502 and Turkish Commercial Code,
The Health Application Communiqué (SUT) and the Social Security Institution's "Additional Fee" regulations,
Private Hospitals Regulation dated 30.01.2025,
Supreme Court precedents,

When considered together:

No additional fees can be charged for services that are free of charge (emergency, intensive care, neonatal, etc.) .
Despite the package fee, arbitrary additional charges cannot be levied for items included in the package, even if those items are later declared "outside the package . "
If an additional fee will be charged;
- Providing the patient with prior written information,
- Obtaining written consent,
- Compliance with the rates stipulated by the legislation is mandatory.
Exorbitant and excessive fees reduced , and excess amounts collected may be refunded.

Therefore,
you don't automatically have to accept every additional cost that arises after you've had a package deal at a private hospital.

By gathering your documents;

To the hospital,
To the Provincial Health Directorate,
To SGK,
You can request a refund of unfair and unlawful additional fees by applying to the Consumer Arbitration Board or the Consumer Court

PACKAGE FEE, SOCIAL SECURITY

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