Health Insurance Claim Denied in Turkey? How to Appeal with SEDDK

Turkey's insurance sector is regulated by the Sigortacılık ve Özel Emeklilik Düzenleme ve Denetleme Kurumu (SEDDK) — the Insurance and Private Pension Regulation and Supervision Agency. Established in 2021 (taking over from the former Hazine ve Maliye Bakanlığı insurance department), SEDDK is the primary consumer protection authority for insurance disputes in Turkey. If your health insurer in Turkey has denied a claim, SEDDK and the Insurance Arbitration Commission (Sigorta Tahkim Komisyonu / STK) are your key escalation bodies.

Turkey's Health Insurance Framework

Turkey has a comprehensive public health insurance system alongside a growing private sector:

• SGK (Sosyal Güvenlik Kurumu): the state Social Security Institution provides universal health coverage to all Turkish citizens and legal residents. SGK policyholders can access all SGK-contracted public hospitals and many private hospitals under agreed reimbursement rates.
• Tamamlayıcı Sağlık Sigortası (TSS): private complementary health insurance supplements SGK coverage, covering co-pays, private room upgrades, and access to non-SGK-contracted private hospitals. TSS is the fastest-growing product in Turkey's insurance market.
• Full private health insurance: for those who want entirely private coverage, including expatriates who are not SGK members

Major private insurers in Turkey include Allianz Sigorta, AXA Sigorta, Anadolu Sigorta, Aksigorta, Güneş Sigorta, Mapfre Sigorta, Groupama Sigorta, and Sompo Sigorta. Many operate health divisions in addition to general insurance.

Common Reasons Turkish Insurers Deny Claims

• Non-contracted provider: the hospital or clinic is not in the insurer's Turkey network
• Prior authorisation not obtained: required for hospital admissions and certain high-cost procedures
• Tamamlayıcı insurance coordination: the claim was processed against SGK first and the supplementary insurer disputes the residual amount
• Benefit exclusion: pre-existing conditions, dental, cosmetic, or psychiatric treatments excluded
• Waiting period: TSS policies often include a waiting period of 6 to 12 months for certain conditions
• Incorrect or incomplete documentation: missing discharge summary, ICD codes, or physician signature

Step 1: Get the Denial in Writing

Request the denial letter (ret yazısı) from your insurer. Turkish insurers are legally required to provide the denial reason in writing. Keep all policy documents, your Yabancı Kimlik Numarası (foreigner ID) or TC Kimlik Numarası (national ID), and the claim reference number.

Step 2: Submit an Internal Complaint (Şikayet) to Your Insurer

Write a formal şikayet to your insurer's customer service or Müşteri Hizmetleri department. Under Turkish consumer protection law (Law No. 6502), companies must respond to written complaints within 20 business days. Include:

• Policy number and ID number
• Denial letter and claim reference number
• Treating physician's medical report and clinical justification
• All invoices and receipts
• Pre-authorisation correspondence if applicable

Step 3: Escalate to SEDDK

If your insurer does not resolve the complaint within 20 business days or provides an inadequate response, file with SEDDK:

• Portal: seddk.gov.tr → Sigorta Şikayet Sistemi (Insurance Complaint System)
• Phone: +90 312 587 45 00
• Email: bilgi@seddk.gov.tr
• In person: SEDDK headquarters, Ankara

SEDDK will register your complaint, notify the insurer, and review the file. SEDDK has supervisory and enforcement powers over all licensed insurers.

Step 4: Sigorta Tahkim Komisyonu (STK) — Insurance Arbitration

Turkey's Insurance Arbitration Commission (STK) is specifically designed to resolve insurance disputes quickly and affordably, without court proceedings:

• Portal: sigortatahkim.org → Online Başvuru (Online Application)
• Phone: +90 212 339 86 00
• Fee: A small application fee applies (waived for low-value claims under certain thresholds)
• STK arbitrators are insurance law specialists and issue binding decisions
• Decisions for claims up to TRY 35,000 (updated annually) are final and not subject to court review
• Higher-value decisions can be appealed to Turkish courts

This is often the fastest and most cost-effective route for policyholders with clear-cut denials.

Step 5: Turkish Courts

For disputes not resolved through STK or for matters involving bad-faith conduct, civil litigation is available through the Turkish Consumer Courts (Tüketici Mahkemesi) for lower-value claims or the Commercial Courts for higher-value insurance contract disputes.

Expat Considerations

Turkey has over 800,000 registered foreign residents. Key points:

• Expatriates who are employed in Turkey and registered with SGK must first claim against SGK. A TSS insurer can only be pursued for residual costs that SGK does not cover.
• Foreign nationals not covered by SGK can purchase full private health insurance from any licensed Turkish insurer. These policies are governed entirely by private law and SEDDK oversight.
• International health insurance policies (e.g., from Cigna, Allianz Care, or Aetna) covering Turkey are primarily governed by the law of the policy's issuing country — check your policy's governing law clause.
• All SEDDK and STK processes are conducted in Turkish. For expatriates, using a Turkish-speaking representative or translator is strongly advisable.

Fight Back With ClaimBack

Turkey's SEDDK and the STK arbitration system provide effective routes to overturn unjust denials. ClaimBack helps you organise your documentation and understand your rights under Turkish insurance law.

Start your free appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Insurance Ombudsman Guide