SGK Medical Device and Hearing Aid Difference Payment Recovery Lawsuit

SGK Medical Device and Hearing Aid Difference Payment Recovery Lawsuit

Citizens who have to use medical devices such as hearing aids, cochlear implants (bionic ears), arm/leg prostheses, or blood sugar sensors due to health problems face a serious financial burden. The Social Security Institution (SGK) determines a specific ceiling price for these devices under the Health Implementation Communiqué (SUT); however, these determined ceiling prices remain far below the prices of high-quality and modern devices sold in the market.

As a result, citizens are forced to pay the “device price difference,” amounting to thousands or even tens of thousands of liras, out of their own pockets. However, high court decisions and current labor court jurisprudence are clear: The full cost of devices that constitute a medical necessity must be covered by SGK, and the differences paid out of pocket can be recovered through litigation.

Why Does SGK Underpay? Is the SUT Limit Legal?

SGK is obliged to cover the medical device and prosthesis expenses of the insured under Law No. 5510. However, citing budget constraints, the institution imposes strict limits on payments with SUT lists.

Judicial bodies, on the other hand, find this restrictive practice of SGK unfair. According to the decisions of the 10th Chamber of the Council of State; restrictions made purely for the purpose of saving cannot lower the quality of service foreseen by medical science. Ceiling price limits that are not based on scientific justifications and cause massive differences to come out of citizens’ pockets are completely contrary to the “social state” principle and the “right to a healthy life” guaranteed by the Constitution.

The Courts’ Precedent Approach: Why is Your Money Being Refunded?

In concrete cases reflected in judicial processes, courts have developed very important criteria protecting the citizen. For example, when the device processor of a patient who has hearing loss in both ears and uses a cochlear implant malfunctions, renewing this device is a vital necessity.

In such a case, the market value of the new device can amount to approximately 170,000 TL. SGK, on the other hand, only pays the company around 76,000 TL due to the ceiling price in its own communiqué, and expects the patient to pay the very high difference of approximately 94,000 TL out of their pocket.

IMPORTANT: What Do Labor Courts Say in This Situation? In the lawsuits filed, labor courts and expert committees look at these two questions:

1. Is the use of this device medically mandatory for the patient’s health and clinging to life?
2. Is there a free equivalent of the same quality that will cure the patient’s ailment within the price scale suggested by SGK? If the device is mandatory and an equivalent cannot be found at that price, courts rule for “The full refund of the difference out of the citizen’s pocket to the patient by SGK, along with legal interest.” Moreover, when the case is won, all court costs and attorney fees are left on SGK, which made the unfair deduction.

For Which Devices Can a Difference Payment Lawsuit Be Filed?

In line with the consistent decisions of the Court of Cassation and the Council of State, a lawsuit can be filed for almost any vital device and material whose medical necessity is proven with a doctor’s report. The types of cases we frequently win are:

Device / Material Type	SGK’s Practice	Courts’ Clear Decision
Digital Hearing Aids	Pays very low ceiling prices with SUT.	The market current value is investigated, and the difference is refunded to the patient.
Cochlear Implants & Processors	Covers only a limited ceiling price.	If there is medical necessity, the full difference is paid without deductions.
Robotic / Transfemoral Prostheses	Rejects because it is not on the SUT list or is expensive.	Due to the right to a healthy life, refund of the actual price is ruled.
Sugar Sensors & Insulin Pumps	Usually does not include on the payment list or underpays.	It is mandatory for the Institution to pay as it contributes to the quality of life.

How Does the Legal Process Work to Recover the Difference Amount?

In order to recover your money from SGK, it is mandatory that you run a specific legal procedure. The process consists of these steps:

1. Preparation of Documents: You must completely preserve the approved invoice showing the difference you paid when purchasing the device, the prescription, and the health board report.
2. Application to the Institution: First, a written application is made to SGK with the documents to request a refund of the difference. The institution will usually respond negatively to this request.
3. Filing a Lawsuit: After the rejection decision, a lawsuit must be filed within the prescriptive periods. If you are under SSK or Bağ-Kur status, the lawsuit must be filed in the Labor Court; if you are a civil servant or retired civil servant, in the Administrative Court.
4. Expert Examination: The court clarifies the medical necessity and market current value of the device by obtaining an expert report from relevant scientific branches of universities such as oncology or ENT.

Don’t Leave the Money You Paid Out of Pocket to SGK!

Millions of citizens give up seeking their rights out of concern that “Will I go to court with SGK?” or “Court costs will amount to more than the money I will receive.” However, as clearly seen in established judicial decisions, when you are proven right, all attorney fees and court costs are loaded onto SGK, which carried out the unfair transaction.

If you have paid high differences for medical devices, prostheses, or hearing aids that you had to purchase for your health; it is your constitutional right to take this money back from SGK with legal interest.

As NS Law and Consultancy, with over eight years of experience in SGK lawsuits and health law, we professionally manage your process of collecting your money from the institution from start to finish. To recover the out-of-pocket payments and secure your rights, you can contact us immediately through our communication channels to make an appointment.