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Old 23rd July 2018, 09:47   #1 (permalink)
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Question SGK - Refused coverage for a chronic condition

I hope that the members of this forum can help me understand why I was refused SGK when I went to Bashkent hospital in Alanya this morning.

I have paid SGK for 6 years. 4 years ago I was diagnosed diabetic and prescribed insulin. I have gone to Bashkent hospital every 3 month since then to get a new insulin prescription and usually blood tests.

I went in January - no problem and again in April 18, again no problem.

I went this morning and was told that SGK would not accept the charges as it was a chronic condition. I had to pay TL 170 to get a doctor to write my usual prescription and was told I would have to pay for my prescription.

Insulin is not cheap! This is a substantial increase in my healthcare costs.

Has anyone else found themselves in a similar position? Does it make sense to inquire at the SGK offices to see if I can get this decision reversed?

If SGK will not pay for these costs does it make sense to remain insured with them? I know new private health insurance will not cover existing conditions, but maybe it will be a cheaper option?

I would appreciate your advice.
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Old 23rd July 2018, 10:36   #2 (permalink)
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Re: SGK - Refused coverage for a chronic condition

I am very sorry to hear about your predicament. Recently, as I understand it, there has been a policy change in the way SGK handles long term or chronic conditions such as diabetes. As usual, it's all about money.

This is what I found out about this, but I could be wide of the mark and you will have to make your own enquiries. Last year, SGK introduced a policy which changed the way they allowed payment on chronic conditions. Up until then, subject to cursory checks, most new people were accepted and payments for chronic conditions were paid. Then strict medical examinations were introduced BEFORE people were accepted, to make sure they did not have any pre-existing conditions. If a claim was subsequently made, it could not include any pre-existing condition.

But what happens to the many people who have already been accepted and receiving treatment- like you? It seems a "shoot first, ask questions later" policy has been introduced, whereby any longstanding medical condition is deemed to have existed before you enrolled. In order to be able to get your SGK restored, you are going to have to prove the diabetes did not exist before you enrolled. Having to prove a negative is going to be difficult, to say the least.

That is my understanding of the situation, but please keep us posted as to how you get on.
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Old 23rd July 2018, 10:42   #3 (permalink)
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Re: SGK - Refused coverage for a chronic condition

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Originally Posted by Rose Cole View Post
, whereby any longstanding medical condition is deemed to have existed before you enrolled. In order to be able to get your SGK restored, you are going to have to prove the diabetes did not exist before you enrolled. Having to prove a negative is going to be difficult, to say the least.
I donīt know the answer, but would it be relevant if the condition had been declared? Like any insurance, if you donīt let them know it can result in a problem, but if they knew about it, and have been taking cash for years while treating it, that may have a bearing; it has not been hidden from them.

Ian

ps and reading it again, the condition started after 2 years of membership.
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Old 23rd July 2018, 12:40   #4 (permalink)
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Re: SGK - Refused coverage for a chronic condition

I am not with sgk ,but i understand chronic conditions are not covered . Where in Alanya ? If i was you i would find your local doctor's surgery and go there he will give you a prescription free of charge ,and make all your blood test free . We have been using them for a few years no problem. Have you tried government hospital. some private hospitals cannot give treatment on certain illnesses. best of luck.

Last edited by enoch; 23rd July 2018 at 12:46..
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Old 24th July 2018, 11:38   #5 (permalink)
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Re: SGK - Refused coverage for a chronic condition

I went to the new SGK offices in Alanya yesterday afternoon. The guy I spoke to was a clerk (not a manager) so he could not make any decisions. You mention the word "chronic" and he replies not covered! So you are right Rose.

I also got the impression that SGK was being more restrictive on private hospitals. Next time I will go to the new devlet hospital. I think a prescription written there is more likely to be covered.

I don't know how to talk with a manager at the SGK offices. I would need an interpreter to explain my arguments (my Turkish is simply not up to that task) and honestly I think the answer would be the same.

I think the lesson here is to use the public hospital with your SGK insurance.

Thank you all for your help.
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Old 24th July 2018, 12:13   #6 (permalink)
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Re: SGK - Refused coverage for a chronic condition

We have struggled before when going to our SGK office, we got new kimliks, went and informed them then when I went for my next prescription, was told we weren't covered (this is after paying our normal monthly fee)
Had to go to our friendly translator who wrote on a piece of paper that we had gotten new residencies and wanted to inform them
I dread to think what would have happened if one of us had an accident
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Old 25th July 2018, 05:41   #7 (permalink)
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Re: SGK - Refused coverage for a chronic condition

Quote:
Originally Posted by enoch View Post
If i was you i would find your local doctor's surgery and go there he will give you a prescription free of charge ,and make all your blood test free . We have been using them for a few years no problem. .
When I registered with the new GP type service in a local clinic, the doctor asked me why I was continuing with SGK. His view was that it was not sensible.

We agreed ( doctor and I) that I should have blood tests as a routine part of annual check-up. He listed what he wanted tested and off I went to the hospital, where the consultant decided that most were not necessary (under SGK), so they were not done. My GP now has in-clinic testing, for which I pay extra, but get exactly what we both agree is needed.

I have stayed with SGK in case of some chronic condition developing, but if they are going to dump me in the event of something serious, then perhaps ı need to just stick with the GP and drop SGK. Sods Law will mean that I would need it the next day!

Ian
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Old 25th July 2018, 06:18   #8 (permalink)
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Re: SGK - Refused coverage for a chronic condition

Ian- I currently have private insurance and fortunately have not needed to make a claim as yet. To try and prevent the issues you describe arising, my husband and I have decided to have a thorough SGK type medical examination that will certify whether we currently have any pre-existing conditions (fingers crossed!).

In the event of any future claim, hopefully it will be easier to show that any condition did, or did not, exist at the time of the claim.

Just like any insurance policy, the test is when you make the claim as they will look for any excuse not to pay out.
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Old 25th July 2018, 06:22   #9 (permalink)
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Re: SGK - Refused coverage for a chronic condition

The upside of the drop in the TL is that SGK is now relatively cheap.

Ian
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Old 25th July 2018, 06:43   #10 (permalink)
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Re: SGK - Refused coverage for a chronic condition

Don't you have to have SGK for your residency permit?
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