The Social Security Institution (SSI) has a central role in financing healthcare services in Turkey. However, in some cases, individuals ‘ device reimbursement applications may be rejected by SSI. In particular, Type-1 diabetes patients’ applications for access to continuous glucose monitoring systems (CGM), insulin pumps or similar medical devices may be rejected on various grounds. In such cases, patients should know that they are not helpless and that they can seek their rights through legal means. It is possible to file a lawsuit against the SSI’s rejection decision in the administrative courts and this process can have positive results for many patients.
Why are SSI Rejection Decisions Made?
The SSI acts in accordance with the provisions of the Health Implementation Communiqué (SUT) and current reimbursement policies when evaluating device reimbursement applications. However, in this process, a rejection decision may be made for the following reasons:
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The device is not included in the SUT list,
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The device is not covered by SSI due to the patient’s age or type of disease,
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Applying with incomplete or incorrect documents,
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The opinion that the device is not medically necessary.
While some of these justifications are based on objective criteria, in some cases, patients may be victimized due to inadequate explanation of medical necessity or the SSI’s evaluation approach. Especially in diseases that require lifelong follow-up, such as Type-1 diabetes, the rejection of continuous glucose meters may constitute a violation of the right to health.
What Should I Do When I Receive an SSI Rejection Decision?
The first thing to do after the rejection decision from the SSI is to carefully examine the written reason for rejection. The content of this decision includes information such as why the device was not covered and according to which legislation the action was taken. This information plays a fundamental role in shaping the next step , the litigation process.
A lawsuit must be filed before the administrative court within 60 days of the notification of the rejection decision. This period is a legal time limit for filing a lawsuit and if it is exceeded , the right to apply may expire. It is therefore of great importance to initiate legal proceedings in a timely manner.
The Process of Filing a Lawsuit to the Administrative Court
Lawsuits before the administrative court are one of the classical types of lawsuits against administrative actions. Since the SSI’s rejection decision is an administrative act, such lawsuits are a struggle for the individual’s rights against the public administration.
The main documents to be submitted to the court during the litigation process are as follows:
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Current medical reports of the patient,
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Epicrises explaining the medical necessity of the relevant device,
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Application petition to SSI and its annexes,
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The SSI’s rejection decision,
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Invoice and payment documents for the device (if purchased in the past),
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Witness statements or expert opinions, if deemed necessary.
The detailed petition to be prepared together with these documents should clearly explain why the patient needs this device, the impact of the device on health and the negative effects of the rejection on the patient’s quality of life.
Approach of the Courts and Precedent Decisions
Administrative courts in Turkey generally rule in favor of patients in cases concerning the right to health. It is emphasized that access to health services is a constitutional right, especially based on Article 56 of the Constitution , which states that “everyone has the right to live in a healthy and balanced environment “.
In previous similar cases in this context, the courts have ruled as follows:
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Reversal of the SSI’s rejection decision,
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Refund of the cost of the device that the patient paid out of their own pocket in the past, with legal interest,
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An obligation for the SSI to provide the patient with the device in the future.
Such precedent decisions are a guide for new cases to be filed. If the plaintiff adds similar decisions to its file, it may create a favorable impression before the court.
The Role of the Lawyer in the Legal Process
Although individuals have the right to apply to the administrative court on their own, in cases such as health law that require technical knowledge and legislative follow-up, the support of a lawyer can be a significant advantage. An expert health law lawyer:
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Prepares the documents completely,
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Strengthens the petition with legal arguments,
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Attaches precedent decisions to the file,
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Defense in court hearings,
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Manages the correspondence and process with SSI in a professional manner.
This saves time and increases the chances of a favorable outcome of the case.
The right to a device is not only a material right, but also a constitutional right
The right of patients to access medical devices is not only an economic demand; it is also a fundamental human right. The relevant provisions of the Constitution guarantee access to health services for all. As a public institution , SSI’s provision of these services is not only a financial consideration but also a requirement of the social state principle.
Especially in chronic diseases such as Type-1 diabetes, the use of devices directly affects not only the health but also the social, educational and professional lives of individuals. For this reason, courts tend to consider the use of devices as a “necessity” rather than a “luxury”.
What can be won as a result of a lawsuit?
As a result of a lawsuit filed with the administrative court, patients can obtain the following benefits:
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Reversal of the SSI’s refusal,
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Reimbursement of the cost of devices purchased with their own means in the past,
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Ordering the SSI to cover the device on a regular basis,
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Setting a precedent for future applications.
These gains are not only an individual struggle for rights, but also pave the way for other patients in similar situations.
SSI Rejection Decision is Not Final
Although the rejection decision by the SSI is perceived by many patients as a final decision, it is in fact only one stage of the administrative process. The real decisive process takes place before the judiciary. The right tohealth is protected by the Constitution of the Republic of Turkey and international human rights conventions. For this reason , obstacles to access to devices must be overcome through legal means.
Do not forget: Do not give upyour rights. Every application rejected by the SSI does not mean that the law will remain silent. With an informed patient, supporting documents, precedent decisions and the right legal steps , it is possible to achieve the right to the device.
