Refund of Excess Charges at Private Hospitals: Additional Fees, Written Consent and Remedies

People treated at private hospitals often find an additional (difference) fee on their bill. When it may be charged, how its limit is set and how to reclaim an amount believed to be excessive are often unknown. This article gives a general framework; it does not replace an assessment of your case and predicts no result. Because figures and rates change over time, rely on the Social Security Institution's Health Implementation Communiqué (SUT) and official announcements for current amounts.

1. What is an additional fee?

Health institutions contracted with the Social Security Institution (SGK) may request an additional fee from the patient beyond the amount the Institution pays. This right is not unlimited. According to a SUT provision quoted in a Jurisdictional Disputes Court decision, contracted institutions may charge additional fees for exceptional health services up to a certain multiple of the SUT-listed transaction fees (Jurisdictional Disputes Court, 2021/494, 2021/453). In a 3rd Civil Chamber decision of the Court of Cassation, referring to the SUT provision on "charging additional fees", it was stated that fees requested for services financed by the Institution count as additional fees, while fees for extra services under a supplementary service contract between patient and hospital that SGK does not finance are not treated as such (3rd Civil Chamber, 2025/1595, 2025/5172).

2. The written consent requirement and the upper limit

Under the contract provision examined in the Court of Cassation General Assembly of Civil Chambers' decision of 22 November 2018 (2017/636, 2018/1762), the institution could request an additional fee not exceeding a set percentage of the Institution's fee, but only after obtaining the written consent of the patient or a relative before each procedure; requesting it without prior written consent or above the limit would lead to action under the contract. In that case the limit was set by the contract then in force; current rates and limits may differ.

In the same decision the General Assembly stated that:

• The additional-fee provision of the contract between SGK and the hospital was treated as a full contract for the benefit of a third party, so an SGK-insured patient could claim a refund of fees above the limit in that contract, even though not a party to it.
• Whether the hospital collected from the insured more than the limit in the contract in force on the date and whether the fee was contrary to the contract must be determined.
• In that case the patient's claim of gabin (exploitation) based on a state of distress was not accepted, and exceeding the limit in the SGK contract alone was not treated as disproportion amounting to gabin. The refund claim was thus assessed on breach of the contract's limit and consent conditions, not on gabin.

3. Services where additional fees may or may not be charged

The SUT can prohibit or limit additional fees for certain services. In a 3rd Civil Chamber decision (2023/908, 2023/3080), in a hospital's suit to annul a contractual penalty imposed by SGK over excess additional fees for a caesarean birth, the first-instance reasoning cited stated that patient consent was required and that nursing and counselling services were not additional procedures. Deciding which item falls within additional fees often requires expert examination of the SUT.

4. How to reclaim an excess charge

1. Collect documents: invoices, payment receipts, consent and undertaking forms, the discharge summary and correspondence with the hospital.
2. Written request to the hospital: state the amount you consider excessive with reasons and request its refund in writing. If there is no reply or it is refused, move to the next steps.
3. Consumer arbitration committee: consumer disputes below the statutory value limit go to the consumer arbitration committee. Mandatory mediation provisions do not apply to disputes within the committee's remit (Law No. 6502, Art. 73/A). In cases before the Jurisdictional Disputes Court, applications to the consumer arbitration committee appear for refund of excess charges at a private hospital attached to a foundation university (2021/677).
4. Objection to the committee's decision: an objection action may be filed before the consumer court. In a decision (2023/2056, 2023/1422), the 3rd Civil Chamber reversed in the interest of the law a first-instance decision in an objection to a committee decision on a claim that additional fees were excessive for a test on 20 May 2022, stating that the court must hold a hearing and decide on the merits.
5. Lawsuit: for disputes above the committee's limit a case can be filed directly, and applying to a mediator first may be a precondition (Law No. 6502, Art. 73/A). Views differ on whether the consumer court or the labour court is competent; the Jurisdictional Disputes Court has stated that refund cases for excess fees are heard by the ordinary judiciary, not the administrative judiciary (2022/234).

5. Points to check

• Whether you gave written consent before the procedure and what the forms you signed said.
• For which procedure or service each fee was charged, from the invoice items.
• Time limits and preconditions: assess without delay when you notice an excess charge.
• Whether the hospital is contracted, whether you are covered by SGK and the type of treatment; these affect which rule applies.

6. Contact

To have your invoices and documents assessed, you can create an appointment or reach us via the contact page.

This article is for general information only, contains no promise of results and is not legal advice. The decisions mentioned are examples only.