Does The Government Cover Balloon Treatment?
The question of whether balloon therapy is covered by the government is one of the most frequently asked questions by individuals and their families researching new treatment methods for COPD. Developed specifically for patients who continue to experience shortness of breath despite traditional treatments, balloon therapy has become a popular method in recent years. However, because this method is a highly specialized procedure, the question of whether balloon therapy is covered by the government becomes crucial during the treatment planning process.
Balloon therapy, also known medically as “endobronchial valve placement,” is typically used in patients with advanced COPD and emphysema. The goal is to place valves in the weakened areas of the lungs to allow healthier areas to function more efficiently, facilitating easier breathing. This procedure generally requires advanced technology, specialized equipment, and is performed with the utmost care. Therefore, whether this treatment is covered by the government is of great financial importance for both patients and their families.
Is Balloon Treatment Covered by the State?
Balloon therapy is not yet a standard practice in all healthcare facilities. Therefore, whether the social security system, or the state, covers this treatment may vary depending on the situation. In Türkiye, this procedure can be performed in some public or university hospitals under certain conditions. However, this may not be the case for every patient.
Whether the state covers balloon treatment is evaluated according to the following criteria:
The treatment must be approved by the Ministry of Health and Social Security.
The patient must have been diagnosed with COPD at a certain stage
Appropriateness for treatment must be documented by relevant branch experts.
The healthcare institution where the procedure will be performed must be authorized to perform this treatment.
If these conditions are met, the procedure may be covered by the Social Security Institution (SGK) for some patients. However, this is entirely dependent on individual assessment and official approval processes.
How is the scope of treatment covered by the government determined?
For a treatment to be covered by the social security system, the procedure in question must be on the “current reimbursement list” and must be deemed medically necessary by a medical board. Because balloon therapy is a procedure performed in some centers with specialized equipment and falls outside standard medical practice, it may not always be covered in this coverage.
The scope of treatment is determined by:
The medical board, composed of physicians working at the hospital, evaluates the patient’s suitability for balloon treatment.
Relevant reports are prepared and submitted to the SSI system.
SGK evaluates whether the treatment is within the scope according to official legislation.
If approval is given, treatment can be administered under state guarantee.
However, in some cases, the patient may have to cover part or all of the treatment with his or her own means.
Can Balloon Treatment Be Applied in Private Hospitals?
Yes, balloon treatment can be performed at private healthcare facilities. However, procedures performed at private hospitals often have different pricing policies. In this case, whether the government, i.e., the Social Security Institution (SGK), will contribute to the treatment depends on whether the hospital has an agreement with the SGK and whether the treatment is covered by the SGK.
Individuals who want to receive balloon treatment in private hospitals should pay attention to the following points:
Does the hospital have an agreement with SSI?
Is the treatment entered into the system with codes accepted by the Social Security Institution?
Is there a physician’s approval and board report?
Have the reimbursement terms been clarified by the patient in advance?
If this information is not clear, it may be possible to encounter a high cost after treatment.
Are There Situations Where State Support for Balloon Treatment Is Not Available?
Balloon therapy may not be covered by Social Security for some patients. The primary reasons for this include the fact that the treatment is a new technology, is not available in every hospital, and has not yet been widely integrated into the healthcare system.
Situations that are not covered by SSI may include:
If the treatment is not included in the Health Practice Circular (SUT)
If the patient is not eligible according to the SSI criteria
If the necessary expert opinions and medical board report are not submitted
If the application is carried out within the protocol of a private center
In such cases, the patient may have to cover the cost of the procedure themselves. However, in recent years, it has been known that this treatment is available free of charge in some public hospitals under certain conditions.
What should be done to receive government support for balloon treatment?
For individuals who want to benefit from this treatment, the general guidelines to follow are as follows:
A chest diseases or thoracic surgery specialist should be consulted.
The diagnosis of COPD must be made clearly and the stage of the disease must be determined.
Relevant tests (breathing test, lung tomography, etc.) should be performed.
If the physician deems the patient suitable for balloon treatment, he or she must report this.
A board decision must be made in the hospital and this report must be submitted to the Social Security Institution.
If the Social Security Institution approves, the transaction can be carried out with state guarantee.
During this process, patients can receive support from health counselors or social services. Proper preparation of all documentation and compliance with official procedures are key factors in securing government support.
How Does the Balloon Treatment Application Process Differ with Government Support?
In government-supported balloon treatments, patients generally receive most of the examinations, procedures, and follow-up services free of charge. However, some specialized devices or valve systems may not be covered by the government. In this case, even if the procedure is approved by the Social Security Institution (SGK), the patient may be required to pay a certain fee. This fee may vary depending on the type of material used, whether it is imported, and the position of the material within the healthcare system.
Therefore, even if a treatment plan is supported by the Social Security Institution (SGK), whether the patient will make a financial contribution can only be clarified before the procedure. Therefore, it is important for patients to obtain detailed information beforehand.
How Much Does Balloon Treatment Cost?
Balloon treatment costs can vary depending on the hospital where the procedure is performed, the patient’s medical condition, and the equipment used. Prices, particularly for procedures performed in private hospitals, can be higher than those in public healthcare settings. Furthermore, costs can increase depending on the scope of the procedure, the tests performed, the number of valves used, and the follow-up period.
Therefore, it wouldn’t be appropriate to give a precise figure. For advanced procedures like balloon therapy, pricing is tailored to each individual based on an individual evaluation. Contact us today to learn more about whether balloon therapy is covered by the government.
