Intermediary and Agency Liability in Medical Tourism: From Whom Can a Foreign Patient Claim Compensation?

Short answer: Depending on the cause of the harm, a foreign patient may bring a claim against the physician, the operator of the health facility, the intermediary company, the foreign organizer or the relevant insurer. However, their responsibilities are not the same. What matters is not only who referred the patient, but who signed the contract, who received the payment and in what capacity, and which service and result each party undertook. The correct defendant is identified by reviewing the contract, the advertising, the payment and the medical records together.

In medical tourism the patient often buys the treatment as a single package. Yet the brand on the screen, the coordinator who sends the messages, the company that receives the payment, the hospital where the operation takes place and the physician who performs it may all be different persons. When something goes wrong, each of them may point to another. This makes it all the more important to clarify the legal relationship from the outset.

This article focuses on private health services provided in Türkiye and the intermediation relationships attached to them. The law applicable to a service provided in a public hospital, a contract with a company in a foreign country or an independent insurance claim may be different, and so may the route of application. A foreign patient who frames every claim as a single "medical malpractice" claim may render invisible the claims based on the organization's breach of contract and on the refund of fees.

Which services is a health tourism intermediary responsible for?

The core duty of an intermediary is to perform the service it has undertaken in accordance with the law, the contract and the principle of good faith. Connecting the patient with the health institution, arranging appointments and communication, forwarding documents, providing interpretation, and arranging transport and accommodation may all be different parts of the same activity. Which part was actually undertaken is understood from the concrete relationship and the documents, not from the name of the company.

The Regulation on International Health Tourism and the Health of Tourists of 26 April 2025 sets out authorization and service standards for health institutions and intermediary companies. Article 6 of the Regulation provides that accommodation, transport and transfers are carried out through authorized travel agencies, and that where the intermediary is itself an authorized travel agency it may perform these services directly. The intermediary company must have the infrastructure to answer calls in at least two foreign languages every day of the week and at every hour, or a service procurement contract to that effect. [K3]

The existence of these rules does not mean that intermediary staff may make medical assessments. A coordinator who decides on the surgical technique, plays down medical risks on the basis of their own knowledge, or promises the patient suitability without a physician's assessment raises separate problems. Nor does an authorization certificate turn every employee into a health professional, and it does not guarantee the lawfulness or the successful outcome of every intervention.

What changes if unauthorized intermediation is detected?

A lack of authorization matters for administrative supervision and sanctions. In a private law claim, however, the breach of obligation and its effect on the patient's decision and loss must be shown separately. The mere absence of an authorization certificate does not automatically turn every expense claimed by the patient into damages. On the other hand, concealing a lack of authorization, giving the impression of working with an authorized health institution, or preventing the patient from reaching safe care may aggravate the liability assessment in the concrete case.

The patient should not rely solely on a document image on a website. It should be investigated to which legal entity, for which activity and at which address the document was issued. Using another company's authorization certificate is not the same as using a brand name that differs from the company's trade name. When the trade registry record, the invoice and the authorization certificate are compared together, the real service provider can be identified more reliably.

How are the physician, the hospital, the intermediary and the foreign organizer distinguished?

The name of a hospital building and the title of the company that operates it may differ. Several branches and companies may operate under the same brand. A person who is a partner, a manager or a sales representative of a company does not thereby become personally liable for all of the company's debts. However, if that person has their own tort, a personal undertaking or another specific ground of liability, the matter is examined separately.

That a physician works in a hospital does not in itself explain the entire content of the contract. A relationship in which the hospital undertakes the whole treatment upon admission differs from one in which the patient contracts with an independent physician and only uses the hospital's facilities. For each party, the patient must formulate a claim that answers the questions: "What service did it undertake? Which obligation did it breach? What damage did it cause?" [K1, K2]

Is the person who receives the payment necessarily the debtor of the compensation?

A payment record is a strong starting point as evidence, but on its own it does not determine the whole legal relationship. An intermediary may be authorized to collect on behalf of the health institution; it may have collected its own organization fee; or it may have sold the entire package, including the treatment, in its own name. The explanation on the bank receipt, the party in whose name the invoice was issued, the note on the offer and the party details in the contract should be assessed together.

Where the money is sent to a personal account, paid in cash or passed through a payment institution in another country, the need for an explanation grows. In such a case, it should be protected who gave the payment instruction, to whom the account belongs, which service the payment was allocated to and who confirmed its receipt. Suing on an abbreviated commercial name that appears only on a card statement may create a risk of naming the wrong defendant.

Where an amount collected under a collection authority is not transferred to the hospital, the intermediary's own contractual or other legal liability may arise. If the hospital defends itself by saying "we were not paid", it is examined whether the intermediary was authorized to collect and how it presented itself to the patient. It cannot be concluded that the patient must pay the same amount twice without first investigating this representation and payment relationship.

In which cases do an intermediary's advertisements and messages count as undertakings?

The responsibility of an organization cannot be assessed merely by looking at the last page of a signed contract. Online promotion that directs the patient to a treatment, personal offers, emails, voice messages and meeting minutes are also important. Clear statements about a specific physician, a specific hospital, the implant to be used, the number of procedures, the follow-up period or a free revision are influential in determining the scope of the contract. In consumer law, the features declared in advertisements and announcements are also significant for assessing defective services. [K2]

A general promotional phrase must be distinguished from a concrete promise made to the patient. "We work with an experienced team" is not the same as writing that a named physician will personally perform the operation. "Revision support is provided" is also different from a commitment that the surgeon, hospital, anaesthesia, flights and accommodation costs will all be covered under certain conditions; each creates a different scope.

For the legal assessment of promotional texts and promises of success, you may consult our article on misleading advertising and treatment promises in medical tourism.

What if a promise of success conflicts with medical information?

If a definite result was promised during a sales conversation, but before the surgery the patient is made to sign a standard form containing extensive uncertainties, the contradiction is not resolved by that alone. What result was undertaken, whether the earlier promise was corrected, when and how the correction was explained to the patient, and whether the patient freely decided under the new conditions are all examined.

If the intermediary guaranteed on its own account a result that exceeds the physician's authority, the legal effect of that guarantee is addressed separately. A physician, however, cannot automatically be held responsible for every marketing statement that does not belong to them. Nevertheless, if the statement was made with the physician's knowledge and approval, or was repeated during the examination or written into the contract, the assessment may change. The claim must be built by showing who used which expression.

Why are the result of an aesthetic operation and consent examined separately?

For interventions performed for aesthetic purposes, where a particular appearance result has been undertaken, the Court of Cassation's approach to the contract for work (eser sözleşmesi) is important. That approach shows that a technically correct operation does not, by itself, resolve every dispute. What aesthetic result was agreed and whether it was achieved are also examined. Procedures where the therapeutic purpose predominates and purely aesthetic procedures should not be subjected to the same legal assessment. [K1, K10]

A commitment of result does not mean that every expectation the patient later voiced is guaranteed. The appearance expected before surgery is made concrete through medical limits, plans, drawings, images and the parties' statements. It should be specifically investigated whether a simulation was used merely to describe a possible appearance, or was presented as an exact result.

Consent (onam) concerns the patient's agreement to the intervention after adequate information. The scope of the procedure, its main risks, the alternatives, the limits of the outcome and the need for follow-up should be explained in a way the patient understands. The existence of a form in a foreign language does not by itself show that the patient understood that language or that a real explanation was given. Who translated and who answered the questions should be recorded. [K4]

A sentence such as "I accept all risks" cannot be used as an unlimited disclaimer that excuses a fault in a specialist service that requires permission from the outset. The limits set by Articles 115 and 116 of Law No. 6098, the Turkish Code of Obligations (TBK), and the review of unfair terms in consumer contracts remain reserved. Moreover, explicit consent does not remove an undertaken aesthetic result, and a result commitment does not cure a lack of consent. These two headings should be kept separate in the questions put to experts and in the description of the claim. [K1, K2]

If the doctor or the hospital is changed, what can the patient claim?

Where a particular physician or health institution forms the basis of the patient's decision, a change may not be a simple internal organizational matter. The reason for the change, its counterpart in the contract, the nature of the alternative and the time at which it was notified to the patient are assessed. A change learned on the day of surgery is not the same as one explained before travel and freely accepted.

That the patient has come to Türkiye and incurred hotel and flight costs does not mean they are obliged to accept a new physician or a more extensive operation. For a new intervention, method or anaesthesia plan, the necessary information must be given and consent obtained. Changes that are medically compulsory should not be confused with changes made for commercial convenience.

Depending on the circumstances, the patient may request performance of the contract as agreed, a suitable alternative, a price reduction or refund, and compensation for related losses. Which right arises depends on whether the service was not provided at all, was provided defectively, the contract was validly terminated for cause, or some other obstacle to performance exists. A refund of the entire cost of flights and accommodation is not automatic; the link between the wasted expense and the change, and whether it could have been avoided, must be shown. [K1, K2]

For the discussion of cancellation of the package and the refund of fees, you may also read our article on cancellation of a medical tourism treatment package and refund of fees.

Can an intermediary escape liability by saying "We only referred the patient"?

This defence is assessed by examining what the intermediary actually did. A person who merely provides communication and transfers is not in the same position as an organization that prices the treatment under its own brand, selects the physician, collects the whole payment and assumes the result in its own name. The fact that the intermediary has no duty to perform the health service does not mean that its own misinformation or organizational fault can be disregarded.

For example, if it is alleged that the organization which undertook to forward medical documents to the health institution failed to send an important document, the existence of this duty and the receipt of the document must first be proven. Then the effect of the omission on the treatment decision or on the loss is examined. Records showing that the documents were sent, defences that the hospital already knew of them, or claims that the alleged loss is unrelated to the omission are also evaluated. In this way the abstract statement "the intermediary is responsible" becomes a verifiable legal claim.

Where several persons are responsible for the same damage, the joint liability provisions may come into play. However, adding everyone to the same file does not by itself satisfy the conditions of joint liability. Contribution to the same damage, different legal grounds, the relationship with auxiliary persons and the obligations each person undertook toward the patient must be made concrete. It should be explained whose liability arises from their own service and whose from the act of another. [K1]

How should Article 6 of the Regulation be read?

The liability provision of the Regulation, which depends on the type of service, is important; however, the original published text should not be read in isolation from later judicial developments. The current consolidated legislation record contains a note on a stay of execution concerning the phrase "complication and" in Article 6(3). As regards the compulsory complication insurance, professional body announcements dated 2026 report that the relevant stay-of-execution decision has been lifted. These developments concern different provisions. [K8, K9]

For this reason, it cannot be concluded that every intermediary is unconditionally liable for every complication. Nor can it be said that an intermediary has no contractual obligations of its own. The date of the procedure, the applicability of the regulation on that date, the concrete service and the general liability provisions must be examined together.

What does the Court of Cassation's decision on the intermediary and the follow-up process show?

Follow-up and revision problems that arise after the patient returns to their home country are also discussed in our article on post-operative follow-up and revision in medical tourism.

Court of Cassation (Yargıtay) 6th Civil Chamber, 15 October 2025, E.2024/2732, K.2025/3451

The decision concerns the compensation claim of a patient who underwent leg-lengthening surgery and later returned to Greece. Among the defendants is a natural person who owns a health consultancy and tourism company. This person argued that they did not undertake the treatment and had only arranged the patient's contact with the physician, the transfer and the accommodation. [K7]

The first-instance court, assessing the medical examination, the signed consent and the follow-up conditions, dismissed the claim against the physician. As for the natural person who owns the company, it concluded that there was no passive standing because there was no concrete relationship. After appellate review, the Court of Cassation upheld the rejection of the claim for pecuniary compensation. The appeal concerning non-pecuniary compensation was rejected because of the amount in dispute. Therefore, it should not be described as if there were a Court of Cassation affirmance on the merits of the non-pecuniary damages claim.

For intermediary liability, the main importance of the decision lies in establishing the person's real role and the correct defendant. The decision does not lay down a rule that "health tourism companies are never liable". In particular, the personality of the company must be separated from that of its partner, and the service the intermediary undertook in its own name, any promise it gave or any independent fault must be investigated in a separate file.

The assessment of follow-up in the decision also does not turn every return abroad into the patient's fault. The notified control plan, the patient's conduct and its effect on the outcome were examined in the concrete file. However, if an organization that built a health tourism service on a short visit and return to the country did not plan any appropriate follow-up arrangement at all, that may raise a different legal problem.

Which evidence reveals the correct defendant and the liability?

Evidence should show not only how the surgery was performed but also how the service was sold. A chronology should be prepared from the first offer to the last complaint, linking each document, its sender, its date, the service described and the payment. Screenshots are useful, but where possible the original emails, message exports, attachments and payment documents should also be preserved. Records whose content has been altered or which have been taken out of context make the evidentiary dispute harder.

• The name, role and contact details of every person and company the patient communicated with.
• A dated record of the advertisement and of any personal offer, including the physician, place, procedure and promised scope of follow-up.
• Contracts, invoices, receipts, card records and payment instructions.
• Procedure-specific consent, translation and examination records; operation and anaesthesia documents.
• Discharge plan, control invitations, complaint messages and the replies given.
• Treatment reports from abroad, expense documents and records of loss of earnings.

Under Article 199 of the Code of Civil Procedure (HMK), electronic records may have the nature of documents. It should not be forgotten that this does not mean every record is conclusive evidence. If health records are missing, the complete file may be requested from the institution. If there is a risk that evidence may be lost or may become harder to obtain later, the route of preserving evidence under Article 400 et seq. of the HMK should be considered. Since a later revision may change the earlier condition, creating appropriate records without delaying health care is important. [K5]

What damages can a foreign patient claim?

Refund, price reduction and compensation must be kept apart. To claim a refund of a transfer that was never provided, bodily harm is not necessarily required. For claims for re-operation, care or loss of earnings, however, the link between the expense or loss and the harmful event must be shown. In calculating pecuniary damage, treatment, transport, necessary accommodation, care and loss of earning capacity each require different evidence. [K1, K2]

An expense incurred abroad is not excluded merely because it was incurred in a foreign country. The authenticity of the invoice, the medical necessity, the reasonableness of the price and its link to the initial event are assessed. Emergency treatment received in the patient's country of residence is not the same as an additional procedure chosen purely on personal preference at a higher cost. A Turkish translation, certification of the foreign official document depending on its nature and, where necessary, a further review may arise; no automatic apostille rule can be established for every foreign medical report. [K5]

Non-pecuniary damages are not an automatic consequence of every breach of contract either. The effect on bodily integrity or personality rights and the relevant legal conditions are assessed. Payments, refunds or insurance payments made on the patient's behalf must be shown separately in the calculation. The same head of loss cannot be claimed twice from more than one party; claims directed at different persons must be framed within this limit.

In which country and before which court is the case brought?

The fact that treatment was carried out in Türkiye is an important connection; however, the applicable law and the international jurisdiction of the court are separate questions. For a Turkish court, the contractual rules in Article 24 of the Private International and Procedural Law No. 5718 (MÖHUK), the consumer contract provision in Article 26 and in particular the exception in Article 26(4) are examined. Because of the exception for contracts under which the service must be provided in a country other than the consumer's habitual residence, it cannot be said that the consumer law of the country of residence automatically applies to every foreign patient. The nature of the package as a package tour is also important. [K6]

For a tort claim, Article 34 of MÖHUK applies; the international jurisdiction of Turkish courts is assessed under Article 40 and related special provisions. Suing a foreign company in its own country requires that country's jurisdiction and choice-of-law rules. There is no single "international health tourism lawsuit rule" for a British, German or other national patient. If a foreign judgment needs to be enforced in Türkiye, the conditions for its recognition or enforcement may also arise.

Where the private health service is a consumer transaction, the consumer courts and, depending on the monetary limit, the consumer arbitration committee (tüketici hakem heyeti) are assessed. Before a consumer court action is brought, recourse to mediation is generally a condition of suit; applications falling within the jurisdiction of the arbitration committee and other statutory exceptions are separate. A commercial recourse action between intermediary companies and a full judicial review route for public health services do not follow the same procedure. Security for costs and exemption conditions for a foreign claimant are also examined under Article 48 of MÖHUK. [K2, K6]

For the general framework, see our guide to malpractice and compensation for foreign patients; for disputes in Türkiye, see our page on medical malpractice and physician error lawsuits.

How should time limits and the order of applications be planned?

There is no single limitation period for claims against the intermediary, the physician and the insurer. Under the Turkish Code of Obligations (TBK), Article 147 contains five-year provisions for mandate, agency and certain claims for work; Article 146 sets the general period; and Article 72 provides, for torts, two years from learning of the event and ten years from the act, together with the possibility of a longer criminal limitation period. For defective work, Article 478 of the TBK applies, and for defective services Article 16 of the Consumer Protection Law No. 6502 (TKHK) is also taken into account. The start date and the special provision to be applied are determined for each claim. [K1, K2]

Sending an email to the hospital, filing a complaint with the Ministry of Health or waiting for an insurer's reply does not, in every case, stop the running of the compensation period. The effect on the limitation and forfeiture periods of the time that passes from the application for recourse to mediation until the final minutes is calculated within the statutory framework. A calendar of time limits should not be postponed on the thought that "negotiations are still ongoing". [K11]

At the outset, the patient's health needs and documents should be protected, the parties identified, and then a reasoned claim and an appropriate route of application prepared. It cannot be said that the patient must personally come to Türkiye for every procedure, since many steps can be carried out through representation. However, personal participation may be needed for examination, expert review or any step the court considers necessary. The form, powers and translation of a power of attorney given abroad should be arranged according to the specific procedure.

For insurance and payment claims concerning treatment costs, see our article on complication insurance in medical tourism.

Conclusion

Determining the right liable party in medical tourism requires more than looking at a single brand or payment record. The service the intermediary undertook, the physician's medical obligations and any aesthetic result obligation, the hospital's organization and the foreign organizer's contract should each be examined separately. Clear consent, concrete commitments of result, reliable records and the correct procedural choice make a foreign patient's claim legally assessable.

Frequently Asked Questions

Can a medical tourism agency be sued directly?

A claim may be brought where it can rest on the intermediary's own contract, an incorrect statement, an organizational fault or another ground of liability. The service it undertook and its link to the damage must be shown. If the error of the physician who provided the health service is alleged, the legal reason why the intermediary is held responsible for it must be explained separately.

Should the owner of the company also be named as a defendant?

Being a partner or manager of a company alone does not create a personal debt. It is examined whether the person has an independent tort, a personal undertaking or another applicable ground of liability. Confusion between the company's trade name and the person's name may lead to the dismissal of the claim for lack of standing.

I paid the intermediary, but the hospital says it did not receive the money. What should I do?

The collection authority, the payment instruction, the invoice and the correspondence are examined together. It must be determined whether the intermediary received the fee in the hospital's name or in its own name. The fact that the payment was not transferred to the hospital does not in every case show that the patient's debt continues; the representation and performance relationship must be resolved.

Is consent signed by a patient who does not speak Turkish valid?

Whether the patient could actually understand the explanation is as important as the signature. Procedure-specific information, the language, the translation, the timing of the explanation and whether the patient was able to ask questions are assessed. The use of a foreign-language form does not by itself prove that all of these conditions were met.

If the aesthetic result is poor, does the intermediary always refund the price?

No. First it is determined which result or service the intermediary organization undertook. The physician's obligation under a contract for work and the intermediary's own contract are not the same. The basis for a refund and compensation must be built on the concrete commitment, the result that occurred and the role of the person concerned.

Can a lawsuit be brought in Türkiye against an organizer in a foreign country?

The international jurisdiction of Turkish courts is answered by examining the parties to the contract and their connections with the dispute. The mere fact that a foreign company works with a Turkish clinic is not enough for every lawsuit. Service of process, the applicable law and the enforcement of the decision should also be planned.

Does a complaint application replace compensation?

An administrative or professional complaint may bring supervision; however, in every case it does not produce a compensation decision that pays money to the patient. Nor should it be assumed that a complaint automatically suspends the limitation periods for a civil claim. Complaints and private law claims should be pursued together, each within its own procedure.

Can I still seek a remedy after returning to my country?

Returning to the home country does not end the rights. A claim can be pursued through the collection of documents, appropriate representation and a regular arrangement for service. Whether the patient followed the control recommendations and whether there is a link between new treatment and the damage are assessed separately in the concrete case.

Sources and Legal Bases

K1 — Law No. 6098, the Turkish Code of Obligations; in particular Articles 20–25, 49–56, 61, 112, 115–116, 146–149, 470–478 and 502 et seq. Official text.

K2 — Law No. 6502 on Consumer Protection (Tüketicinin Korunması Hakkında Kanun); Articles 3, 5, 13–16, 48, 51, 68, 73 and 73/A. Official text.

K3 — Regulation on International Health Tourism and the Health of Tourists (Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik), Official Gazette (Resmî Gazete) of 26 April 2025, No. 32882; in particular Articles 5–7 and 12. Official Gazette. The text as first published should be read together with subsequent judicial developments.

K4 — Regulation on Patients' Rights (Hasta Hakları Yönetmeliği); in particular Articles 15–18, 24–25 and 31. Ministry of Health institutional publication.

K5 — Law No. 6100, Code of Civil Procedure (Hukuk Muhakemeleri Kanunu); Articles 199, 219–224, 266 et seq. and 400 et seq. Official text.

K6 — Law No. 5718 on Private International and Procedural Law (Milletlerarası Özel Hukuk ve Usul Hukuku Hakkında Kanun); Articles 24, 26, 34, 40, 45, 47–48 and 50 et seq. Official text.

K7 — Court of Cassation (Yargıtay) 6th Civil Chamber, 15 October 2025, E.2024/2732, K.2025/3451. Full text and citation verified. Decision record.

K8 — Istanbul Dental Chamber (İstanbul Dişhekimleri Odası), 11 September 2026, "Compulsory Complication Insurance in Health Tourism Back in Force" ("Sağlık Turizminde Komplikasyon Sigortası Zorunluluğu Yeniden Yürürlükte"). Institutional announcement. The announcement is not the full text of the decision.

K9 — LEXPERA, note on the court decision concerning Article 6(3) of the Regulation on International Health Tourism and the Health of Tourists (Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik). Consolidated legislation record. Accessed 13 October 2026.

K10 — Court of Cassation (Yargıtay) 6th Civil Chamber, 19 March 2025, E.2024/1507, K.2025/1137; assessment of aesthetic result and the contract for work. Decision record. Full text reviewed.

K11 — Law No. 6325 on Mediation in Civil Disputes (Hukuk Uyuşmazlıklarında Arabuluculuk Kanunu); Articles 16 and 18/A. Official text.