Allianz Personal Health Insurance Issue

I am an Allianz private health insurance policyholder, and I would like to file a complaint regarding a surgery that was first approved by pre-authorization and then rejected after the procedure. My surgery took place on 2 April 2026 at Medipo University – Acıbadem Bölge Hastanesi under my Allianz private health policy, policy number 0001071010019255. Before the operation, Allianz provided pre-authorization and clearly confirmed that the surgery could be carried out within the scope of my policy. Relying on this confirmation, I proceeded with the treatment and the surgery was completed. However, after the procedure, my claim was rejected based on medical records from 2018 and 2019, and an exclusion for “cardiovascular diseases” was applied to my policy. The reasons given for the rejection are not consistent with the medical facts. The 2018 record only states “suspected heart attack” in the emergency department; all subsequent tests, including troponin, were normal and no cardiac disease was diagnosed. The 2019 “hypertension” entry was based on a one-time measurement and did not lead to any diagnosis, treatment, or medication. Despite this, these records have been treated as if they were clear evidence of a pre-existing condition and used as justification to exclude cardiovascular diseases from my coverage after the fact. There is also a serious inconsistency in Allianz’s own practice. A cardiology consultation I had on 9 March 2026 was reimbursed by Allianz under the same policy. This shows that the same risk was previously considered within coverage, while the surgery that followed and was pre-authorized was later denied. This contradictory approach creates confusion and undermines trust in the evaluation process. The pre-authorization given before the surgery created a legitimate expectation and directly affected my decisions. If approval had not been granted, I would have compared different hospitals and cost options, and I also had the possibility to receive treatment abroad (in China) through another insurance policy. Due to Allianz’s clear pre-authorization, I chose to proceed with the operation at the stated hospital, and I am now facing financial and emotional hardship because the claim has been rejected afterwards. All the requested up-to-date cardiological reports and test results have been submitted to Allianz. Despite this, the claim was first refused and the process is now being prolonged and made unnecessarily difficult, instead of being resolved transparently and fairly. I find this situation incompatible with good faith, standard insurance practices, and the trust relationship between insurer and policyholder. I request an urgent and fair re-evaluation of my file, the cancellation of the unjust exclusion decision based on the 2018 and 2019 records, and full coverage of the surgery and related expenses in line with the pre-authorization given. If this issue is not resolved promptly and fairly, I will proceed with formal action before the Insurance Arbitration Commission and other relevant legal channels.