How medical tourism agency commission works and why your quote is higher
Agencies are paid out of what you pay the clinic. The three payment models, how to audit a quote, bait pricing, and which channel keeps a right to reverse.
Last updated: August 2026
Most medical tourism agencies are not paid by you. They are paid out of the price you pay the clinic, which is why the consultation is free, the reply arrives in four minutes, and the same operation at the same hospital can carry two different numbers depending on which door you walked through. No facilitator publishes its rate and there is no public register of what agencies charge Turkish clinics, so any specific percentage you read online is unverified. What is documented is the legal frame: since 26 April 2025 Turkey's international health tourism regulation requires the clinic and the agency to hold separate authorisations, states that a clinic may accept a patient who applies to it directly, and gives you the right to demand, free of charge, an itemised breakdown of every fee the agency charged. This page covers the three ways intermediaries earn, how to tell which one produced your quote, and what to do when the number changes after you land.
Commission, per-patient fee and markup are not the same thing
One word covers three arrangements that behave very differently for the person paying. The agency takes a percentage of the treatment price, paid by the clinic after you pay the clinic. Or the clinic pays a fixed amount per treated patient, agreed in advance and unrelated to the size of the case. Or the agency buys at a wholesale clinic rate and resells at its own price under its own brand, so you never see the clinic rate and the clinic never sees your price.
| Model | Who pays the intermediary | Effect on your price | How to recognise it |
|---|---|---|---|
| Percentage of the treatment price | The clinic, out of what you paid | Sits inside the list price for every patient, including those who came direct | Clinic letterhead, payment to the clinic, same figure by any route |
| Fixed fee per patient | The clinic, per case | Flat; it does not grow when the operation grows | Same price through any channel, and the agency bills you nothing |
| Package resale, often sold as free consultancy | You, without seeing it | Whatever the reseller added; not disclosed | Agency letterhead, payment to the agency, and the clinic will not confirm the figure |
A fourth arrangement sits upstream: lead fees, where a comparison site sells your enquiry to several clinics as an advertising product. The cost to you there is not a markup but the volume of calls that follows.
Which model you are in decides one practical thing above all: whether the money you send is ever seen by the people who will operate on you, and therefore who you can hold to the price.
What Turkish law says an agency is allowed to sell
Turkey rewrote this rulebook in 2025. The text in force is the Regulation on International Health Tourism and Tourist Health, Official Gazette 26 April 2025 (No. 32882), which repealed the 2017 version. The parts that matter while you read a quote:
- Both sides need their own certificate. Article 5 requires the clinic and the intermediary to hold an international health tourism authorisation certificate, issued by the Ministry of Health for the clinic and by USHAŞ, the state international health services company, for the intermediary. Article 6 forbids a licensed clinic from using an unlicensed intermediary.
- Going direct is explicitly permitted. Article 6 states that a facility may accept an international health tourist who applies directly, without an intermediary.
- The agency's own service list is logistics and consultancy. Article 4 defines the intermediary as providing consultancy, clinic organisation, accommodation, transport and transfer, with the travel legs running through an agency licensed under Law 1618.
- You can demand the fee breakdown. Article 12 requires the clinic to issue an invoice with an annex itemising the service and its unit prices, and the intermediary to hand over, free of charge on request, an itemised breakdown of what it charged for accommodation, transport, transfer, interpreting and consultancy.
- The names have to match. Article 13 requires both to run a website whose organisation name matches the title on the certificate.
- Responsibility does not end at discharge. Article 6 makes each party responsible for its own services, covering complications and malpractice arising after treatment, and makes complication insurance compulsory for procedures performed in an operating theatre.
None of this caps what an intermediary may charge. It does establish that the sales conversation and the medical conversation are legally two separate things run by two separately licensed parties. The NHS puts the patient version in one line: make sure you have a consultation with the surgeon, and avoid meetings only with sales people.
Is it cheaper to book directly with the clinic?
Sometimes, often not, and you can rarely prove it before you commit.
Under a percentage model the commission already sits inside the list price, and most clinics hold one price across channels so their partners are not undercut. Going direct then saves nothing unless the clinic chooses to discount. Under a resale model direct is cheaper by construction, because you remove a layer that sets its own price, but you also remove the transfer, the interpreter, the 24-hour line and the person whose job is to chase the clinic when nobody replies. Under a fixed-fee model the price is identical either way.
The only way to find out is to ask both channels at once, described further down. Before that, know the published band for your procedure so neither number arrives without context: the DoctorVi price list shows the ranges we see across verified clinics.
Reading a quote: four questions that settle most of it
Who issued the document, who receives the money, what is inside the number, and what happens if something changes. A clinic quote names the clinic, with legal entity, tax number and address. An agency quote names the agency and often calls itself a treatment plan while naming no clinician anywhere. A logo on a PDF, or a price sent as a chat message, is not yet a quote.
A price without a unit is also not a price: implants at €3,900 means nothing until you know the count, the brand, whether abutments and crowns are included, and whether the crown is temporary or final. Ask for all of the following in one document, before paying.
| What to ask for | A workable answer | What should stop you |
|---|---|---|
| The quote document | Legal entity, tax number, address, date, validity period | Logo only, chat message, no entity named |
| Payee details | Account in the name of the contracting entity | Personal account, third-country account, unexplained name |
| Line items | Counts, brands, materials, nights, transfers, each priced | One total, or a package described in adjectives |
| Cancellation, refund, substitution | Written deadlines and amounts, plus what happens if the surgeon or hospital changes and who pays for a revision | Verbal reassurance, or non-refundable with no conditions stated |
| Medical author | A named clinician who reviewed your images | A coordinator, an unnamed team, an instant plan |
Bait price mechanics: how a low headline becomes a bigger bill
The advertised number is often true and useless at the same time. Four structural gaps do the work.
- The unit is undefined. A hair transplant from €1,500 with no graft count, or a dental implant from €300 with no abutment and no crown. Published ranges make the gap visible: a single implant with abutment and crown runs roughly €480 to €820 and a zirconium crown €140 to €280, so a headline covering only the fixture is around half a tooth.
- The medical assessment is deferred to arrival. Nothing has been ruled in or out, because nobody has examined you, and the examination that fixes the final quantity happens after your flight stops being refundable.
- The deposit is calibrated: small enough not to argue about, large enough to make you keep the appointment.
- The bill lands when leaving is expensive. You are far from home, the return flight is booked and the hotel is paid.
Check any headline against a published band before you travel. What a full mouth implant package actually covers and what sits inside a Turkish hair transplant package list the items that most often fall outside the advertised figure.
When you are asked for more money after you arrive
An extra procedure is not automatically a scam. A scan can genuinely show that a sinus lift is needed, and a hairline drawn on your actual head can genuinely need more grafts than a photograph suggested. The test is not whether an addition exists, but whether it is documented, priced and consented to in the order a planned procedure would be.
- Ask which clinician made the finding, and to see the imaging or chart entry behind it. A coordinator is not a clinical source.
- Get the addition in writing, with its own price, on the clinic's paper, before sedation and before payment.
- Ask what happens if you decline. A clinic may decline to operate, which is legitimate. A clinic that forfeits your deposit unless you accept an unplanned addition is telling you something about its process.
- Ask for the clinic's invoice with the itemised annex Article 12 requires. If only the agency will invoice you, you have just learned which model you were in.
- Pay on site by card, not cash, and never without a document naming the receiving entity.
If the demand arrives with a countdown, or a hint that your records or discharge depend on it, that is a complaint matter rather than a negotiation, and a written complaint to the clinic copied to the agency creates the record you may need later. What remains possible once you are home is narrower, and is set out in your real options when surgery abroad goes wrong.
Payment channel: where you keep a right to reverse
| How you pay | Reversal route | Practical limits |
|---|---|---|
| Credit card | Section 75 claim in the UK, plus scheme chargeback | Single item over £100 and not more than £30,000; usually requires buying directly from the provider |
| Debit card | Chargeback only | A rule between banks, not a statutory right; the bank can refuse and time limits apply |
| Bank transfer, SEPA or SWIFT | None once executed | Recovery depends on the receiving bank's cooperation |
| Cash on site | None | No proof you paid unless you hold a receipt naming the entity |
For UK patients, Section 75 of the Consumer Credit Act 1974 makes the credit card issuer jointly and severally liable with the supplier for misrepresentation or breach of contract, within those single-item limits, and it applies to purchases made abroad. The detail that connects straight back to commission models: Citizens Advice notes you usually cannot use Section 75 if you did not buy directly from the trader, and paying an agency for a clinic's surgery can put you in exactly that position.
Outside the UK the picture is thinner. Card scheme chargeback exists in most markets but is a rule between banks rather than a legal right, and a completed transfer has no equivalent. Putting at least the deposit on a credit card costs a fee and buys a route.
Ask both channels the same week
Send the same case description, photographs and scan to the clinic directly and to the agency, then compare four things: the total and what it includes, the entity that would receive the money, whether the medical plan is identical, and whether anyone names the clinician who reviewed your case. A different graft or implant count for the same photographs is a finding about the process, not about your body. Do it with two or three clinics, because the disagreement between quotes tells you more than any single figure. How to verify a Turkish clinic and surgeon and how to verify a dental clinic before you pay list what to check inside each reply. You can filter verified clinics yourself by city, licence type and procedure.
What no commission means here, and how DoctorVi is paid
DoctorVi takes no share of what you pay a clinic. Clinics pay a fixed subscription to appear on the platform, and that subscription is the entire business model, so nobody here earns more when you pick a more expensive clinic or a larger operation, and there is no quota to fill. That is a statement about incentives, not about your result: DoctorVi does not treat patients, does not set clinic prices and cannot promise an outcome. What it can do is publish a clinic's documentary status, including the 4,667 listed clinics holding the Ministry of Health health tourism authorisation certificate, and print the questions above without a financial reason to soften them.
Frequently asked questions
Do medical tourism agencies take commission and inflate the treatment price?
Most are paid by the clinic rather than by you: a share of the treatment price, a fixed fee per patient, or a markup on a wholesale rate. The rates sit in private contracts and are not published, so treat any specific percentage you find online as unverified. What you can check is whose letterhead the quote carries and whose account receives the money.
Is it cheaper to book directly with the clinic than through a facilitator?
Sometimes. Under a resale model direct is cheaper by construction. Under a percentage model the commission already sits inside the list price and most clinics hold one price across channels. Turkish regulation allows a clinic to accept a patient who applies directly, so ask for its own price list and compare.
Why is my quote higher than the price advertised online?
Usually because the advertised figure describes an undefined unit: grafts without a count, implants without abutments or crowns, packages without nights. The real quantity is only set at examination, after you have travelled.
The clinic asked for extra money after I arrived even though the price was fixed in the contract. What can I do?
Ask for the demand in writing with its own line items before consenting to anything, ask which clinician made the finding and to see the imaging, and ask for the clinic's invoice with the itemised annex the regulation requires. A record created before payment is what a card dispute or a formal complaint will rest on.
The clinic says I need an extra procedure on site. Is that a real need or upselling?
Both happen. A finding shown to you on imaging, explained by a named clinician, priced before consent and consistent with the pre-travel plan behaves like a real finding. A verbal addition presented at the door of the theatre, priced afterwards, with nothing shown, behaves like a sale. Ask to postpone rather than decide under sedation pressure.
Should I pay by card or by bank transfer?
A card leaves a route to dispute; a completed transfer does not. UK patients paying by credit card may have a Section 75 claim against the issuer for a single item over £100 and up to £30,000, though that generally requires buying directly from the provider. At minimum, put the deposit on a credit card.
How do I get an itemised breakdown of what I was charged?
Ask in writing, citing the invoicing article of the regulation. The clinic must issue an invoice with an annex itemising the service and unit prices, and the intermediary must supply, free of charge on request, an itemised breakdown of what it charged for accommodation, transport, transfer, interpreting and consultancy.
DoctorVi takes no commission on any treatment. Clinics pay a fixed subscription to be listed, which is why this page can print the questions that make a quote harder to sell rather than easier.
Compare published bands on the treatment price list, then send one written case description to more than one clinic and read the clinic red flag checklist before you pay any deposit.
Sources: T.C. Ministry of Health, Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik, Official Gazette 26 April 2025 No. 32882 (resmigazete.gov.tr), Articles 4, 5, 6, 12 and 13; Ministry of Health Department of Health Tourism, register of authorised health facilities (shgmturizmdb.saglik.gov.tr); NHS, Cosmetic surgery abroad (nhs.uk); Consumer Credit Act 1974 section 75 (legislation.gov.uk); Citizens Advice, getting your money back if you paid by card (citizensadvice.org.uk). DoctorVi directory counts as of August 2026.
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