How paying for private care works (quotes and invoices)

Terms used

• Presupuesto — The presupuesto is a written quote from a clinic, stating the price and the date until which it is valid.
• Factura — The factura is an official invoice showing the clinic's and your details, the service, tax and total.
• IVA — IVA is Spanish VAT, a sales tax added to many goods and services; most medical services are exempt.
• NIF — The NIF is the Spanish tax identification number.
• NIE — The NIE is the tax identification number given to foreigners in Spain.
• Factura simplificada — The factura simplificada is a short invoice without the customer's details, allowed for small amounts.
• Reembolso — The reembolso is the refund an insurer pays you for care you paid for yourself, under a policy that includes it.

Key rules

• Cash limit: Cash payments involving a business are capped at 1,000 euros for tax residents, or 10,000 euros for non-residents.
• Invoice: Ask for an itemised factura at every private visit, because a receipt or ticket is not enough for insurer claims or disputes.
• Quote validity: A written surgery quote is commonly valid for 30 to 90 days, with the validity date stated on it.
• Deposits: For larger treatments, clinics often ask for a deposit; agree its size and terms in writing.

What to expect at a private clinic

You get a price, you usually pay on the day, and you ask for an invoice. Do all three properly and most problems never start.

Quotes: get the price in writing

For anything beyond a simple consultation, ask for a written quote (presupuesto). Consumer law requires the total price, taxes included, to be given clearly before you contract a service. Some regions also require clinics to display prices or give a written quote on request. There is no national public price list for private clinics, so a signed quote is your best protection. Use the message template below to ask for one.

Check these on the quote:

• What the price includes, and what is billed apart. Pre-operative tests, follow-up visits, physiotherapy and complications are often excluded.
• The validity date printed on it. Surgery quotes usually last 30 to 90 days. If yours lapses, ask for a new one.
• Whether IVA is included. Medical services are mostly exempt, but cosmetic treatments generally are not.

The final price can rise if the surgeon finds a different diagnosis, the operation is extended, you need a different implant or anaesthesia, or your hospital stay is longer. The final price should not exceed what was agreed without your consent. If the plan changes, ask the clinic to confirm the new price in writing before you go ahead.

Paying: usually on the day

For consultations, tests and small procedures, you normally pay at reception after the visit. For bigger work such as surgery, dental plans, fertility treatment or cosmetic procedures, clinics commonly ask for a deposit or reservation payment. The balance is due before or on the day, or in instalments. Agree the deposit and its terms in writing, including what happens if you cancel.

If you have insurance and the clinic is in your insurer's network, you usually pay nothing or only a co-payment.

Most clinics take debit and credit cards and cash. Many, especially small ones, accept Bizum, but not all. Bank transfer is common for large bills and deposits. Some clinics offer financing for dental and cosmetic work. Confirm accepted methods when you book.

Cash has a legal limit. Payments involving a business are capped at 1,000 euros for tax residents, or 10,000 euros for non-residents. For a large bill, pay by card or transfer.

Invoices: ask at every visit

Ask for an itemised invoice (factura) at every private visit. A simple receipt or ticket is not enough for insurer claims or disputes. Clinics must issue an invoice when you ask for one.

A full factura shows:

• an invoice number and issue date
• the name, tax ID (NIF) and address of both the clinic and you
• a description of the service
• the amount, and either the IVA or a reference to the exemption
• the total

Ask for it in your name, with your NIF or NIE if you need it for tax or insurance. A simplified invoice (factura simplificada) leaves out your details and is allowed for small amounts. Do not accept it if you plan to claim anything back.

Invoices also support business or self-employed expense claims. Some regions allow income-tax deductions for health spending, but relief is limited and varies, so check yours.

Claiming money back from your insurer

Only policies with reimbursement cover (reembolso) pay this way. Closed-network policies do not. Insurers generally want the itemised original invoice in your name, a medical report with the diagnosis and treatment, proof of payment and their claim form. Some procedures need prior authorisation, so ask before treatment. Claims must be filed within your policy's time limit, so check the policy for the deadline.

The checklist of questions to ask before booking, the documents list and the timeline below walk you through the steps in order.

Timeline and deadlines

• Get the written quote and note its validity date: Before you agree to treatment; quotes are commonly valid for 30 to 90 days

• Confirm the price in writing if the surgeon changes the plan: Before the procedure goes ahead, if the diagnosis, implant, anaesthesia or hospital stay changes

• Ask for a new quote if yours has lapsed: After the validity date printed on the quote has passed

• Pay and ask for a full itemised invoice: At the visit, when you pay

Quote validity varies by clinic and insurer claim deadlines depend on your policy, so check both in writing.

Documents you need

• Full invoice (factura) from the clinic, showing an invoice number, issue date, and the name, tax ID (NIF) and address of both the clinic and you. It also needs a description of the service, the amount, and the total. Health services are normally VAT-exempt, so the invoice should mention the exemption.

• Itemised original invoice in your name, if you plan to claim reimbursement (reembolso) from your insurer for out-of-network care. It must show the clinic's tax ID and details, the date and each service. Closed-network policies do not pay this way.

• Medical report stating the diagnosis and treatment, which most insurers ask for with a reimbursement claim.

• Proof of payment (payment receipt), which insurers ask for alongside the invoice. A receipt or ticket on its own does not replace an invoice.

• Your insurer's claim form for the reimbursement.

• Simplified invoice (factura simplificada), which leaves out your details and is allowed for small amounts. It is fine for your own records, but ask for a full invoice in your name if you need it for an insurer, tax or a dispute.

• Written quote (presupuesto) with its validity date, kept as proof of the agreed price if the final bill is higher.

Questions to ask a private clinic before you book

• Ask for the total price in writing, and what it includes: consultation, tests, surgeon, anaesthetist, hospital stay, implants, follow-up and complications.

• Ask whether the price includes IVA (Spanish VAT). Many medical services are exempt, but aesthetic work is not.

• Ask which extras are billed apart, such as out-of-hours surcharges, call-out fees, supplies, a separate anaesthetist or radiologist, and fees for reports or certificates.

• Ask how long the quote is valid and what date is printed on it.

• Check the doctor's registration number (colegiado) and the clinic's health authorisation.

• Ask about payment terms: deposit, financing, card charges and which payment methods the clinic accepts.

• Ask about cancellation and missed-appointment fees.

• Ask for an official itemised invoice (factura) in your name, with your NIF or NIE if you need it for tax or insurance.

• Ask how to make a complaint (hoja de reclamaciones) and which language the consent forms are in.

• If an insurer is paying, ask the insurer whether the specialist, tests and drugs are covered by its list of providers (cuadro médico).

Message asking a clinic for a written quote (presupuesto)

Copy this message, fill in the blanks and send it by email or through the clinic's contact form. It asks for a quote in writing, with every item priced, so you know the full cost before you agree to anything.

Asunto: Solicitud de presupuesto por escrito

Buenos días:

Me llamo [su nombre y apellidos] y soy paciente particular (sin seguro médico público ni privado para este tratamiento).

Quisiera solicitar un presupuesto por escrito y detallado para el siguiente tratamiento o prueba:

[describa lo que necesita, por ejemplo: "consulta con un traumatólogo y resonancia magnética de rodilla" o "limpieza dental y empaste"]

Les pido que el presupuesto incluya:

- El precio de cada concepto por separado (consulta, pruebas, intervención, material, medicación y revisiones).
- Si el IVA está incluido o no en cada precio.
- Si hay costes adicionales posibles (anestesia, ingreso, urgencias o pruebas extra) y cuánto costarían.
- El nombre del profesional que atenderá el caso.
- El plazo de validez del presupuesto.
- Las condiciones de pago y de cancelación.

Si necesitan más información o una visita previa para preparar el presupuesto, indíquenmelo, por favor.

Les agradecería que me lo enviaran por correo electrónico a [su correo electrónico]. Mi teléfono es [su teléfono].

Muchas gracias. Un cordial saludo,

[su nombre y apellidos]

What the message asks for, in English

You are a private patient. You ask for a written, itemised quote for the treatment you describe. You want each item priced separately, to know whether IVA (Spanish sales tax) is included, and to know about possible extra costs. You also ask for the name of the professional, how long the quote stays valid, and the payment and cancellation terms.

Before you send it

• Describe the treatment in plain words. If you have a referral or a doctor's report, attach it.
• Keep the clinic's reply. If the final bill is higher than the quote, you can show it.
• If the clinic only gives a price by phone, write back and ask for it in writing.

Private care payment quick answers

How much does a medical certificate for a driving licence or sport cost?

A driving-licence certificate typically costs about 30 to 60 euros for a standard car licence, and professional licences cost more. Sport or gym certificates from private doctors typically cost about 20 to 60 euros, and a fuller sports medical with an ECG or stress test costs more. Driving certificates are issued at authorised driver recognition centres, and the traffic fee for renewing is separate.

Will a public doctor accept my private test results?

Public doctors usually accept private test reports as information, but they often repeat tests that matter for decisions. Repeats are likely for imaging and specialist bloods, or when results are old or incomplete. Bring the full report and the images on disc, because there is no national rule requiring acceptance.

Can I pay by card or Bizum at a private clinic?

Yes, most private clinics accept Visa and Mastercard, and many accept Bizum, but not all. American Express is less widely accepted, and bank transfer is common for large bills and deposits.

Is there a limit on paying a clinic in cash?

Yes, cash payments involving a business are capped at 1,000 euros for tax residents, or 10,000 euros for non-residents. Pay larger bills by card or bank transfer.