Paying for emergency care

It is for anyone considering, planning or carrying out a move to Spain. You will know whether an emergency will cost you, who will bill you and how to handle it.

Start with "Do you pay for public emergency room (urgencias) care?". It sets out when a public emergency visit is billed and when ambulance or follow-up charges apply. From there, pick the page that matches your situation:

• Emergency care before your health card or residence is sorted
• Using private health insurance in an emergency
• What to do about an unexpected hospital or ambulance bill
• International private clinics in tourist areas, worth the price?

Choosing which door to go through and what happens clinically are covered elsewhere, as are visitor entitlement and choosing a private policy.

Key rules

• Public urgencias cost: If you are covered by the Spanish public health system, urgencias care, admission and follow-up are free at the point of use.
• Emergency care: Urgent care for illness or accident must be given to everyone in Spain, whatever their status or card, until medical discharge.
• Contest deadline: You have one month from notification to file a written appeal against a public hospital bill, and two months to go to court after a decision.
• Other payers: Insurers or other liable third parties are billed instead of you in accident cases.
• Immigration: Hospitals do not report your immigration status, and registering for care does not trigger enforcement.
• Life-threatening emergency: Call 112 or go to the nearest emergency room without waiting for insurer approval.

Paying for emergency care: the whole process, step by step

• Get emergency treatment; it cannot be refused whatever your card or status (Emergency care before your health card or residence is sorted): straight away, until medical discharge

• Show your health card, EHIC or GHIC, or insurance details at admission; public urgencias care is free if you are covered (Do you pay for public emergency room (urgencias) care?): at admission

• Call your insurer's 24-hour assistance line, printed on your member card, and ask for an authorisation or case number (Using private health insurance in an emergency): as soon as you can, often within 24 to 72 hours of an emergency admission

• Check any bill that arrives to see who is being charged and why (What to do about an unexpected hospital or ambulance bill): as soon as the bill arrives

• File a written appeal against a public hospital bill you dispute (What to do about an unexpected hospital or ambulance bill): within one month of notification

• Go to court if the appeal is rejected (What to do about an unexpected hospital or ambulance bill): within two months of the decision

Documents you may need

• Passport — Emergency care before your health card or residence is sorted

• Your ID — What to do about an unexpected hospital or ambulance bill

• Proof of address — Emergency care before your health card or residence is sorted

• The invoice or payment notice you received from the regional health service — What to do about an unexpected hospital or ambulance bill

• Proof of entitlement or insurance — What to do about an unexpected hospital or ambulance bill

• Proof of registration at your town hall — What to do about an unexpected hospital or ambulance bill

Paying for emergency care: questions that cross several articles

Can a hospital bill me if I am a tourist with an EHIC or GHIC?

Normally no, because a valid EHIC or GHIC lets you use public hospitals on the same terms as insured Spaniards. The hospital copies your card and ID and claims the cost from your home country, though some ask for a deposit if you do not show the card. Private hospitals are not covered, so read Do you pay for public emergency room (urgencias) care? and International private clinics in tourist areas, worth the price?.

Will I be refused emergency care if I have no health card or papers?

No, emergency care is given to everyone in Spain until medical discharge, whatever your status or card. A bill may still follow under regional rates, especially for tourists and non-residents, and an unpaid bill is not a reason to stop treatment. Read Emergency care before your health card or residence is sorted, then What to do about an unexpected hospital or ambulance bill.

Is an ambulance free in the same way as the emergency room?

Medically necessary emergency ambulance transport is free for covered patients in most regions. Some regions charge insurers, non-entitled people, or for non-medical or air transport, and the charges differ by community. Read Do you pay for public emergency room (urgencias) care? and What to do about an unexpected hospital or ambulance bill.

When can a public hospital bill me for emergency care?

It can bill when someone else is legally liable, such as a traffic or private insurer, or when you are a visitor whose home system should pay. It can also bill non-entitled people under regional rates, and charge for extras like a private room. Read Do you pay for public emergency room (urgencias) care? and Using private health insurance in an emergency.