How provider networks and hospital access work

Key rules

• Insurer-specific: Every insurer has its own network, and doctors may accept only some of its products.
• Province: Networks are published by province, so check the one for the town where you will live.
• Hospital ties: Some hospitals are tied to insurers, so confirm your exact product covers the hospital you want.
• Outside the network: Non-emergency care outside a closed network is generally not covered, and you pay the full cost.
• Cancelling: To cancel at renewal, you give one month's notice.

Verify access before you buy

Each insurer has its own network of doctors and hospitals. The networks are published by province, and some hospitals are tied to particular insurers. So a policy that looks good on paper may not give you the doctors or hospital you want in your town. Check the network first, then buy.

Networks belong to the insurer

Your policy only works with the providers in your insurer's list, the cuadro médico. A doctor who accepts one insurer may not accept another. Even within one insurer, a doctor may accept some products and not others. Ask about your specific product, not just the insurer's name.

Networks are organised by province

Your premium and your available providers depend on the province where you live and on your age. Cover is generally usable across Spain, but the quality and depth of the network vary. Large cities have more specialists and hospitals than rural areas. A few regions, such as Catalonia and the Balearics, can have different offers, and some insurers sell regional products.

Check the network in the town where you will actually live. If you move province later, check the network there too.

Where to find the list

Insurers publish the cuadro médico on their websites. It is usually a searchable tool by province, specialty and name, and often also in a mobile app. You may need the customer area to see the full directory. Some insurers offer downloadable lists by province or send printed ones on request. Interfaces and app names change, so start from the insurer's own website.

Hospitals and insurer ties

Some insurers own hospitals, and some hospital groups have their own insurance product. Examples are Sanitas with its own hospitals, Asisa through its hospital arm, and HM Hospitales with its own product. Owning hospitals does not generally mean rival insurers' patients are barred. Access depends on agreements between the hospital and the insurer. Some hospitals or services are included only in higher levels of a product. Agreements change, so ask your insurer to confirm that the hospital you want is covered for admission under your exact product.

What happens outside the network

With a closed-network policy, non-emergency care outside the network is generally not covered. You pay the full cost. The exceptions are:

• Emergencies. Vital emergencies are usually covered even at a non-network centre, and the insurer may move you to a network centre once you are stable. Emergency rules differ per policy, so read yours.
• Cases the policy names, such as no network provider being available.
• Hybrid products that include reimbursement.

If the network changes

Your insurer can add or remove providers during the policy year. The policy conditions define your cover, not any single doctor. Changes to your premium or terms generally apply at renewal, and the insurer must give you notice.

If a change clearly makes your service worse, complain to the insurer's customer service first. If that fails, you can escalate to the Dirección General de Seguros y Fondos de Pensiones, the insurance regulator. You can also cancel at renewal by giving one month's notice. The timeline below shows the order.

Test the network now

Use the checklist below before you pay. The FAQ covers out-of-network visits, living in another province, and insurer-owned hospitals.

Timeline and deadlines

• Your insurer adds or removes doctors and hospitals from its network: at any time during the policy year

• Changes to your premium or policy terms take effect, with notice to you: at renewal

• Complain to the insurer's customer service if a network change makes your service clearly worse, then escalate to the Dirección General de Seguros y Fondos de Pensiones, the national insurance regulator: as soon as you notice the problem

• Cancel the policy if the change leaves you with a materially worse service: give one month's notice before the renewal date

Checklist: test a policy's network before you buy

Test a policy's network before you buy

• Search the insurer's current provider directory (cuadro médico) for specialists and hospitals in your town.

• Check that the doctors you plan to see are listed, at the location you will use.

• Call a few clinics or doctors directly and ask if they accept the insurer and your specific product.

• Call the insurer's customer line and ask which hospitals are covered for admission and emergencies.

• Ask whether English-speaking doctors are available and how to find them in the directory.

• Ask which procedures need prior authorisation and how long it takes.

• Ask about waiting periods, exclusions and whether pre-existing conditions are covered.

• Ask how often the network changes.

• Ask the insurer to confirm by email or in writing that your doctors are in the network before you rely on it for costly care.

• Request the general conditions and the application questionnaire in writing before you sign.

Frequently asked questions

What happens if I see a doctor outside my network for non-emergency care?

With a closed-network policy, you generally pay the full cost yourself for non-emergency care outside the network. Exceptions are cases your policy names, such as no network provider being available, and hybrid products that include reimbursement. Check your policy conditions before booking.

Will my network cover me if I live in a different province?

Networks are organised by province, and your policy generally covers the networks of the provinces where you receive care. Your premium and the providers on offer depend on your province and age. Big cities have more specialists and hospitals than rural areas, and Catalonia and the Balearics can differ.

Where can I find an insurer's list of doctors and hospitals?

Insurers publish their cuadro médico (list of network providers) on their website, usually as a search by province, specialty and name, and in a mobile app. You often need the customer area for the full list. Some insurers also offer PDFs by province or send a printed directory on request.

Do insurers that own hospitals block patients of rival insurers?

Hospital-owning insurers generally do not bar patients of rival insurers, but access depends on the agreements between the hospital and your insurer. Some hospitals or services are in an insurer's network only at certain product levels. Ask your insurer whether a specific hospital is open to your exact product.