Using your policy

It is for anyone considering, planning or carrying out a move to Spain. After reading, you will know how to get appointments, authorisations and the right doctor.

Start with "Setting up and using a new health policy in Spain". It shows you how to activate your policy and use it in the first weeks. From there, move on to the other pages:

• Booking specialists, tests and hospital care without a GP referral
• Prior authorisation (autorización previa) and how it works
• Finding a good in-network doctor or second opinion
• Telemedicine and app consultations with your insurer

Emergency care, claims and refusals, and use of the public system are covered elsewhere.

Key rules

• Complaint reply time: The insurer's customer service department must answer a complaint within two months.
• Authorisation validity: An approved authorisation is usually valid for around 30 to 90 days, so book the test or procedure within that window.
• Emergency admission notice: If you are admitted through emergency care, tell the insurer within the period in your policy, typically 24 to 48 hours.
• Waiting periods: Costly services such as surgery and childbirth are not covered from day one, so check your start date and waiting periods first.
• Prior authorisation: Ask your insurer which services need authorisation before you book scans, procedures or a hospital stay.
• Specialists: In-network specialists can usually be booked directly, with no GP referral.

Using your policy: the whole process, step by step

• Check your start date and waiting periods (carencias), then register in the insurer's app (Setting up and using a new health policy in Spain): On the day the policy starts

• Open the digital card, save the emergency and authorisation numbers, and check the doctor directory (Setting up and using a new health policy in Spain): In the first week; a plastic card usually arrives by post within one to two weeks

• Ask the insurer which services need prior authorisation, and book a first non-urgent visit if you want one: Within the first week

• Book a specialist directly, with no GP referral needed (Booking specialists, tests and hospital care under a policy): When you need a consultation; routine consultations usually have no waiting period

• Get a medical request from your doctor, then ask for prior authorisation for tests, surgery or admission (Prior authorisation (autorización previa) and how it works): Before the test or procedure; routine tests often take minutes to 48 hours, scheduled surgery one to several working days

• Book the approved test or procedure and take the authorisation, card and ID: Within the 30 to 90 days the authorisation is usually valid

• If authorisation is refused, ask for the reason in writing, resubmit with a fuller medical report, or complain to the insurer's customer service department (Prior authorisation (autorización previa) and how it works): After a refusal; the department must answer within two months

• Tell the insurer if you are admitted through emergency care: Within the period in your policy, typically 24 to 48 hours

• Wait for hospital care, surgery or childbirth cover to start: Hospitalisation and surgery usually after around 6 months, childbirth about 8 to 10 months

Documents you may need

Identity and residence

• A photo ID to show with the card — Setting up and using a new health policy in Spain
• Insurance card and ID to show at the centre when you go for the test — Prior authorisation (autorización previa) and how it works

Other documents

• Medical report from the treating doctor with the diagnosis and proposed — Prior authorisation (autorización previa) and how it works
• Authorisation number or document from your insurer — Prior authorisation (autorización previa) and how it works
• Proof of previous cover — Setting up and using a new health policy in Spain
• Written reason for the refusal — Prior authorisation (autorización previa) and how it works

Using your policy: questions that cross several articles

Do I need a GP referral to see a specialist, and does that mean no authorisation either?

No, you can usually book an in-network specialist directly without a GP referral, but tests and procedures may still need authorisation. Consultations, basic blood tests, X-rays and ultrasounds normally do not. Read Booking specialists, tests and hospital care under a policy, then Prior authorisation (autorización previa) and how it works.

Who asks the insurer for prior authorisation?

It varies, but usually the clinic or hospital asks for it, or you send your doctor's medical request through the insurer's app or phone line. See Prior authorisation (autorización previa) and how it works.

What happens if I have a test that needs authorisation without getting it?

The insurer can refuse to cover it, and you then pay the whole cost. Emergencies are normally exempt. Ask your insurer before booking, as covered in Setting up and using a new health policy in Spain, and read Prior authorisation (autorización previa) and how it works.

What can I do if the insurer refuses my authorisation?

Ask for the refusal and its reason in writing, then send a new request with a fuller report from your doctor. See Prior authorisation (autorización previa) and how it works.