Visiting from outside the EU: what if you need a Spanish hospital?

Key rules

• Emergency care: You will never be refused emergency treatment, but you will be charged for it unless a treaty or insurance covers it.
• Insurer first: Call your travel insurer straight away to ask for authorisation and to find out whether it pays the hospital directly.
• Unpaid invoice: An unpaid hospital invoice becomes a debt that can be pursued after you leave Spain.
• Agreements: Only a limited set of non-EU countries have a health agreement with Spain, and it often covers only certain groups.

Will you be billed?

Yes, most likely. Non-EU visitors on a short stay who have no treaty or insurance cover are billed for hospital care. Emergency care is never refused, but it is charged.

Non-EU short-stay visitors are generally billed at the public prices set by the region where you are treated.

EU and EEA visitors with an EHIC card, and visitors covered by an agreement, are in a different position. If that is you, see the agreements section below.

What it costs

Each region publishes its own public prices for patients who are not entitled to Spanish public healthcare. Prices are revised from time to time, so the same treatment can cost different amounts in different regions.

As a rough guide, a consultation costs a modest amount. An emergency visit costs more. Hospital stays and surgery cost far more, often running to thousands of euros. Ask the billing office for the exact price list that applies.

How the invoice works

The hospital's admissions or billing office (administración or facturación) takes your passport, address and insurance details. It then issues an invoice at the regional public price.

You can usually pay by card, bank transfer or at the hospital cashier, within the time stated on the invoice. If you have already left, the invoice may be sent to your address abroad or to your insurer. Procedures vary by region and hospital.

How travel insurance fits in

Call your insurer as soon as you can, to ask for authorisation. Insurers generally work in one of two ways:

• They guarantee payment straight to the hospital, sometimes through their assistance line.
• They reimburse you. You pay first, then claim with the invoice, the medical report and proof of payment.

Policy terms differ, so check your policy's direct billing conditions before you travel. If you needed a Schengen visa, your travel medical insurance had to cover at least 30,000 euros, including emergency care and repatriation. That policy is the one to call.

Agreements between Spain and your country

Spain has health or social security agreements for temporary stays with a limited number of non-EU countries. They include Chile, Andorra, Morocco, Tunisia, Peru, Brazil, Paraguay, Ecuador, Colombia, Argentina, Uruguay, Venezuela, the Dominican Republic and the Philippines. Ukraine and Russia are covered for limited groups only.

Cover is usually for urgent or necessary care. It is often limited to workers, posted workers, students or pensioners. You normally need a certificate from your home country's health institution, so get it before you travel.

UK visitors use the GHIC or EHIC for temporary stays. EEA countries and Switzerland use the EHIC. Most other non-EU visitors have no cover and need private travel insurance.

Check your exact entitlement with the Spanish social security institute (INSS) or your home country's insurer before you travel.

If you leave without paying

An unpaid invoice becomes a public debt. The regional health service or its tax agency can chase it with reminders and then enforced collection, often with surcharges and interest. Collecting from someone abroad is hard, but it can sometimes be done across borders.

Spain does not generally bar entry because of an unpaid hospital bill. A debt could still cause trouble with a later visa or residence application. Pay before you leave, or ask the billing office how to pay from abroad.

The checklist, documents list and questions below cover the practical steps.

Choosing between options

Will your insurer pay the hospital or will you pay first and claim back?

• Insurer pays the hospital directly: Your policy guarantees payment, sometimes through its assistance line. Call the insurer at once so it authorises the care.

Read your policy's direct billing conditions: if it guarantees payment to the hospital, give the hospital the insurer's details; if not, pay and claim.

Documents you need

• Your passport, which the hospital's admissions or billing office takes to issue the invoice.

• Your insurance details, such as the policy and assistance line number, so the hospital can bill the insurer or send the invoice on.

• The invoice, the medical report and proof of payment, which you need to claim a refund from your travel insurer if you paid first.

• A certificate from your home country's health institution, if your country has an agreement with Spain covering temporary stays. It is usually for workers, students or pensioners.

Checklist

• Call your travel insurer at once to ask for authorisation and to find out whether it pays the hospital directly or reimburses you.

• Check whether your country has a health agreement with Spain for temporary stays, and bring the certificate from your home institution if it does.

• Ask for the invoice at the regional public price and check the payment deadline written on it.

• Look up the public prices for non-entitled patients in your region's official gazette if you want to compare the bill.

• Keep the invoice, medical report and proof of payment for your insurance claim.

• Pay the invoice before you leave, or ask the billing office how to pay from abroad, so it does not become an enforced debt.

What to watch out for

• Emergency care is charged: Emergency care is never refused, but non-EU visitors without treaty or insurance cover are billed for hospital care. Stays and surgery can run to thousands of euros. Buy travel medical insurance before you travel and keep its assistance number with you.

• An unpaid invoice becomes a debt: An unpaid invoice becomes a public debt that can be chased with reminders and then enforced collection, with surcharges and interest, even abroad in some cases. It could also cause trouble with a later visa or residence application. Pay the invoice or settle it with your insurer before you leave, and keep proof of payment.

Check how an unpaid invoice is handled with the regional health service, as practice varies.

Frequently asked questions

Can I be refused treatment if I cannot pay on the spot?

No, emergency care in a Spanish public hospital is not refused because you cannot pay, but you will still be charged for it.

Can the hospital send the invoice to my home abroad or to my insurer?

Yes, if you have already left Spain, the invoice may be sent to a foreign address or to your insurer. Give the admissions or billing office your passport, address and insurance details before you leave.

Do I pay first if I have travel insurance?

It depends on your policy: some insurers pay the hospital directly, others reimburse you after you pay. Call the insurer at once for authorisation, and keep the invoice, medical report and proof of payment if you have to claim back.