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''CUADRO MEDICO'' Understand what a Spanish medical policy provides when you can only use the medical network.
- watersidesales
- 4 days ago
- 2 min read
Top Mistakes with Spanish In-''Network Only" Health Insurance
Thinking of getting private health insurance in Spain?
Many expats choose "closed network" (cuadro médico) policies for lower premiums, but not understanding the rules can lead to massive out-of-pocket expenses.
Avoid these common mistakes:
1. Going to the "Closest" Hospital:
Never assume a nearby hospital takes your insurance. You must check the specific cuadro médico list for approved providers in your town. It is the individual doctors who register to provide services to an Insurer's Cuadro Medico. A hospital may have doctors in your network, but there will also be doctors who offer NO services in any medical networks.
2. Ignoring "Authorisation" (Pre-Approval):
While you can visit specialists directly, procedures like MRIs or surgeries usually require prior authorisation from the insurer.
Ask the doctor if the treatment he is suggesting requires an Insurance Company pre-approval. If it does, make sure you walk away with the treatment prescription ticket and the medical report.
The insurer will ask to see all the medical reports leading up to the need for the treatment.
3. Using Out-of-Network Providers:
If you visit a doctor not in the network, your policy likely will not reimburse you, leaving you with the full bill.
To see a doctor or specialist who is not in a network, you would need the higher-level reimbursement-type policy. The insurance company settles the cost directly if you use a medical network, so for that reason, you never pay.
4. Misunderstanding Reimbursement:
Most budget policies do not allow you to go anywhere and get money back. You must use the provided network list, and you are not charged at the hospital or clinic for consultations or treatments.
Pro Tip: using a network type policy:
If you're unhappy with a network doctor, simply find another provider on the app/directory and book a new appointment.
5. Private Medical Networks vary by size. Size means nothing if the medical network's coverage is too limited. Some networks include prosthetics, others do not. Some will charge you for donor tissue, but better insurers will not.
The more costly network providers will have higher-level medical options available.
For instance, most lower-cost to mid-cost policies will pay for your prostate surgery with a scalpel. Higher-level medical policies will offer more advanced options, such as Robotic arm surgery or laser surgery solutions.
6. The Insurance Company does not choose the network doctors.
Doctors make the decision to add themselves to an insurer's medical network. Any doctor can add themselves as long as they are registered and qualified to practice in Spain, and they agree to the contractual payment rates the insurer offers for the area they plan to work in. So an insurance company does not have a relationship with a doctor, and a doctor being listed in a medical network is not a recommendation by the insurer.
With a medical network, if you are not happy with a doctor, then the policy usually lets you see another doctor.
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