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Private Medical Insurance - AUTHORIZATIONS

Private hospitals in Spain can and will obtain the authorization from the insurer, but only when they want to do so. They tend to only do so when there are combined specialists involved and where there are higher costs involved such as combinations of Surgeons, anaesthetists, operating theatre and hospital bed. They will also do so at the A&E department. 


Most private hospitals and clinics  USUALLY CHOOSE NOT TO apply for you unless its for surgery when they need to combine approvals for bed, anaesthetist and surgeon .


They prefer  to only apply for your treatments when it is for Surgery, as its costly to the hospital or clinic if you mess up the process of getting authorized.


Hospitals and Medical clinics, could if they wanted to apply for each and every treatment, scan, test that needs pre-approval .  If only they had the administrative team to do so, but fact is that based on volumes they simply cannot undertake this for all. 


But not employing teams of admin is a factor that contributes to why medical treatment in Spain is far cheaper than the majority of countries and it is also why a Spanish network medical policy costs so little, compared to other countries.


In UK Germany Dubai  USA  the hospital always  apply for authorizations for the customers.

BUT HEY !  if your paying a yearly premium of $8,000,00 per insured and medical costs are thru the roof,  then maybe YES they will apply for every authorization you need, as the private healthcare profits in these countries are massive. 


To arrange an authorization yourself is NOT tedious.

There is a process and once you know the process it is very straight forward.


Perhaps  Not so straight forward if you do not understand Spanish.

Hence get insured using English speaking agency of the Insurer who knows the policy can speak to area office or head office and has access to your Insurers systems.


PRACTICAL INFORMATION - ARRANGING AUTHORIZATIONS.


OK so you need an authorization - WHEN YOU APPLY make sure your email provides correct information.


TO AVOID AUTHORIZATION DELAYS.


Do the insurance company have registered the email you are using NOW to email them ?

Make it clear in the email which policyholder from the policy needs the treatment.

Make sure attachments are in jpeg or preferably pdf format.

Make sure the correct policy number is given.


ONCE you email the authorizations department - Most insurers will have an AUTOMATED RESPONSE EMAIL , this only acknowledges the submission and it will usually contain a UNIQUE REFERENC NUMBER (CRM number /customer relationship manager number) which you can use to save time if you need to chase up, or provide additional information.


After sending authorization request - REMEMBER TO CHECK YOUR EMAILS & SPAM BOX

looking out for the response. You may get asked for additional information or to obtain more details from the doctor. If you do this is normal and you simply email the clinic or hospital sending them the request and the admin staff will arrange to obtain the info from the doctor.


My description below is generally how most SPANISH Insurers offering a network type of medical insurance policy require you to obtain a pre-approval. There maybe variation on this but this gives you the gist of it.


To get DKV Seguros authorization you email the authorizations department and attach to  the email all the medical reports and the treatment prescription ticket. Yes SEND ALL OF THEM that apply to the medical issue at hand. Not just the recent reports.


If in the doctors medical report, it refers to any earlier doctor consultations ,  then the insurer will note this and will probably ask to see the original consultation. So to avoid delay make sure full history is presented.


When you talk to a doctor everything you state is written in the report, so keep in mind if you were to inadvertently mention that 3 years ago you had similar issue then this would be in the report and in Spanish so none Spanish patients may not pick up on this.


If the patient has mentioned anything historical and it is submitted for a pre-approval of treatment ,then EXPECT AUTHORIZATIONS department to ask to see previous reports from that time or for you to explain yourself if the issue was never declared.


If you do not have any reports from then , then best to not mention it to the doctor at all 

(WARNING Particularly never mention anything historical  if it pre-dates the policy)


Maybe the medical condition being looked at does not pre-date the policy and all matters concerning the issued have been attended under the medical policy you have.

YOU may then ask yourself - why the Insurer who you believe has your records is now asking you to send them previous reports that the insured paid for you to have.


Well the fact is that when you use a network type policy the insurance company 

DOES NOT GET TO SEE YOUR MEDICAL REPORTS, DIAGNOSIS OR SCAN OR TEST RESULTS. 


All the insurer can see is that you visited a doctor, the location and the cost the insurer paid for the visit. The insurer does get to find out, details about your treatments, diagnosis and results.

The insurance company see your medical results and diagnosis ONLY when you volunteer to submit them which is only when you need authorization

With a network type medical policy you only ever pass details of your medical results to the insurer when you need an authorization.


Francis Payne.

Tailor Made Healthcare Spain.

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