TRUST PILOT and the MEDICAL INSURANCE reviews Spain.

Working in the industry I often refer to Trust Pilot reviews to check on how customers are finding their experience with medical insurers.

Years gone by a medical insurer would only take people on after they provided a detailed medical history from a persons family doctor records and many would be rejected on the entries seen therein. These days self declaration is acceptable but lets face it once we hit the mid 50s we probably know that there are possibly undetected issues that can arise.

Remember Trust Pilot have a Spanish version and also a UK version and I regularly take the time to compare Spanish Trustpilot reaction as well as British Trustpilot reactions. Of course the Spanish version of Trustpilot will show a better rating because there is not the level of misunderstanding.

HOWEVER - Spanish insurers are often not the best for communicating how a policy work and many people can be a little slack at taking thee time to investigate properly.

AVOID CONFUSION UNDERSTAND YOUR POLICY.

CAN I MENTION HERE GOOGLE TRANSLATE - A great tool for understanding sections of policy.

Many people are also surprised to find out that you can have a translation phone app where you can scan a letter or a computer screen then click select all text and a translation appears.

I CANNOT STRESS THE IMPORTANCE OF INSURING USING AN ENGLISH SPEAKING AGENCY

IF YOU DO NOT SPEAK SPANISH.

All to often people take up medical insurance without really knowing how it works or exactly what it covers and have no one to provide the detailed assistance they will need at the most stressful of times - when ill. Again having an English Agency to fall back on will save you a lot of stress.

From my experience the majority will buy a private health insurance based on price with no thought for the actual cover. The truth is for a Spanish medical insurance the more you pay the better the cover will be. Lower cost policies have a lot more exclusions, caps and limitations.

Insurance Companies will display on their web page bullet point vague detail of what is covered and may even provide a similar vague bullet point list of exclusions - things that are NOT covered. These bullet points showing you exclusions are simply marketing ploys that make you think you have read the exclusions. The reality is that there maybe 2 to 6 pages of exclusions in the real policy document.

So delve into the Trust Pilot review pages for any Spanish medical insurance companies and you will see the stats scores are generally poor for all the companies with many complaints providing only 1 or 2 stars. Below I will tackle the more prolific complaints where I see an absolute complete failure by the complainer to understanding the policy. Of course the British Trust Pilot reflects a worst score for each insurer when compared with the Spanish equivalent.

TRUST PILOT REVIEWS - COMPLAINTS

So lets start with REIMBURSEMENT.

Many people on the review pages condemning the fact that they went to a Hospital or Clinic and saw a Doctor then were charged for the consultation or treatment. The policyholder subsequently complain in a review that the insurer robbed them by refusing any reimbursement.

In Spain there are two types of policy. The majority choose the more affordable network medical insurance. Fewer have a more expensive reimbursement type policy.

I MADE A CLAIM AND HAVE NOT BEEN PAID

DID THEY EVEN HAVE A REIMBURSEMENT TYPE POLICY ?

The vast majority of people will have what is known as a network medical policy.

The network insurance is a medical policy where there is no payment to be made to any Hospital, Clinic or Doctor and you only use the doctors who are registered in the insurers national network.

With a network policy the insurance company has an agreement that when customers attend a Doctor listed in their network, the doctor will NOT charge the policyholder. Instead the insurer always pays the cost direct to the medical facility. So no money ever changes hands.

The fact that you have been charged could of course be an error by the reception at the medical facility. However this is not common reception will check by asking for your insurance card and checking it on their system.

Reception swiping that card will see that only certain doctors in that particular hospital or clinic are approved to attend you.

INSURER REFUSES TREATMENT - UNDERSTANDING A PRE-EXISTING CONDITION.

Whilst I am in no way comparing people to motor vehicles, I use the example of a car so we can comprehend the basic principles of an insurance policy.

You have bought a second hand car and when buying it you are very aware of a couple of small dents in the bodywork, accidents by the previous owner but perhaps you bought thinking the dents were minor yet when you come to need a repair the entire panel needs replacing so you try and claim it ( an unknown pre-existing condition) . Well we all know that the insurer will not accept it as it is historical. That is the principle of insurance that you start paying and protection commences from that date.

When we buy the car we know we need to get insurance cover to provide a protection from the date we purchased the car.

Most of us will accept that we cannot claim for damage the car has that pre-dates the start of your cover. Medical Insurance works the same way your protection is there to insure you for medical issues that develop from the date you start paying for the protection and the moment a doctors report suggests that the issue diagnosed is long term or pre-dates the policy there will be no cover.

The Trust Pilot review pages reflect many angry people who went to hospital and were refused treatment because the medical issue was shown to pre-date the policy and the review they leave reflects their anger at having been refused treatment for a condition they did not know they had.

The Insurance Company will refuse to treat you if the Doctors medical notes confirm a chronic issue that could only develop to that level with time.

Many things such as heart disease, lung disease, tumors will result over time. A heart attack can be seen in an ECG scan which will accurately establish the date it happened.

So should the insurer simply treat us ? I suggest that if this was possible then insurance companies would not exist for very long.

Lets face it if this was possible then there would be many people queueing up to take a policy the minute a cancer has been detected claiming they were not aware of it.

CANCELLING A CONTRACT IN SPAIN.

I cancelled my contract and yet the insurer refused to accept the cancellation and renewed me.

I cancelled my insurance yet the company kept taking another 6 months of payments.

The medical insurance policy we sell sets out in the small print how to cancel. All the mainstream insurers will set out the process in the policy document. My customers ask me and we send them an easy to understand email explaining what to do.

All of us need to feel safe from fraudulent attempts to interfere with our personal space.

The world these days has many rules and regulations set up to protect us from those who would interfere with our private business and private personal arrangements. The most common fraud is an email hack where someone takes over your email account and starts recontacting friends and business contacts claiming they are YOU.

Financial Services Regulators for SPAIN provide regulations to Insurance Companies, Banks and the Service Business Industry. So to cancel your insurance you will have a deadline date to submit your cancellation notice by. The insurer will be required to make sure that the request for cancelling a medical insurance policy is from you the insured. For that reason you will be asked to email your request with full names, policy number stating you wish to cancel and attaching for security a copy of your iD and a dated letter that confirms your wish to cancel with the policyholders signature on it.

It is my experience that despite sending a process in a very easy to understand email, about 5 out of 10 people do not read the email or do not follow all instructions and will make an error or errors.

Forget to attach the letter, forget to enter the policy number, forget to sign the letter, forget to attach anything.

So how do we know about these errors ?

As an agency we ask the customer to send the cancellation to the insurer with the attachments and copy us in on the email. If it is correct we submit it as a precaution to our own area office.

We ask for a copy so we can check it - WE THEN find ourselves frequently having to ASK for it to be resent correctly.

So again Trust Pilot have a good number of people on the web site cursing the insurer for not cancelling but we know that left to their own devices many will never even ask what the process is.

THE DOCTOR WAS AWFUL - THE RECEPTION WERE RUDE AND UNHELPFUL.

Trustpilot reviews contain quite a number of people who have cancelled their policy because they believe that the doctor they saw or the treatment they received was not satisfactory. They blame the insurance company.

Let us look at the role of the INSURANCE COMPANY.

A medical insurer will provide a list of doctors, specialist doctors, clinics and hospitals where consultations , checks tests and treatments can be arranged.

The insurance companies are NOT RECOMMENDING any doctor, clinic or hospital. Any doctor , specialist doctor who is a qualified practitioner and licensed to provide medical care in Spain can add themselves onto a private medical network. All medical care in Spain is regulated by the Inter-territorial Council of the Spanish National Health Service.

(Consejo Interterritorial del Servicio Nacional de Salud de España, CISNS).

As long as they are licensed by the CISNS they can add themselves onto any insurance companies national network. The insurance companies do not vet them.

So when you are provided with a medical network and you need to choose a doctor the choice is you get to look up specialist doctors and choose one. Many people will ask locally for other peoples experiences, some will check reviews, others will read up about the doctor on the world wide web and then decide.

So when I see on Trust Pilot reviews that people actually state that it was the Sanitas Doctor or the Axa Doctor who was rude or failed to understand the issues, they wrongly lay the blame on the insurer.

I wonder if they are aware that the doctor they refer to is probably a network Doctor for 10 or 12 insurers and changing insurer will not get them a different options locally.

You will see on the DOCTOR SEARCH FOR DKV that you are able to rate your experience with a star rating for a particular doctor. Any criticism of a doctor should be at the doctor not the insurer who have no control at all over independent doctors, specialist doctors, hospitals or clinics

When using a medical network people need to be aware that if you are NOT HAPPY with a particular doctor, whether its due to not listening to you, or being rude or perhaps not happy with a diagnosis or in your opinion a combination of everything, then simply look up another doctor option in the network and get a second opinion or even a third opinion.

All the better insurers like Sanitas, Axa, DKV Seguros do not require any referral or permission to simply walk away from a Doctor, Clinic, Hospital you are unhappy with and book in with a different practitioner.

Francis Payne

Tailor Made Healthcare Solutions Spain.