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Doctors and Insurance cover

Posted: Tue Aug 20, 2019 9:07pm
6 replies132 views3 members subscribed
leon54

Posts: 101

17 helpful points

Joined: 7 May 2018

I am a little lost with with regards to private medical insurance in Spain.

Am I bound to see only doctors covered by that insurance company ? what if there are none in my place that work with that particular insurance ? Do  I pay him/her and get reimbursed perhaps ? I can t see how a person who is ill should be asked to travel say to Alicante or Torrevieja when he has 5 or sic doctors in town who he/she could see/

Regards

Cheryl

Posted: Tue Aug 20, 2019 9:38pm

Cheryl

Legendary helpful member

Posts: 2973

3533 helpful points

Location: Albatera

Joined: 8 Jun 2017

Posted: Tue Aug 20, 2019 9:38pm

How about working the other way around? Maybe you could contact the private doctors that are close to you and ask them which insurers they work with.

Kimmy11

Posted: Tue Aug 20, 2019 9:57pm

Kimmy11

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Posts: 6869

12554 helpful points

Joined: 8 Aug 2017

Posted: Tue Aug 20, 2019 9:57pm

Hi Leon,

Yes, you have to visit a doctor who is included in your insurers' approved list of clinicians.

I'd be surprised if there is a shortage of them in a good sized town like Guardamar.  Perhaps the way around this is to ask for recommendations for doctors in Guardamar, then do as Cheryl has suggested.

I agree that Alicante or Torrevieja is too far to travel for GP appointments, but presumably you would be made aware of your nearest doctor before deciding which insurance to buy?

Kind regards,

Kim

leon54

Posted: Wed Aug 21, 2019 1:02am

leon54

Original Poster

Posts: 101

17 helpful points

Joined: 7 May 2018

Posted: Wed Aug 21, 2019 1:02am

I am very aware of misinformation aimed at producing sales. So it would not be unusual for an insurance company to list doctors on their sales material whom then you may find do not work - anymore - with your Seguro.

There are a couple , for example, who are quoted by the insurance I have set my eyes on , whom - on various medical directories on the net - are show to be recognised by any other other insurance company but the one I would like to subscribe to.

My question remains unanswered: if I decided to be visited by my nearest doctor , how would he be paid and /or how would I be reimbursed, if ever? Because otherwise the exercise of paying a premium would  result just in a waste of money.

 

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Kimmy11

Posted: Wed Aug 21, 2019 5:20am

Kimmy11

Legendary helpful member

Posts: 6869

12554 helpful points

Joined: 8 Aug 2017

Posted: Wed Aug 21, 2019 5:20am

Hi Leon,

You asked, "Am I bound to see only doctors covered by that insurance company ?" and I said, "Yes".

Regarding your other questions, "what if there are none in my place that work with that particular insurance ?" and "Do I pay him/her and get reimbursed perhaps ?",  you would need to ask the insurance company in question.

Even if you chose to share the name of the insurance company to which you refer, I doubt anyone on this forum would be able to give you more definitive advice based on their own experience with the same company.  Personally, I would only rely on the advice given by the insurer.

Kind regards, 

Kim

Cheryl

Posted: Wed Aug 21, 2019 7:40am

Cheryl

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Posts: 2973

3533 helpful points

Location: Albatera

Joined: 8 Jun 2017

Posted: Wed Aug 21, 2019 7:40am

Hello Leon,

Insurers have agreements in place with doctors who will guarantee certain rates for different procedures, consultations etc which was why I suggested you contact doctors in your area as your main concern is having a GP close to you. If they work with various insurers, you will need to read each relevant set of terms and conditions to ascertain which insurer would work for you. There is no one size fits all with policy wording. If you have a particular insurer in mind then you can ask for the policy wording or maybe look it up online and then you will be able to answer your own question. It is rare for insurers to leave the choice of doctor to the insured as they will have no control over the amount charged for the service so the option of you paying up front and claiming back is not likely.
Another choice you have is to contact an insurance broker and Gran Alacant Insurance advertise on this site and receive many recommendations but even so, for something as important as health insurance there is no avoiding poring over the terms and conditions to avoid any unforeseen nasty surprises in the future.

leon54

Posted: Wed Aug 21, 2019 9:40am

leon54

Original Poster

Posts: 101

17 helpful points

Joined: 7 May 2018

Posted: Wed Aug 21, 2019 9:40am

Thank you all for your replies. There is also the probability that a doctor might work with an insurance in the year ones takes cover , but changes  it in the following year. It seems restrictive unless one lives in a large town with an extensive list of doctors.

Regards

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AA Free English TV
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Gran Alacant Insurances
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