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Healthcare

Private Health Insurance

Many of us will take out private insurance when we move to another country, which sometimes (not always) offers a more comprehensive service if and when you need a doctor or hospital appointment. Patient Advocate Cecilia Tacchi, who is based in the South of Spain, lists 15 important questions to ask when taking out private medical insurance.

1. Which companies have better reputations?
This is very difficult to find out because anecdotes do not constitute evidence. A study has been made by the investigative TV program “consumidores”, and they ranked the yop 5 companies. You can find it here: www.seguropia.es/blog/post/los-5-mejores-seguros-de-salud.html

2. Do they have good quality doctors? 

3. Do they offer assistance in another country? 
This is a good plus.

4. Does it cover out-of-hospital expensive medications, for example oncology in an outpatient basis? 
This is very important, I have known many people that have insurance, and suddenly they are not covered for cancer, because the treatment comes in pills. I have seen many cases of this. Keep in mind that treatments are heading towards an out-patient basis.

5. What happens if my injury is because of a “dangerous” sport? Is it covered?
There are many companies that EXCLUDE what they call dangerous sports, and that could include skiing.

6. Does it have a maximum that you can spend in one year? 
This is very important also. Medicine can be very expensive.

7. Does it cover check-ups?
Very important 

8. Does it cover TAC, MRI, and PET scan?

9. Does it let me pick my GP and specialist?

10. Do I have a co-pay?

11. Do they cover dental care or can I add it on for a small amount?

12. Does it cover transplantation?

13. Does it cover special procedures like dialysis?

14. Does it cover screening?
Video-colonoscopy, mammography, etc.

15. Will you increase the amount I pay if one year I use it “too much”?

Things to have in mind about the administrative side of things:

1. Coverage: are they transparent about coverage? Or is it written in a vague language or even in language impossible to understand?

2. Exclusions: what kind of things do they consider pre-existing conditions?

3. Wait period: what are their wait periods, and what happens if something happens during those?

4. Change of company or unsubscribe? Many companies do not let you get out of your policy for the full year that you have signed for, but they can “sack” you as a client if they want to.

5. Use: if you are sick during one year and use the medical services more than you did previously, would they raise the premium, or cancel your insurance? I have been hearing this more and more. People that are ill have had their policies cancelled, or raised when they are due for renewal.

Note I: Very important thing to ask: suppose you are admitted to a hospital, call (you or somebody else) your insurance and make sure that they are OK with that admittance. I have heard many stories where the patients were admitted, the hospital failed to get authorization from the company and then they had to pay 10.000€ for 4 days in the hospital. They tried to fight it, but could not get the company to retract, because the policy said that for admissions, previous authorization should be obtained.

Note II: the same goes for procedures, it used to be that private hospitals made sure that the authorization was in place BEFORE any admittance or procedure that needed it. I have cancelled procedures because the company did not authorize them. What is happening now? They are doing the procedures without the authorization and without telling the patient that it’s not authorized, and then charging the patient!

This article first appeared in Compass Healthcare Guidance.