What You Need to Know Before Taking out Private Medical Insurance

Here is a list of 15 important questions to ask when taking out private medical insurance.
Why so many questions?  Because you don’t want to have been paying for 10 years, have cancer and then they tell you that oral medicine is not covered! or dialysis, or speech therapy!!!
These things are in the basic services in the NHS, and in my opinion they should be covered too, but when one goes to shop for insurance, we usually choose based on the marketing skills of the person we are talking to, and that is a mistake.


 Very important questions to ask when taking out a private insurance (these are not in order of importance)
1 Which companies have better reputation? 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 got to a ranking. I will not post that ranking here because I don’t completely agree with their methodology, but you can find it here
2 Do they have good quality doctors?  Here in the costa (and I think that would be all over Spain) the doctors are usually he same. Here every insurance covers the main private hospitals.
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 very important, I have known many people that have insurance, and suddenly they are not covered for cancer, because the treatment comes in pills, mind you exorbitantly priced pills!!!!. I have seen many cases of this. Keep in mind that treatments are heading towards an out-patient basis. This is a very important question to ask.
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 be skiing!
6 Does it have a maximum that they are going to spend in one year? This is very important also. Medicine is very expensive.
7 Does it cover check-ups? Very important .
8 Does it cover TAC, MRI, and PET scan? (The last one is VERY important for cancer)
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”?
Now, 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 an impossible to understand legalese?
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.
There is a very good paper (in Spanish) where they did an in-depth investigation of companies, you can access it here
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!
Please note: The information provided is based upon our understanding of current legislation. It is not legal advice but is provided freely to enable you to be properly informed. We recommend that if you are considering taking action, you should seek professional advice.

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