Complaints and Rejected Health Insurance Claims in Spain

Ask for the contractual reason in writing then follow the insurer’s formal complaints route.

Before you begin

Before comparing a policy, establish whether you already have a public healthcare route. Start with public entitlement →

Short answer

A rejected authorisation or claim should be checked against the policy wording, personalised exclusions and the medical evidence supplied. Request a written decision before escalating the complaint.

Written by Jon Grocott

Identify what was refused

A refusal can concern cover, medical necessity, network use, prior authorisation or missing documents. Each has a different response.

Use the insurer’s complaints service

Send the complaint to the customer service or ombudsman identified in the policy documents. State the remedy sought and attach only relevant evidence.

Escalating to the DGSFP

The DGSFP complaints service can consider eligible insurance complaints after the required internal route has been used. Check its current admissibility and document rules.

Urgent care is separate

Do not delay medically urgent treatment while disputing an insurance decision. Use the appropriate emergency route and address payment or reimbursement afterwards.

Official sources used for this page

DGSFP: complaints service ↗Insurance Contract Act ↗

What to do next

If you are comparing cover, read the benefits and exclusions together, then compare the full contract rather than the product name.

What policies may cover →What policies may exclude →