Spanish Medical Providers
 

A SIL was planning on moving to Madrid. She did her due diligence and completed all the onerous paperwork needed by Spain and then went to finalize health care. Although she filled out the forms well in advance, when she went to pay, she was denied because of a previous condition. She went back and checked the literature and the forms and there was no warning about to refusal of coverage due to pre-existing conditions. So after months of preparation and costs and trying to comply with all the laws and covenants, she cannot move to Spain. She does not want to lie nor fly back to the US for well care. So her dream was shattered.

The health care providers are to blame for their lack of honesty.

Confused....was she denied coverage with insurance based in Spain? for how long a period? I have used GeoBlue on my trips out of the country, and you can get it for extended periods. They do cover you (at least some of the policies) if you have a pre-existing condition.

Confused.
Title is "Spanish Medical Providers" later stating "she was denied because of a previous condition."
So is this a case of an American Health Insurance or a Spanish Health Insurance doing a dirty?

It is normal a health insurance will not cover for any previous illness.

It is a pre-existing condition. In the US, under Obamacare, you cannot be denied healthcare coverage due to a pre-existing condition.

Ribe:

What does a Spaniard do, if they are denied coverage, due to a pre-existing condition?

Many people in the US were denied coverage for pre-existing conditions prior the Affordable Care Act. If this is repealed, US citizens may well be back in the same state. In the past, US citizens with pre-existing conditions often had to pay privately to have those conditions treated but other conditions might have been covered by insurance.

I don't think health care providers are the ones to be blamed but perhaps she did not fully understand the system of health care in Spain. Here is a good site: https://www.expatica.com/es/healthca...in_101467.html and: https://www.expatica.com/nl/healthca...ts_445243.html.

That second link mentions being sure to investigate which pre-existing conditions may or may not be covered.

Ktravel

Did you actually read the sites you posted? The terms could not be much vaguer. My SIL, spent considerable time investigating the requirements and was fully surprised at the last moment. She did all the required steps including being fingerprinted for an FBI background check and the absurd and almost Catch 22 bureaucratic requirements of the Spanish government. She also went on ex-pats boards continually to ask questions and see the experience of others.

The forms she filled in for healthcare coverage and the accompanying literature made no mention of the lethal covenants.

Has she talked to an immigration specialist? She would have to pay, but maybe she could get one to help her jump through this particular hoop. Lincasanova sent me a link to as association of them; let me know if you would like it for your sister, I can post it.

Yes, I did read the sites. I agree they don't specify what exactly would or would not be covered but clearly indicate much research might need to be done, preexisting conditions might be an issue, and that private insurance would likely be necessary. Was she applying for private insurance that was denied or was she hoping to be covered by the state healthcare system?

Not every expat has the same situation, particularly those that have worked or are working in the EU.

I think the idea of speaking with an immigration specialist might be helpful.

As a health care provider, I don't make up the rules about health coverage but try to provide care within our health care system (whose rules are constantly changing.) I am not sure why you think Spanish medical providers are dishonest or should be blamed for the rules of their government.

I do hope your SIL is able to figure out a way to make this dream work for her.

Well, it sounds like there are private companies as well. Did she apply for private or public? The first link makes it sound like you're entitled to public if you're a resident, not as if you have to qualify for it to become a resident. Can she afford to pay out of pocket? Because that sounds like another option. And people are always saying that routine care is much cheaper there than here.


I have mixed feelings about Obamacare. On one hand, it has made it so like your sil, I get insurance. On the other hand, it's so screwed up in some ways that it hasn't actually improved the level of care. I drive 6 hours because I can't actually find a doctor accepting new patients. But at any rate, the way Trump is going, she'll be able to move in a few years because there may be no coverage to stay for. Cheerful thought, that.

I also fail to see the dishonesty.
The guys looking at her file just follow the rules like some did in 42 in Dachau except that these rules have been established under democratic rules so they are legit.
Don't expect these guys to bend the rules or show compassion or even be creative. It is up to your sil to overcome it or accept it.

Maybe it is easier to complain.

I was once confronted to a situation where health guys refused something and I had to fight for it.

Happy travels.

we are not denied health care. We have a similar system to the UK where payments are deducted at income to cover universal/public health care. We have to "contribute" for meds., when purchased at the pharmacy.
I believe that this is considered a bit too left for some US politicians.;-)
One can purchase extra insurance to cover "private" hospital stays extra treatments etc.

Ah. Depends on the visa, I see.

But this source might help:


https://wagonersabroad.com/medical-i...a-application/

Although unfortunately their original path (travel insurance) may no longer be a possibility. But different Spanish companies may have different criteria of pre-existing conditions. Basically, if I were her, I wouldn't give up hope until exhausting all options.

The guys looking at her file just follow the rules like some did in 42 in Dachau except that these rules have been established under democratic rules so they are legit.
_______________________

Godwin's law "As an online discussion grows longer, the probability of a comparison involving Hitler approaches."
_______________________________________

There were some absurd possibilities such as paying $2,500 a month for health insurance. Or lying about her condition. Or flying back to the US, on occasion, for medical attention assuming nothing major erupted again. She already had a airline ticket, a place to stay while looking for a long term rental. All this after she had hired an expediter and translator to help with the Spanish bureaucracy in the US.

She believes she has exhausted all possibilities. As her father was born in Spain, she could have applied for Spanish citizenship, but she did not want to give up her American citizenship, which is a condition, here in the US.

My understanding is that the USA doesn't recognise dual citizenship, but doesn't force you to give up your American citizenship if you claim citizenship of another country as well unless you want to:

https://travel.state.gov/content/tra...tionality.html

Quote from above website: U.S. law does not mention dual nationality or require a person to choose one nationality or another. A U.S. citizen may naturalize in a foreign state without any risk to his or her U.S. citizenship. However, persons who acquire a foreign nationality after age 18 by applying for it may relinquish their U.S. nationality if they wish to do so.

Since the US taxes its citizens on worldwide income regardless of residency (unlike almost every other country in the world), if she plans to live in Spain for good she might be better off renouncing her US citizensip. Even if she owed no tax to the US, filling in the paperwork can be expensive and time consuming. Of course, relinquishing your citizenship can be expensive too, but it is a one-time hit.

In any case, I have no idea why she thinks she cannot hold dual citizenship. It used to be an issue, but there was a Supreme Court case in the 50s that clarified the matter.

https://travel.state.gov/content/tra...tionality.html

If she went ahead with the move and sought health care on an as needed basis, would that not be the same position that a traveler without travel insurance would be in? I always believed that health care was inexpensive in European countries. If this is true, could she not seek the care as needed without bankrupting herself? (I just want to know, I'm not commenting on her decision..)

I'm in Spain now. I bought no insurance. If I had to go to a hospital or see a doctor, would that be as pricey as in the US?

Health insurance may be a requirement of her visa?

Lots of good information on the site marvelousmouse posted.

I previously have always heard health insurance was one of the biggest obstacles/issues to be dealt with in considering an out of country move. Easier, possibly, if she has been offered a position working in the EU. Is she retired or does she plan to be working? Did she apply to more than one private insurance company?

I know lots of people asking the same questions and on an fb page " Valencia Information exchange" I have seen an insurance provider who can help her. I will try to find it for you.
An immigration specialist is not necessary.. i don't think

another group is Americans in Spain, Americans living in Valencia,

Linca, that would be wonderful. Thank you. She had been on various ex-pat boards from the beginning of the process. But another solution would be welcome.

The Spanish government requires health insurance as part of a visa of more than 90 days, among things like a criminal background check and a financial statement.

At various times members of the family have investigated Spanish citizenship, but you must relinquish US citizenship.

She is retired.

She applied to one healthcare provider and was refused coverage investigated many others.

On our various trips to Spain, we have seen doctors and have gone with relatives for their visits. (A Spanish tradition.)

Whilst she may gain Spanish citizenship that will not necessarily gain her entry into the public health system. She would have had to pay into the system before retirement.
Plus Spain also does not reorganise dual nationality unless she is from a South American country.
https://www.spanishpropertyinsight.c...dency-permits/
http://www.exteriores.gob.es/Consula...rementVisa.pdf
http://www.billdietrich.me/MovingToSpain.html

What's the longest she's been in Spain?

If not longer than a vacation...Perhaps she could go for one of the absurd policies and test the waters for a year. Or even go for 3 months on travel insurance.

It may be that the realities will get to her. Or it may be that she'll love it so much that she won't mind giving up her American citizenship. I don't quite see why that would be a sticking point if this is her lifelong dream and she plans for the move to be permanent. I would think it would be a lot more beneficial to live as a citizen there than an expat.

The longest she has been in Spain is about 5 weeks, but has visited many times.

"Godwin's law "As an online discussion grows longer, the probability of a comparison involving Hitler approaches."

I should have said I didn't care and I didn't see the relevance of your rant on a travel forum. I tried to be somehow nice.

Fodors law : don't get involved in a rant, there is nothing to be gained and OP will bite you.

Rules are rules, mate. You or your SIL don't like them ? Not my problem. Not Spain's problem. Fight it or lose it. Seems your SIL doesn't have the stomach to fight it. So be it. Just don't complain that Spanish people are dishonest.

Fodors law : don't get involved in a rant, there is nothing to be gained and OP will bite you.
__________________________
You apparently missed lincasanova's offer to help.

Rules can be bent, broken, and changed. Many rules are the result of power and influence. Rules change with the times and with regimes. It is a facile mind that says rules are rules. That sees the world in the most simplistic form.

It lacks the understanding of history and the law and human nature.

You have asked some questions from me I have given answers but they seem to have been overlooked.
Now you are going on about breaking rules. It is not a rule breaking you are asking about here, but the law (or two). That is going way too far in most peoples books.
Laws about immigration certainly do change with what you call regimes! Just look at what a certain head of a "regime" near you wants to build to stop illegals from entering.

I did not ignore your Ribe. I appreciated the every day knowledge and it clarified the situation. The comments about the rules were directed elsewhere.

I know about where they are directed, but your statement about rules are there to be broken sort of thing, has left me a little bit offended.
Maybe we can push regulations to a limit, but if pushed too far one comes a cropper. The same in breaking them.
Personally I find that is a step too far. Hence my bit of forum rage.
As you have tried American insurance providers maybe she can try Spanish providers.
https://www.mapfre.es/seguros/partic...uros-de-salud/
http://www.sanitas.es/landings/segur...canal=ownmedia
https://www.axa.es/seguros-salud-modalidades

There will be others and I do not know if what they will give cover for. There may be a need for an NIE before one can get a quaote then it will be catch 22. However it would be ok after the first insurance period has ended.

Ribe

Sanitas was her choice of providers. After they denied coverage, she tried some of the others.
_________
There are many on these boards who apparently have never bent rules, hired a lawyer or accountant to see how far they could push the law, or simply have broken the laws. But when someone else does it, they become Torquemada.

Fodor's attracts only those who are smug in their unsullied life.

As noted above, my SIL refuses to do anything that is illegal. But some how that is not enough for self-righteous here.

Once again this was not directed at you.

As someone who did regulatory work for many years, my job was to figure out how to do something within the law. And unless there was an out and out prohibition, I usually figured out a way to do it legally either partially or in full. Everyone knew I would condone something illegal.

Many laws are written to protect the financial interests of the wealthy or corporations, as they have the influence and resources to do so. Thus I have no compunction in asking how to do something within the law, that is not usual.

National laws in Europe requiring long-stay visitors to show proof of health insurance are there to protect the Spanish (or Italian or French) taxpayer, since it is a publicly funded system. From the point of view of the national health care system, your SIL is the least desirable "demographic" to have inside the country. She's older, she has had previous health issues, and she hasn't paid a peso into the national health care system -- yet should she develop a serious illness and need major treatment or hospitalisation, it is like to be of the most expensive kind. If you think the Spanish are self-protective about this, take a look sometime at how the Canadians would treat your non-Canadian SIL.

I have no experience of the Spanish government with regard to immigration, but I am wondering if Brexit is causing a stricter application of the rules for non-EU long stay visitors providing proof of insurance. For years, elderly EU citizens from the UK could visit Spain for months on end, confident the EU reciprocity agreements would cover their health costs. That's over, and the Spanish taxpayer does not want to foot the bill for loads of non-Spaniard sun-seeking elderly folks. You can come if you have health insurance and therefore won't be using the national system as EU citizens are entitled to.

It doesn't seem unfair to me and it's just unfortunate your SIL didn't understand the obstacle that her pre-existing condition would pose to getting a long-stay visa.

She was going to purchase private insurance and not be a burden on the Spanish taxpayer. She also passed the Spanish government's means test.

As far as the Brit pensioners on the Costa Del Sol (and in neighboring Portugal) I believe the requirements will be renegotiated as there are a bit over 100,000 in Spain.

It seems that she can appeal to the Spanish Consulate. The other alternative is that the Spanish private health insurance will not cover a recurrence of her pre-existing.

The appeal offers offers only the remotest of chances and will be the final step if all else fails.

I'd take the policy even if it doesn't cover pre-existing conditions. If necessary, she can return home to be treated for that.

We've only had coverage for pre-existing conditions for a short time now, and who knows how long that might last !! Nothing unusual for Spanish insurers not to cover this.

Bedar-she is considering that.

Here is ironic twist, on the law is the law. Someone on one of the ex-pat boards claims some Spanish consulates in the US are more lenient about the requirements of seeking a long term visa. So as a last resort, she will appeal to the one with the reputation of being more understanding.

If the Spanish government's means test is like all others, it only establishes she has the mean so support herself for every day living without working. It doesn't say she has the means to cover life-saving medical treatment, which can run to hundreds of thousands of euros.

If she can get the insurance minus covering a recurrence of her previous condition -- and doesn't want to return to the US should she need treatment for a recurrence -- she should look into the existence of private care in Spain or other European countries. I once went a private clinic while in the UK and paid to have a medical test. If the nature of your SIL's previous condition is such it's unlikely it would involve huge out of pocket expenses or many doctor's visits, might be cheaper than plane transatlantic plane tickets to get treated by private European clinics.

>>As far as the Brit pensioners on the Costa Del Sol (and in neighboring Portugal) I believe the requirements will be renegotiated as there are a bit over 100,000 in Spain.<<

Indeed. And it won't be re-negotiated to the benefit of the pensioners. They'll be asked to get health insurance if they want to go on living in Spain, and they'll face the same issues as your SIL, as if they had never been EU citizens.

The main problem of the Spanish economic collapse of 2008 was real estate. Although it has improved there is still a great deal of undervalued real estate. (I do not know if there are still ghost towns.) It would behoove both sides not to upset the lives of the Brit pensioners and the economy of Southern Spain. That said, when is common sense part of any political equation?

More likely the UK government will be asked to underwrite the costs of coverage for British residents in Spain.

Was that not the goal of Brexit ?
To save money on healthcare and to reduce immigration ?
Seems it works both ways.