The price of medical help on The Way

[Dov of the Galilee]

A little background and then the quandary…

Leading up to Leon I was in a herd of people that one particular woman became increasingly sick; a head cold by all accounts. On the day I was to arrive in Leon this lady announced at an outdoor café to anyone who would give an ear that her friend tested positive for Covid, she herself was looking terrible and said she was going to get tested. I never saw her again.

As I walked into Leon I started having a low grade fever, I took a single room and spent the next four days isolated nursing the fever. No sneezing, no coughing, just flu like symptoms. I had Covid three years back and I never had been so sick in my life for two and a half weeks, this was not that.

After four days I went to walking. Each night I’d feel like I had a low grade fever and generally “dog’s dish”. I pressed on taking private rooms when they were available but again I had no coughing or sneezing whatsoever.

By the time I got to Sarria I was still with the fevers and now lower GI problems. I had watched many YT videos leading up to this trip and many threads over years time. I always heard that medical help was very affordable and good in Spain.

So I went to a clinic, the receptionist was very kind, took down all of my details and she wanted my insurance card from my home country….now I intended to pay cash, that was not allowed nor was I told how much it would be, I asked and there was no bill given to me after I saw the doctor either.

So I saw the doctor, NO LAB TESTS WERE DONE, he listen to my complaints, my heart, temperature and BP all was in working in order and he gave me four over the counter medicines to take that cost forty euros. He diagnosed with out lab work that I had a “virus” and for the remaining time I was in Spain I never got healed despite taking the medicine prescribed faithfully.

So I received treatment on the 28th of September , the bill was stamped on the 29th of November [ two months later] and it arrived to me here in Israel today. They said my insurance would not pay which does not surprise me that’s why I have TRAVEL INSURANCE and it requires that I pay for the bill and submit for reimbursement. It further requires me to do so within ninety days of completing the journey which has now passed.

The sum they are requiring is 268.34 Euros. If that would have been said up front I would have left even with the traveler’s insurance.

I am flummoxed as to how to proceed.

 

[MickMac]

I am flummoxed as to how to proceed.

Explain to clinic and ask that that correct date of treatment is issued, explain to travel insurance what has happened it will be grand , or pay the bill and pursue later.

 

[J Willhaus]

I would ask if I could pay by credit card then submit to the travel insurance with an explanation that you received the bill this week. Don't use that agency again if they don't pay would be my advice.

In Spain the public medical centers don't have the ability to take payment on the spot so that isn't unusual.

 

[Dov of the Galilee]

I would ask if I could pay by credit card then submit to the travel insurance with an explanation that you received the bill this week. Don't use that agency again if they don't pay would be my advice.

In Spain the public medical centers don't have the ability to take payment on the spot so that isn't unusual.

From the insurance side there is no leeway, why would there be?They got their money and they won't pay out as I've been told.
If I knew the cost before service I would have left but I was told she didn't know before hand and there was no bill after I was seen. In israel I'm a tour guide and I've had many trips to the hospital for rehydration issues, broken arms or foot and Israel has social medicine and surprisingly their take on low cost medical issues is that it is good for tourism. So when I didn't hear from anyone for three months I figured Spain had a similar out look. Apparently not. The clinic wants to only be paid through a bank transfer which I unable to do.

I could send to Spain my travel insurance proof of coverage for that time, explain the scenario and the fact that due to taking more than three months to send a bill my time for filing a claim has elapsed.

Another strange thing is that the envelope has no cancelation mark. So when it was posted is anyone's guess

 

[trecile]

It's too late for @Dov of the Galilee, but after a couple of medical experiences on the Camino I found that it's best to go to a private clinic or hospital where you can pay with credit card at time of service, and are given a bill to take home to send to your travel insurance right away for reimbursement.

In 2018 I suffered from shin splints, and when I arrived in Santiago I decided to get checked out to make sure that it wasn't something worse. I asked the staff at my hotel where I should go, and they recommended the public hospital. After quite a wait I was finally seen. The doctor basically just moved my leg in different directions and asked when it hurt. No testing or imaging was done, and I was sent off. I tried to find someone to pay at the hospital, but they told me that I would receive a bill later, which finally came a couple of months later in the amount of 361.59 Euros! Fortunately, I was in time to submit it to insurance, but the only option to pay was via wire transfer, which cost me an additional $30.

On a subsequent Camino I fell in a very slippery shower room and cut open my elbow. Before the local health clinic would give me stitches they wanted an Xray done to make sure that a tendon hadn't been cut, so I had to go to the hospital in A Coruña. The clinic recommended a private hospital with an English speaking liaison person. I was able to pay the bill on the spot with my credit card, and the liaison even called my insurance company to get the claim started. When I returned home it was very simple to send them the bill I received.

 

[Tincatinker]

It further requires me to do so within ninety days of completing the journey which has now passed.

Why don’t people read the small-print. My travel insurance requires me to notify them of a claim within 90 days of the incident giving rise to the claim. NOT make the claim and provide them with all the sodding paperwork and a photograph and a get-well card from the Guardia Civil. Just notice that I will be lodging a claim. That opens the claim process which remains open until it concludes (seldom in the claimant’s favour but that’s a separate matter).

Dov, you didn’t feel very well. You went to a “clinic” (public or private?) where you got told you probably had a viral infection and were recommended to take otc prophylactics. What other outcome did you expect other than a sub-€300 bill. You could have gone to a Farmacia and got the same advice for free and the meds at otc prices.

As to how to proceed: either pay the bill or don’t. Your next challenge will be finding a method of paying the bill. Good luck

 

[Dov of the Galilee]

Why don’t people read the small-print. My travel insurance requires me to notify them of a claim within 90 days of the incident giving rise to the claim. NOT make the claim and provide them with all the sodding paperwork and a photograph and a get-well card from the Guardia Civil. Just notice that I will be lodging a claim. That opens the claim process which remains open until it concludes (seldom in the claimant’s favour but that’s a separate matter).

Dov, you didn’t feel very well. You went to a “clinic” (public or private?) where you got told you probably had a viral infection and were recommended to take otc prophylactics. What other outcome did you expect other than a sub-€300 bill. You could have gone to a Farmacia and got the same advice for free and the meds at otc prices.

As to how to proceed: either pay the bill or don’t. Your next challenge will be finding a method of paying the bill. Good luck

When I was in Leon I did just that I went to the pharmacist and got a sack of solutions. Pharmacists can be helpful but they are not physicians, depending on the country they are very bound by laws . As for doctors, they are scientists, exams are part of a work up, blood work and a covid test are facts they exclude or conclude and you go from there in trouble shooting. In situation I had to return home and have that done to get back to being well.

As for knowing the small print, good luck with that! I travel a bit, always have travel insurance, most times I never file $20 , $50 claims, it just seems counterproductive for me but it certainly is your right.

I am of the thought that you should present a bill at the time of service, if they want to extend a 90 day period to pay that's fine. I wonder how many people don't pay? You have no real way of recouping your losses outside of your country.

 

[Kathor1]

Another strange thing is that the envelope has no cancelation mark. So when it was posted is anyone's guess

There is nothing strange about this. The stamp on the envelopes where my hospital sends me their invoices look similar. It's business mail.

 

[Dov of the Galilee]

There is nothing strange about this. The stamp on the envelopes where my hospital sends me their invoices look similar. It's business mail.

For international mail it is strange. But more so the franking of a stamp is legal proof of when it entered into the government mail system. So in my case the contents were signed November 29, but where has the letter been all of this time?Since this is s time sensitive matter the proof is necessary.

 

[Kathor1]

For international mail it is strange.

No. I get international mail with the same preprinted stamp. The invoices that I regularly get from my own hospital (regular treatment) are similar to what you describe: There are 3 dates on my hospital invoices: date of treatment, date of invoice, and date of dispatch (which may or may not be the day when they actually put it in the mail). It's the way their invoicing system works. There are two to three months between the date of treatment and the date I receive the hospital invoice in my letter box.

 

[Dov of the Galilee]

So I,will photocopy their dates , copy the 90 day clause on my insurance and let them fight it out. This cannot be their first go around yet they stick to this . You can buy a coffee everywhere with a credit card but you can't pay a Healthcare service center... and they don't know the price at the time of service? something is wrong.

 

[trecile]

As I walked into Leon I started having a low grade fever, I took a single room and spent the next four days isolated nursing the fever. No sneezing, no coughing, just flu like symptoms. I had Covid three years back and I never had been so sick in my life for two and a half weeks, this was not that.

The Covid virus has mutated and changed in the last three years, and an individual's second bout could be very different from the first. Without a test you don't know for sure.

 

[J Willhaus]

In the US it is very common for the insurance to deny on the first presentation so I would appeal even if you are initially denied.

 

[trecile]

You can buy a coffee everywhere with a credit card but you can't pay a Healthcare service center... and they don't know the price at the time of service? something is wrong.

The public clinics and hospitals are set up to serve the Spanish citizens and residents who have health cards which give them access to health care often at no out of pocket cost. Their system is not set up to treat foreigners. There's no point in paying to have a business office at the clinic or hospital when most patients are never billed for services.

This is why I recommend using private hospitals and clinics to non-Spaniards and those whose countries don't have a reciprocal health care system.

 

[Dov of the Galilee]

The Covid virus has mutated and changed in the last three years, and an individual's second bout could be very different from the first. Without a test you don't know for sure.

That is true, this is why I told him the history of the other pilgrim, her degree of illness and that her friend was diagnosed with Covid. You would have thought that a simple test would have been conducted to rule it out.

 

[Robo]

I'm just grateful that when I need medical assistance, as I have done more than once.
That it was available.

 

[SabsP]

Covid rapidtests are easily available and cheap in Spanish pharmacies.
No need to ask for this simple test in a hospital.

 

[Kathor1]

I wonder how many people don't pay? You have no real way of recouping your losses outside of your country.

Since you wonder ... I guess it is a hypothetical question? You would not be the only one if you decide to join those who do not pay their invoice for a hospital consultation while on visit in Spain.

Google with search terms like "turistas extraneros" hospitales espana site:.es and there will be plenty of articles with information about this topic. Below is a link to one of many such news articles (in Spanish). The numbers about exact amounts unpaid vary but it is a lot; millions of euros per year:

The medical debts of foreigners - a problem for Spanish tourism. The amounts amount to millions of euros for the administrations which try to collect without success (in Spanish)​

The Spanish health care system is organised by region (Galicia, CyL, Navarra, Balearic Islands etc). The main culprits are European visitors, especially from the United Kingdom, Germany, France and Italy. Although they have the right to a "health card" (even when from the UK and after Brexit) which regulates who pays for their urgent medical care, many of them don't bring the card with them. So they are treated like those tourists and other visitors who don't have public health insurance in Spain or in their country of residence. Among those from non-EU countries who owe the most to the Spanish Treasury due to their unpaid medical bills are the United States and Argentina. (Source: article linked above).

BTW, according to the article: The Balearic government (Mallorca is one of the most popular holiday destinations) announced last May that it will hire a collection service abroad for these invoices which will take care of pursuing the debtors and collecting at least 40% of the unpaid amounts.

 

[Dov of the Galilee]

Since you wonder ... I guess it is a hypothetical question? You would not be the only one if you decide to join those who do not pay their invoice for a hospital consultation while on visit in Spain.

Google with search terms like "turistas extraneros" hospitales espana site:.es and there will be plenty of articles with information about this topic. Below is a link to one of many such news articles (in Spanish) - the numbers about exact amounts unpaid vary but it is a lot. Millions of euros per year:

The medical debts of foreigners - a problem for Spanish tourism. The amounts amount to millions of euros for the administrations which try to collect without success (in Spanish)​

The Spanish health system is organised by region (Galicia, CyL, Navarra, Balearic Islands etc). The main culprits are European visitors, especially from the United Kingdom, Germany, France and Italy. Although they have the right to a "health card" (even when from the UK and after Brexit) which regulates who pays for their care, many of them don't bring it with them. So they are treated like those tourists and other visitors who don't have public health insurance. Among those from non-EU countries who owe the most to the Spanish Treasury due to their unpaid medical bills are the United States and Argentina. (source: article linked above).

I would and will do all I can do to prevent that from happening . My travel insurance cost me $10 usd per day, I was in Spain six weeks. I wish in this day and age an insurance policy such as mine provided a digital card for these incidents. The company I use is in Israel where I live and if they are forced to operate in anything outside of Hebrew it takes a terrible turn. Now since this problem has become known I am dealing with language barriers.

 

[Anhalter]

The public clinics and hospitals are set up to serve the Spanish citizens and residents who have health cards which give them access to health care often at no out of pocket cost. Their system is not set up to treat foreigners. There's no point in paying to have a business office at the clinic or hospital when most patients are never billed for services.

Maybe, after a couple of decades where Spain has made a substantial amount of it's GDP from tourism they should have come up with a solution of treating foreigners in the hospital. It isn't rocket science...

 

[Josep Montserrat]

A little background and then the quandary…

Leading up to Leon I was in a herd of people that one particular woman became increasingly sick; a head cold by all accounts. On the day I was to arrive in Leon this lady announced at an outdoor café to anyone who would give an ear that her friend tested positive for Covid, she herself was looking terrible and said she was going to get tested. I never saw her again.

As I walked into Leon I started having a low grade fever, I took a single room and spent the next four days isolated nursing the fever. No sneezing, no coughing, just flu like symptoms. I had Covid three years back and I never had been so sick in my life for two and a half weeks, this was not that.

After four days I went to walking. Each night I’d feel like I had a low grade fever and generally “dog’s dish”. I pressed on taking private rooms when they were available but again I had no coughing or sneezing whatsoever.

By the time I got to Sarria I was still with the fevers and now lower GI problems. I had watched many YT videos leading up to this trip and many threads over years time. I always heard that medical help was very affordable and good in Spain.

So I went to a clinic, the receptionist was very kind, took down all of my details and she wanted my insurance card from my home country….now I intended to pay cash, that was not allowed nor was I told how much it would be, I asked and there was no bill given to me after I saw the doctor either.

So I saw the doctor, NO LAB TESTS WERE DONE, he listen to my complaints, my heart, temperature and BP all was in working in order and he gave me four over the counter medicines to take that cost forty euros. He diagnosed with out lab work that I had a “virus” and for the remaining time I was in Spain I never got healed despite taking the medicine prescribed faithfully.

So I received treatment on the 28th of September , the bill was stamped on the 29th of November [ two months later] and it arrived to me here in Israel today. They said my insurance would not pay which does not surprise me that’s why I have TRAVEL INSURANCE and it requires that I pay for the bill and submit for reimbursement. It further requires me to do so within ninety days of completing the journey which has now passed.

The sum they are requiring is 268.34 Euros. If that would have been said up front I would have left even with the traveler’s insurance.

I am flummoxed as to how to proceed.

Hi Dov,

If the medical care was given in Sarria, the competence to deal with a claim lies with the Galician Institute of Consumer Affairs and the competence.


https://reclamacionsconsumo.xunta.gal/marco_public-web/asistente
Only in Galician and Spanish
Step 1
What I would do complain to the company that you want to charge, explaining everything in detail.
Request the cancellation of the invoice.
Step 2
After a month complain to the Consumer Institute of Galicia

In my opinion 263 euros is a lot for a medical visit. Make sure that the issuer of the bill is really the one who gave you the service.

Bon Camí.

 

[Kathor1]

This is why I recommend using private hospitals and clinics to non-Spaniards and those whose countries don't have a reciprocal health care system.

I've been following these threads and comments about cost and organisation of the Spanish health care system for years. I also tried to inform myself better about the various fees and payment procedures but without much success.

The problem is that those who are insured under the Spanish public health care system or under the public health care system of a European country where there are treaties about mutual payment for emergency care of their members in the foreign country or who are from countries that have such a separate agreement with Spain (there are a few) don't know how much the total cost for their care is.

We also don't know how privately insured travellers (i.e. travellers with a travel insurance policy) are charged - whether they go for consultation and treatment to a private clinic or to a public hospital.

I know from Germany's health care system where they have a large sector of privately insured persons who have opted out of the public health care insurance that doctors are legally entitled to ask 2 to 3 times (!) more for medical care and consultation when the patient is privately insured versus a publicly insured patient - for the same treatment!

The idea that public health care systems are organised and financed in the same way in every European country is false. There are huge differences.

(I am not enrolled in a public health care insurance system so I have a bit of insight into payment processes and fees in several EU countries and in the UK but I am not an expert. Peregrin@s must get used to the fact that it is different from home and different from what they may have heard ).

 

[Stephan the Painter]

I found the same thing that @trecile found. It's much easier and cheaper to go to a private doctor in Spain. When I saw a private podiatrist, the bill was €40 paid on the spot. When I had to go to a hospital in Almeria it was about €200 paid three months later through a confusing process. When I tried to see a doctor in Santiago, I went to the hospital and they told me flat out that it would be €250 just to see someone ( which I skipped, because I wasn't that sick. I just went to a pharmacy instead).

For all non-emergency health concerns in Spain, it seems best practice to stop in a pharmacy first. Of course I always have travel insurance, but when you buy this in the United States there's a often a deductible. I usually select $500. The insurance will only pay claims over that amount.

@Dov of the Galilee: Paying a bill in Spain if you don't live in the EU is difficult. I have a "WISE" Euro account that gives me the right numbers to make and receive payments in Europe. This is an account non-Europeans can have. On the bill they sent you, there should be bank numbers to make a payment to. On the other hand, they are unlikely to pursue you legally.

Health costs are cheaper in Spain then many places, especially the United States. I'm so used to seeing insane medical bills in the US that it all seems cheap. I want to see my doctor for a routine yearly examination last month and with a few blood tests and it was billed at $1100.

By the way, I am self-employed US resident so I have to buy my own health insurance. It costs $14,400 a year. I get a partial subsidy on that from the federal government because my income is fairly low, but that's the price.

 

[NancyCooke]

That is true, this is why I told him the history of the other pilgrim, her degree of illness and that her friend was diagnosed with Covid. You would have thought that a simple test would have been conducted to rule it out.

But then again, There is no médication to treat viruses, some help with the symptoms but antibio does nothing for viruses.

 

[Perambulating Griffin]

But then again, There is no médication to treat viruses, some help with the symptoms but antibio does nothing for viruses.

So true, but perhaps if people would confirm that they have a virus like CoViD (which can still do terrible damage at random), they would take a few days off the communal camino and not continue spreading their viral particles everywhere.
We have norovirus running rampant in our communal settings in Canada now… the only thing to do for it is rest and fluids… but with about 4000 of our students living in residence on campus, and with so few *washing their damned hands*, the virus os spreading outward.
Why do viruses spread outwards? A combination of “what they do by definition” and “people are entitled jerks who can’t be arsed to wash their hands”…. Then they come into shared classroom spaces and put their paws all over display terminals, document cameras, lab equipment etc etc.

If one is out on camino and feels poorly (CoV or not), they should stop for a few days, take whatever medications help them feel less awful with whatever virus, and not expose the others to their GI disturbances, their viral pneumonias (yes, that can happen), and yes, the CoV that has not gone away and can still leave people impaired after they have “recovered”.

And pay the darn bill!

I do not know why people go seeking medical treatment and expect not to have to pay for it. Do they also “dine and dash”? Skip out on hotel bills? Stiff the shuttle driver?

I understand that the OP has insurance and that the insurance company is posing some technical problems, but one ought to be prepared for that to happen. Insurance companies always aim not to pay.

Pay the bill, then sort it with the insurance company, and recognize that as many have noted, the public system in Spain is intended to serve its residents. It is *not* designed to tend to tourists. Tourists will have a much easier time if they go to a private hospital. Also, billing processes vary by autonomous region, so the 138 euro bill that the Astorga health centre charged last summer to handle an ear infection (and they were lovely, efficient, dealt with my antibiotic allergy as a variable… told me how to avoid future issues — no more topones— and assured me it would be safe to double my doses of inbuprofen and paracetamol for a few days) might not be reflected in Asturias or Galicia, Castile-Leon, Navarre etc.

Astorga does not have a private hospital and I would not see one until Ponferrada, so I did not wait. They took all my information and some months later they sent me the bill, and my insurance company still has not reimbursed me (maybe they will and maybe they won’t because of the timelines). The same treatment here would cost $350 CAD to the traveller, and it would have taken a full day of waiting in an ER in a public hospital, and there would have been signs all over the place telling the traveller that, fundamentally, our services are not intended for those from out of province, never mind from out of the country, and all the costs are posted for typical tests and services(X-ray: $175; physicians consult: $175; blood draw, $150; each prescription, $75; casting broken limb: $750; ambulance: $145…).

The issue is not with a lack of care or hospitality in medicine in Spain for travellers. The issue is with one’s insurer setting unreasonable parameters for processing times for the bill — they know bloody well how long the bureaucracy can take to move a piece of paper for a *foreign* traveller, and they set their deadlines for receipts well in advance of that timeline.

 

[Molly Cassidy]

But then again, There is no médication to treat viruses, some help with the symptoms but antibio does nothing for viruses.

And whether it is Covid or another virus makes little difference to the treatment, at least in mild cases.

 

[henrythedog]

it will hire a collection service abroad for these invoices which will take care of persecuting the debtors and collecting at least 40% of the unpaid

Probably ‘prosecuting’ (and quite rightly). Persecuting - at least in the UK - is generally reserved for tax collectors and carpark operators.

 

[Peregrinopaul]

I've been treated in hospital twice. The first time at a private hospital in Portugal. At admittance I had to present a credit card which was charged for the bill on discharge (about E3000 from memory). They made sure I had all the paperwork and Allianz paid up without a problem when I claimed from Australia on return. The second time, in Estella, the hospital provided me with no billing, and I received the account about 3 months later and had to pay with a direct bank transfer which I found very inconvenient.

 

[PiesIrlandeses]

This thread serves as a reminder to always bring an EHIC card with you, if you are coming from a country where you are eligible for one.

 

[Hans-Georg Goebel]

For information only, EU residents are treated free of charge in the health centres (Centros de salud) with their health insurance card. I had to use it once at the VdP (2011). While working as a hospetalero at the Astorga Albergue, I went there with some sick pilgrims, who were all treated without any problems or costs

 

[Barbara]

None of this applies to residents elsewhere in the EEC or countries with a reciprocal arrangement. Check before leaving home. Get your government card from your national health service and you will be treated as a citizen of the country you are in. You may need to pay and claim while there or once you are home. There is a payment system in force. You may have to pay a small part of the bill. If they can't take a credit card they will probably take cash. Don't go to a hospital for minor problems, go to the health centre.

 

[VNwalking]

You can buy a coffee everywhere with a credit card but you can't pay a Healthcare service center... and they don't know the price at the time of service? something is wrong.

You're not a customer, you're a guest. Because you don't have a Sanish health card, they aren't set up to bill you. That's what private clinics are for.

The rigamarole of needing to do a bank transfer later on (and not being able to) is a story repeated here many times in many threads. So. Word to the wise...private hospitals are more convenient for those of us without an EHIC card.

 

[trecile]

So I,will photocopy their dates , copy the 90 day clause on my insurance and let them fight it out

The hospital and insurance company are not going to "fight it out." As far as the hospital is concerned the bill is your responsibility. Reading your insurance policy to know what is required of you to make a claim is also your responsibility.Travel insurance rarely pays the provider directly. They work on a "you pay, then they reimburse" basis.

 

[SabsP]

The hospital and insurance company are not going to "fight it out." As far as the hospital is concerned the bill is your responsibility. Reading your insurance policy to know what is required of you to make a claim is also your responsibility.Travel insurance rarely pays the provider directly. They work on a "you pay, then they reimburse" basis.

I am also pretty sure any insurance company will keep insisting the customer to pay the bill. I can imagine that next year when new payment is due , they put non obliging cutomers on the black list.

 

[Kathor1]

Probably ‘prosecuting’ (and quite rightly). Persecuting - at least in the UK - is generally reserved for tax collectors and carpark operators.

Oh thanks for this correction - and the laugh . I should have noticed the mistranslation but I simply copy-pasted the Google translated news article.

Deepl.com would have made a better job of it. They propose: that is why the Balearic government announced last May that it is going to contract a foreign collection service for these invoices, which will pursue debtors and aims to collect at least 40% of the unpaid amounts. An alternative proposition is "chase" - so just trying to get hold of the debtors and of the money owed and not even to prosecute them in the legal sense which is too difficult to do on an international level for such cases of relatively minor unpaid invoices.

 

[Kathor1]

Don't go to a hospital for minor problems, go to the health centre.

You are making a good point !