Question
So when I signed up my Health Insurance in Spain plan (Sanitas), my broker never had me do a questionnaire. I had a back surgery about a decade ago. I’m having back issues again but in a different part and when they did a review of my history they did an x-ray and saw I have a fusion in a part.
The problem isn’t that part at all but I got a letter that said I withheld info (didn’t get asked) and all back surgeries are excluded. That seems wild since there are so many aspects that are involved. Is there a way my dr can appeal because it’s unrelated to the original surgery? Has anyone dealt with this before? I honestly didn’t know about the questionnaire because it wasn’t even offered. She just had me sign papers and that was that.
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Answers
These are the answers from Spainguru’s Facebook group members:
“Yes, it happened to me with DKV. You likely signed a document that states that you do not have a medical problem and had no history of surgeries. You can look that up on your Sanitas page. Your policy is scanned.
Our broker gave us the papers that we blindly signed. She filled out the questionnaire that stated no medical conditions. She just wanted to sell the policy.
I needed a procedure that was completely unrelated to my medical problems or surgeries (surveillance colonoscopy for my age) and it did not get approved because they saw my past medical history when I faxed my doctor’s note for approval. I needed later another approval and they denied it. I was able to change insurance.”
“I’m appealing because according to Spanish law: Under Ley de Contrato de Seguro, insurers must:
✔ Clearly inform you of any exclusion
✔ Highlight it separately
✔ Make sure you understand what is NOT covered
✔ Provide the questionnaire in a meaningful way
✔ Ensure you answer it intentionally
✔ Ensure you know false answers = exclusions,
You cannot be bound to paperwork you didn’t complete and my broker completed and signed a questionnaire for me without my knowledge. She also sold me a plan and never told me about pre-existing. Not once.
I have all of the emails and found the questionnaire today that she typed out and misspelled my name. I never noticed because I don’t get mail. Because of the nature of the emails, I have a strong case and am going to appeal.”
“I did go back to my broker and asked why she implied that I did not have medical problems. Her answer ‘if I do that they deny it’.”
“I am going to try first to have my dr change my diagnosis to the correct one.”
“Sanitas😀. I did have to talk to an auditor and ‘cleared’ my past medical history and she approved. However, I wanted my husband to switch and he was not lucky. I have to say that DKV has been better with him.”
“No, it was not approved.”
“My PCP explained to me that DKV does not do tests to prevent diseases. They treat😂. I understood that the medical association discussed prevention with DKV and they don’t want to approve those procedures.
I had a PAP smear and the gynecologist wanted to check for papilloma virus on the PAP sample. The test was not approved. Again, prevention.
DKV requested a previous abnormal PAP which I didn’t have.”
“I’m sorry to hear you’re going through this. Unfortunately, health insurance in many countries outside the US is managed similar to the way it was in the US before 2010.
In other words, pre-existing conditions and all potentially associated future issues are excluded. For example, if someone has high blood pressure, they may exclude all cardiovascular issues, such as heart attacks and strokes.
Because you have had surgery in one part of your spine, they likely will exclude anything to do with any other part of your spine. That was the case with me.”
“I don’t know which ones are better. I have mine through ASSSA. Sanitas seems to be a consistent ‘no’ for most pre-existing conditions. I suggest working with a new broker if you aren’t happy with yours.”
“Public covers pre-existing conditions. Private generally excludes them.”
“I guess this is a good lesson that we need to apply for convenio especial as soon as we are eligible after year one.”
“Yes, definitely would best to use public health care for something like this, given the insurance companies are trying to find ways to not pay! My thoughts exactly!”
“And it takes about 5 months after application!”
“That is what we did. (convenio especial)”
“2-3 months in Madrid.”
“I had a similar problem with Sanitas when I had a procedure and possible stent surgery, they wouldn’t authorize it. They said I had a pre-existing condition I hadn’t listed. Totally not true. At any rate, they dropped me! €22,000 hospital cost.”
“My cardiologist who knew my state of health since the year before was shocked by their accusations.”
“It’s time consuming, but this is an unfortunate example of the need to always read papers before signing them…especially when dealing with any type of insurance organizations.”
“You can always appeal! You have a valid issue.”
“Same for my husband with DKV.”
Conclusion
This conversation highlights how health insurance in Spain can exclude treatment for pre-existing conditions, sometimes very broadly, even when the current issue is unrelated to a past surgery. Several members shared similar experiences with denied authorizations or exclusions after insurers reviewed prior medical history.
A recurring theme is the importance of questionnaires and disclosures. When these are completed by brokers without the applicant’s direct involvement, disputes can arise, especially if exclusions were not clearly explained or acknowledged. Some members also noted that private insurers may deny preventive care, while public healthcare covers pre-existing conditions.
The key takeaway is that expats should carefully review all documentation, insist on completing medical questionnaires themselves, and consider appeals or alternative coverage options when dealing with health insurance in Spain.
This article is based on personal opinions from the Spainguru community and is not legal advice.
Frequently Asked Questions about Health Insurance in Spain
What happens if a pre-existing condition is discovered after I sign a private policy?
With health insurance in Spain, private insurers may review your medical history after enrollment.
If they determine a condition existed before the policy started, they may exclude related treatments or deny coverage, even if the issue appears unrelated.
Several community members reported exclusions applied broadly once a prior surgery or condition was identified.
Is a medical questionnaire always required when applying for health insurance in Spain?
Yes, a medical questionnaire is standard for private health insurance in Spain.
However, some members shared that brokers completed or submitted questionnaires on their behalf without clearly explaining them.
This can later lead to disputes if insurers claim information was withheld.
Can an insurance company deny coverage if the broker filled in the questionnaire incorrectly?
According to experiences shared, insurers may still deny coverage even if the error came from the broker.
That said, some members believe appeals are possible, especially if exclusions were not clearly explained or acknowledged.
Keeping written communication and copies of all documents was considered essential.
Are all treatments related to a past surgery automatically excluded?
Many members reported that insurers apply exclusions very broadly.
For example, a surgery in one area of the spine may result in exclusions for all spinal issues, even in different areas.
This approach was described as common in private health insurance in Spain.
Do private insurers in Spain cover preventive tests like colonoscopies or PAP smears?
Several members stated that some private insurers do not cover preventive or screening tests.
They explained that certain companies only approve procedures once a medical problem already exists.
This can come as a surprise to expats used to preventive care being standard.
Is public healthcare in Spain different when it comes to pre-existing conditions?
Yes. Community members consistently noted that public healthcare in Spain covers pre-existing conditions.
This is why some expats plan to apply for the convenio especial once eligible.
Public coverage was seen as more comprehensive for long-term or chronic conditions.
Can I appeal a denial from my health insurance provider in Spain?
Yes, appealing is possible and was encouraged by several members.
Some reported success when they could show that exclusions were not properly disclosed or that diagnoses were incorrect.
Appeals may involve doctors’ reports, corrected diagnoses, and documentation of how the policy was sold.
Is switching insurance companies an option after a denial?
Some members were able to switch insurers after a denial, though acceptance was not guaranteed.
In certain cases, an auditor reviewed medical history before approving coverage.
Switching providers may help, but outcomes vary depending on medical history and insurer policies.
What is the main lesson expats shared about health insurance in Spain?
The most common advice was to read every document carefully before signing.
Completing medical questionnaires personally and understanding exclusions upfront was seen as critical.
This can help avoid unpleasant surprises when using health insurance in Spain later on.
