Once you have found a doctor in your network, the next question expats often ask is: why can I book this appointment straight away, but not that scan? The answer is authorisation. It is one of the most practical parts of using private health insurance in Spain, and understanding it in advance saves both time and money.
In short, some care can be booked directly, while tests, scans, procedures and hospital treatment often need the insurer to approve them first. This guide explains what authorisation means, why it exists, which treatments usually need it, and exactly what to do before you book — so you are never left with a bill you did not expect. It follows on naturally from our guide to the cuadro médico, because finding a covered doctor and getting a treatment authorised are two separate steps.
Contents
- What authorisation means
- Why authorisation exists
- Seeing a specialist vs getting a test or procedure approved
- Which treatments often need authorisation
- Why the doctor’s prescription or report matters
- What documents the insurer may request
- Why you should not book or pay before checking
- Authorisation in urgent and emergency situations
- How authorisation connects to the cuadro médico
- How authorisation differs from reimbursement or pay-first policies
- What expats should do before treatment: a quick checklist
- How long does authorisation usually take?
- What families, retirees and visa applicants should know
- How 247 Expat Insurance helps
- Frequently asked questions
What authorisation means
Authorisation — in Spanish, autorización — is the insurer’s approval for a specific test, procedure or hospital treatment before it goes ahead. Rather than simply turning up and having the treatment, you (or your doctor) ask the insurer to confirm in advance that it will be covered. Once approved, the provider can be paid directly under your policy. The important principle to remember is simple: the insurer decides whether authorisation is required and whether the treatment is covered under the policy terms.
Why authorisation exists
Authorisation is a normal part of how private health insurance works, in Spain and elsewhere. It lets the insurer confirm that a treatment is covered by your policy and appropriate before the cost is committed, which keeps the system running smoothly and helps keep premiums reasonable. For you, it also brings certainty: once a treatment is authorised, you have clearer confirmation that it is covered under the policy terms, which helps reduce the risk of surprises afterwards. It is a check, not an obstacle — and knowing how it works turns it into a quick step rather than a stressful one.
Seeing a specialist vs getting a test or procedure approved
It helps to separate two things that often get confused. Seeing a doctor and having a treatment authorised are not the same step. In most cases you can book a consultation with a GP or an in-network specialist directly. What may then need approval is the next stage — the scan the specialist orders, the procedure they recommend, or the hospital admission they arrange. So a typical journey is: book the specialist, attend the appointment, receive their report, submit for authorisation, and then book the test or treatment.
Which treatments often need authorisation
It varies by insurer and by policy, but the categories that commonly need approval are fairly consistent. The table below gives a general picture — always check your own policy terms.
| Usually can be booked directly | Usually needs authorisation first |
|---|---|
| GP / general practitioner appointments | MRI and CT scans |
| Many in-network specialist consultations | Surgery and planned operations |
| Basic X-rays and simple tests (often) | Hospital admission and inpatient stays |
| Routine check-ups | Courses of physiotherapy or rehabilitation |
| — | Advanced diagnostics and higher-cost tests |
Ultrasound sits somewhere in the middle: some policies cover it directly and others ask for authorisation, so it is worth checking. When in doubt, assume anything beyond a standard consultation may need approval, and confirm before booking.
Why the doctor’s prescription or report matters
Authorisation is normally set in motion by a medical document — the specialist’s report, referral or prescription explaining why the treatment is needed. Without it, the insurer has nothing to assess. The report is the basis for the decision, and the insurer decides whether authorisation is required and whether the treatment is covered under the policy terms. This is also why it is worth asking your doctor for a clear report at the appointment, rather than having to go back for one later.
What documents the insurer may request
- The prescribing doctor’s report, referral or prescription.
- The name of the treatment or procedure and the provider who will carry it out.
- Sometimes supporting test results or relevant clinical history.
Your insurer will tell you exactly what is needed for your policy. If any of it is in Spanish and you are not sure what is being asked for, this is a good moment to get help understanding the request — more on that below.
Why you should not book or pay before checking
It is tempting to schedule a scan or procedure straight away, especially if you are anxious to get it done. But if you pay before authorisation is granted, you may not be able to recover the cost. The insurer approves the treatment in advance — not a bill you have already settled. A few minutes spent confirming authorisation first can save a significant amount later.
What can go wrong if you pay first
The most common problem is simple: a client books and pays for a private scan or procedure, then submits the receipt expecting to be reimbursed, only to find that without prior authorisation the cost is not covered. Getting the approval in place first avoids that entirely. If you are ever unsure whether something needs authorisation, treat that as a reason to check, not a reason to skip it.
Authorisation in urgent and emergency situations
Emergencies are treated differently from planned care. In a genuine emergency, seek urgent medical help first — do not delay care to arrange paperwork or check a directory. Afterwards, contact your insurer or their assistance number as soon as you reasonably can, so any follow-up treatment is handled correctly. Because you cannot plan an emergency, the best preparation is to know your details in advance: your policy number, your insurer’s emergency or assistance number, and your nearest listed hospital.
How authorisation connects to the cuadro médico
Authorisation and the cuadro médico are two separate checks, and it is easy to assume one covers the other. Being treated by a provider inside your network means the insurer can settle the cost directly — but the specific treatment may still need authorisation. In other words, using an in-network hospital does not automatically mean a scan or operation there is pre-approved. Check both: that the provider is listed, and that the treatment is authorised.
How authorisation differs from reimbursement or pay-first policies
On a standard Spanish network policy, authorisation is about getting approval before treatment so the insurer can pay the provider directly. That is different from a reimbursement or “pay-first” policy, where you pay the provider yourself and claim the money back afterwards. With reimbursement cover, an unauthorised or uncovered treatment can leave you out of pocket while a claim is assessed. Understanding which model your policy uses — and how authorisation fits into it — helps you avoid surprises with larger bills.
What expats should do before treatment: a quick checklist
- Get the report. Ask your doctor for a clear report or prescription for the recommended test or treatment.
- Check if authorisation is needed. If it is anything beyond a standard consultation, assume it might, and confirm with your insurer.
- Submit for authorisation. Provide the report and the provider’s details as your insurer requires.
- Wait for approval. Do not book or pay until you have it.
- Then book the treatment with a provider in your network.
How long does authorisation usually take?
How long authorisation takes varies by insurer and by the type of treatment, so it is not something that can be promised in advance. Straightforward requests are often handled quickly, while more complex treatments may take longer because the insurer may want to review the medical report in more detail. The practical lesson is to allow time. For planned, non-urgent treatment, start the authorisation process as soon as your doctor recommends it, rather than the day before you hope to have it done. If your situation is time-sensitive, say so when you contact your insurer, and keep the report and any supporting documents ready so there is no delay in submitting them. Building in a little breathing room means that an approval taking a few extra days does not disrupt your plans — and it is one more reason not to leave a scan or procedure to the last minute.
What families, retirees and visa applicants should know
Families
With children, tests and referrals can come up at short notice. Knowing the authorisation process in advance means you are not learning it during a stressful moment. Keep the insurer’s contact details and your policy numbers somewhere easy to find.
Retirees
Older policyholders tend to use diagnostics, specialists and planned procedures more often, so authorisation comes up more frequently. It is worth being comfortable with the process and keeping reports and approvals organised.
Visa applicants
Many visa-suitable policies are ordinary private policies, so once you are living in Spain the same authorisation rules apply. The application itself is about the policy meeting the usual visa insurance requirements and giving full private cover in Spain; authorisation is about how you use that cover afterwards. For the Digital Nomad Visa, some applicants may instead use Spanish Social Security registration or a certificate-of-coverage route depending on their employment and application circumstances, so it is worth checking what applies to you. You can read more on our visa health insurance and student visa health insurance pages.
How 247 Expat Insurance helps
Understanding an authorisation request in a second language is exactly where a bit of guidance helps. 247 Expat Insurance explains how your policy’s authorisation process works in plain English, and helps you understand what the insurer is asking for and why. We do not make medical decisions and we do not approve treatment — that stays between you, your doctor and the insurer, who decides whether authorisation is required and whether the treatment is covered under the policy terms. What we can do is make the process clearer, so you know what to do before you book. You can see how we help across cover types on our pages for expat health insurance and private health insurance.
Frequently asked questions
What does authorisation mean in Spanish health insurance?
Authorisation, or autorización, is the insurer’s approval for a specific test, procedure or hospital treatment before it goes ahead. Routine appointments can often be booked directly, but many higher-cost or planned treatments need approval first. The insurer decides whether authorisation is required and whether the treatment is covered under the policy terms.
Do I need authorisation to see a doctor?
Usually not for a standard appointment with a GP or many in-network specialists, which you can normally book directly. Authorisation tends to apply to tests, scans, procedures and hospital treatment rather than the consultation itself.
Which treatments usually need authorisation?
Commonly imaging such as MRI and CT scans, surgery, hospital admission, courses of physiotherapy and advanced diagnostics. It varies by insurer and policy, so it is best to check your terms or ask before booking.
Does an MRI or CT scan need authorisation?
Often, yes. Imaging beyond a basic X-ray is frequently subject to authorisation, usually requested on the back of a specialist’s report. Check before booking so the cost is covered.
Why does the insurer ask for a medical report?
The report or prescription explains why the treatment is needed, which is what the insurer reviews. The insurer decides whether authorisation is required and whether the treatment is covered under the policy terms, and the report is the basis for that decision.
Can I book treatment before authorisation is approved?
It is safer to wait. If you book and pay before approval, you may not be able to recover the cost. Get the authorisation first, then book the treatment.
What happens if I pay first without authorisation?
You may not be reimbursed, because the insurer approves the treatment in advance rather than a bill you have already paid. Checking and getting approval first helps reduce that risk.
Is authorisation the same as being in the cuadro médico?
No. The cuadro médico is the network of covered providers, while authorisation is separate approval for specific treatments. A provider can be in your network and the treatment can still need authorisation.
What should I do in an emergency?
In a genuine emergency, seek urgent medical help first. Afterwards, contact your insurer or their assistance number as soon as you reasonably can, so any follow-up is handled correctly. Do not delay urgent care to sort out paperwork.
Do visa health insurance policies require authorisation?
Many visa-suitable policies are ordinary private policies, so the same authorisation rules apply once you are using the cover. The application itself is about the policy meeting the usual visa insurance requirements; authorisation is about how you use the policy afterwards. For the Digital Nomad Visa, some applicants may instead use Spanish Social Security registration or a certificate-of-coverage route depending on their employment and application circumstances.
Can authorisation be refused?
Yes. The insurer decides whether authorisation is required and whether the treatment is covered under the policy terms, so approval is not guaranteed. If it is declined, ask the insurer for the reason and what options you have.
How can 247 Expat Insurance help me understand the authorisation process?
247 Expat Insurance explains how your policy’s authorisation process works in plain English and helps you understand what the insurer is asking for. We do not make medical decisions or approve treatment; that stays between you, your doctor and the insurer.
Questions about how your Spanish policy works?
247 Expat Insurance explains authorisation, medical networks and certificates in plain English — before and after you buy.
Get a Quote Contact UsRelated reading: What is a cuadro médico · Understand your policy before you need it · English-speaking agent · Reimbursement / pay-first health insurance · Arrange cover before your visa appointment · Health insurance exclusions · Switching without losing cover · Is the cheapest policy always best? · Keeping UK or international cover · Copay vs no-copay health insurance · Private health insurance after residency · Private health insurance