Authorisations are a guarantee of cover. These referrals are necessary for tests or treatments which have a high cost or that have some kind of limitation. In this way, both the insured and the medical centre have proof that the test or treatment is covered by us before it is carried out.
In the General Conditions document that we send with your policy, you will find the services that require authorisation. In general, this applies to complex diagnostic tests, treatments and hospital admissions. Usually the consultant will tell you if the test requires prior authorisation. If in doubt contact customer services on 91 290 80 75.
You are required to have your insurance card and doctor’s note which indicates the necessary data. In some cases, it is also required to also provide the exact date and location where the test or service will be carried out, as in the case of hospital admissions, surgical operations and out-patient tests.
When requesting authorisation via the Private Login, it will be necessary to attach a photograph of the doctor’s note.
Yes, always. If the admission is an emergency, it can be authorised in the following 72 hours. If it is scheduled, it must be authorised before it takes place. This saves a lot of time and ensures the process is more seamless.
In most cases, it is sufficient to call our customer care team at 91 290 80 75. Remember you must have your insurance card and the doctor’s note ready.
The doctors on our medical team must always give you a note from Nueva Mutua Sanitaria. Currently if for any reason they do not have a note, they can write a prescription on their own stationery, stamp and sign it. However, in such cases, you will need to supply us with a photograph or scan of the document to email@example.com Once received we can issue the authorisation.
You must also send us the name and insured number of the patient and a contact telephone number. You can submit these details in the secure Private Login portal on the website.
The sooner you can make this request, the better. 90% of authorisations can be dealt with in real-time via a telephone call. However, if there is any issue comes up or if details are missing, up to 48 hours may be needed for the issue of the authorisation number.
In foreign countries, our authorisations are not valid. The cover that we have in these cases is a travel assistance policy which covers accidents or illnesses arising during the trip. For further details contact our 24/7 helpline (+34) 91 290 80 78.
During the qualification period, you do not have access to the benefits which require authorisation. For this reason, we cannot authorise services until you have qualified for cover.
Usually this applies to benefits which have a limitation. The possible limitations are always reflected in the general conditions of your policy. The report must reflect a reason which is in line with the cover contracted for to authorise the benefit.
E-mail is the most secure and effective way: firstname.lastname@example.org.
Once the report is e-mailed, how long will it take to receive a reply?
We respond within forty-eight working hours, although we always try to reply sooner.
It is advisable. From the moment that we issue an authorisation, it will be valid for of 30 days. If, for any reason, the conduct of the test or treatment is delayed, the authorisation may lapse. In these special circumstances you would have to reapply.
Nueva Mutua Sanitaria, in accordance with the provisions of the legislation currently in force, has a Customer Assistance Service (CAS) that all policyholders, insured persons, beneficiaries or successors of all of the foregoing may address to present any complaints and claims related with this Policy, for which purpose Nueva Mutua Sanitaria has available printed forms at its offices.
Complaints or claims, which must be made in writing, may be addressed to the CAS or to the Customer Ombudsman by any of the following means:
- Personally or by letter to Calle Villanueva, nº 14, cuarta planta, 28001 Madrid.
- By e-mail to the following address: email@example.com
- CUSTOMER OMBUDSMAN (D.A. DEFENSOR S.L.):
- Personally or by ordinary letter to Calle Velázquez 80, 1º, 28001 Madrid,
- By e-mail: firstname.lastname@example.org.
- Fax 913 084 991
In case of dissatisfaction with the response given by either of these bodies, or if you have not received a reply within the space of one month, you may make a claim or complaint to the Complaints Service of the General Directorate of Insurance and Pension Funds. For this purpose, you must accredit that the period of one month has passed from the date of presentation of the claim or complaint to the SAC or the Customer Ombudsman, without them having solved the problem, or that the claim or complaint has not been accepted or that it has been rejected totally or partially.
Without prejudice to the foregoing, interested parties can bring the actions that they consider appropriate before the ordinary courts.