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.
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:
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.