Health Insurance Complaints and Rejected Claims in Spain

Short answer

Complain in writing to the insurer's customer service department (Servicio de Atención al Cliente) or its Defensor del Cliente first, and keep proof of the date. If it rejects you, or one month passes without an answer (two months if you are not a consumer), you can take the case free of charge to the DGSFP's complaints service. Its report is not binding, so if the insurer still refuses, the final step is court in the place where you live, normally within five years.

Key facts

You must complain to the insurer before the DGSFP will accept your case.
Consumers can escalate to the DGSFP after one month without a reply.
The DGSFP service is free, but its final report is not binding.
The DGSFP will not accept cases more than six years after the facts.
Court claims go to the insured person's home court; contrary clauses are void.

First, work out why it was refused

Ask for the refusal in writing, with the policy clause the insurer relies on. Most refusals fall into one of these groups, and the response is different for each:

Reason given	What to check
Not covered / excluded	The exclusion in the general conditions. Under article 3 of Ley 50/1980, clauses limiting your rights must be specially highlighted and specifically accepted in writing. If it was not, you have an argument.
Pre-existing condition	Whether the health questionnaire actually asked about it. Article 10 limits your duty to what the questionnaire asked.
Waiting period (carencia)	Your start date and the period for that service. Vital emergencies are not subject to waiting periods, as Mapfre notes.
No prior authorisation	Whether the service needed authorisation and whether it was an emergency.
Outside the network	Whether the policy has a reimbursement element and whether a network provider was available.
Missing documents	Simply supply them and ask for a fresh decision.

Before escalating, it is worth asking your doctor for a short report explaining medical necessity, or resubmitting a corrected authorisation request. See what private insurance doesn't cover and pre-existing conditions.

Never delay urgent treatment while you argue. Go to the nearest emergency department and deal with payment afterwards. See what your insurance does in an emergency.

Step 1: Complain formally to the insurer

The first formal step is the insurer's customer service department (Servicio or Departamento de Atención al Cliente) or, where it has one, its Defensor del Cliente (customer ombudsman). The DGSFP will not accept your case until you have been there. Contact details are in your policy conditions. Sanitas's general conditions, for example, direct complaints to its Departamento de Reclamaciones by post, fax or email at reclamaciones@sanitas.es, with a copy of your ID.

The DGSFP's guide recommends addressing the complaint explicitly to the customer service department or the Defensor. A message to a general customer helpline may not count.

Your letter should include:

Your name, NIE or passport number, and policy number
What happened, with dates
The clause the insurer relied on and why you think it does not apply
Supporting documents (refusal letter, medical reports, invoices)
What you want: authorisation, reimbursement of a specific amount, or reconsideration

Keep proof of the date

You will need to show the DGSFP when the insurer received your complaint. The DGSFP accepts:

burofax or registered post with acknowledgement of receipt (keep the letter, the signed receipt and the date)
email, but only with an acknowledgement showing the date and recipient
a copy of your letter stamped with the date by the insurer
an acknowledgement from the customer service department or Defensor
the insurer's written reply

Step 2: The DGSFP complaints service

The Dirección General de Seguros y Fondos de Pensiones (DGSFP) runs a free, out-of-court complaints service under Orden ECC/2502/2012. You can go to it when the insurer has rejected your complaint, or when the waiting period has passed without a resolution. That period is one month if you are a consumer, two months otherwise.

How to file

Online, with a digital certificate or other electronic signature, through the DGSFP sede electrónica
By post to Servicio de Reclamaciones de la DGSFP, Paseo de la Castellana 44, 28046 Madrid, using the downloadable forms or your own letter

Include your identification and postal address, the insurer's name, the type of insurance, a clear statement of the complaint, proof of your prior complaint, a list of documents, and a signed statement that the matter is not before a court, arbitrator or other authority. A phone line (952 24 99 82, weekdays 9:30 to 14:30) handles general questions only, not complaints.

The forms are in Spanish. If your Spanish is limited, write short factual sentences or attach a translation.

What happens next

The DGSFP checks the complaint is admissible and opens a file.
It sends your complaint to the insurer, which can respond with its arguments and must copy them to you.
You can reply in writing.
The DGSFP issues a final report to both sides.

The report is not binding and cannot be appealed. It is still a written, independent view you can put to the insurer or use in court, and filing the complaint suspends or interrupts limitation periods for your legal claims.

What the DGSFP will not handle

matters already before, or decided by, a court, arbitrator or other authority
facts that can only be proved in court
disputes over how much compensation or money is owed
disputes that need specialist expert assessment outside insurance-conduct rules
complaints filed more than six years after the facts

If your dispute is mainly about how much is owed, or turns on expert evidence, the DGSFP may decline it and court is the realistic route.

A bill to replace the DGSFP, Banco de España and CNMV complaints services with a single Autoridad de Defensa del Cliente Financiero has been going through parliament since 2024. Until it is in force, the DGSFP route described here applies.

Step 3: Arbitration or court

Consumer arbitration (Sistema Arbitral de Consumo) only works if the insurer has signed up to it. Sanitas's conditions state that it does not adhere to any consumer arbitration board, so check your own policy.

Court is the final step:

Where: the court of the insured person's home. Article 24 of Ley 50/1980 makes any contrary clause void.
Time limit: five years for claims under personal insurance contracts, including health insurance (article 23).
Before filing: since 3 April 2025, Ley Orgánica 1/2025 requires most civil claims to show that an out-of-court resolution was attempted first. For consumer financial disputes, a DGSFP resolution counts towards this, which is another reason to use the DGSFP route first.

For larger claims, get advice from a Spanish lawyer (abogado) who handles insurance disputes.

Cross-border policies

If your insurer is based in another EEA country (some international plans are), complain to it first. The DGSFP is part of FIN-NET, the EU network of financial dispute bodies, which can direct you to the right scheme in the insurer's home country. To check where an insurer is authorised, use the DGSFP register.

Complaints about a non-renewal or a premium rise follow the same route; see cancelling, renewing or switching for what the law allows.

Common questions

How long does a Spanish insurer have to answer a complaint?

Insurers' own rules often say two months; Sanitas's conditions, for example, promise a reasoned written decision within that period. For consumers, the DGSFP accepts a case once one month has passed without a reply.

Is the DGSFP decision binding on the insurer?

No. The DGSFP's final report is expressly not binding and cannot be appealed as an administrative act, but it gives you an independent written view to put to the insurer, and filing interrupts limitation periods.

Can I complain to the DGSFP in English?

The DGSFP's guidance and forms are in Spanish, so write in Spanish or attach a Spanish translation. Keep sentences short and stick to dates, policy clauses and what you want.

My insurance is with a company based in another EU country. Who handles my complaint?

Complain to the insurer first. The DGSFP takes part in FIN-NET, the EU network of financial dispute bodies, which can direct you to the scheme in the insurer's home country.

Sources

Written by Jon Grocott

Jon lives in Spain and runs this site independently. He isn't an insurer, broker or lawyer: every rule and figure is checked against the official or named source linked on the page. Spotted something out of date? Report a correction.

Complaints and Rejected Health Insurance Claims in Spain