Most of the time, you won't need to file a claim at all. Sanitas uses direct billing for network providers. But if you do need to claim, the process is straightforward, transparent, and fast. Learn everything here.
Sanitas health insurance works differently depending on where you seek care. Understanding these four claim types helps you make informed decisions about where and how to access healthcare.
Visit any Sanitas network provider, present your card, and walk out. Sanitas bills the provider directly. No paperwork, no upfront payment, no reimbursement needed. This is the standard way 85% of Sanitas members access care.
Visit a non-network provider or private clinic. Pay the full cost upfront, keep your receipts, then submit to Sanitas for reimbursement. You'll receive payment (typically 70-90% depending on your plan) within 5-10 business days.
If you require emergency care in Spain or abroad, call Sanitas immediately or seek treatment. Submit your claim within 48 hours if possible. Urgent claims are typically assessed and approved within 24-48 hours, with payment following standard timelines.
Covered for travel outside Spain depending on your plan. File claims from anywhere in the world via the Blua app or email. International claims may have different coverage limits and timelines—check your policy documentation.
Certain procedures (surgery, major tests, specialist referrals) require Sanitas pre-approval. Contact Sanitas before scheduling. Pre-authorization speeds up claims processing and ensures you know your out-of-pocket cost in advance.
Sanitas network GPs can refer you directly to specialists without separate claims. The referral system integrates with the claims process automatically. Your GP handles the coordination—you just book and attend.
Direct billing is how Sanitas healthcare works for most people, most of the time. Here's exactly what happens when you visit a network provider.
Direct billing eliminates friction from healthcare. You don't need to wait for reimbursement, calculate percentages, or chase paperwork. The system handles it automatically through Sanitas' integrated network. When you present your Sanitas card at a network provider, their system checks your eligibility and coverage in real-time. Everything is coordinated electronically, meaning no surprises, no complex paperwork, and no delays waiting for reimbursement checks. This is the preferred way Sanitas operates because it benefits everyone: patients get hassle-free care, providers get guaranteed payment, and Sanitas controls costs through contracted rates.
Sanitas has contracted rates with thousands of doctors, dentists, hospitals, and clinics across Spain. These providers agree to bill Sanitas directly in exchange for a steady patient stream and reliable payment. You benefit from negotiated prices—network providers typically charge less than private providers because Sanitas negotiates bulk rates. The provider handles all billing administration, you handle only your copay, and everyone benefits from the streamlined process.
Reimbursement claims happen when you visit a non-network provider or need care outside Sanitas contracted clinics. You pay the full cost upfront, then submit to Sanitas for reimbursement within 30 days of treatment.
Collect original receipts, medical documentation, and proof of payment. Organize clearly. Use Blua app to check exact document requirements for your claim type.
Easiest: Use Blua app—take photos of documents and submit instantly. Alternative: Email to expats@sanitas.es with policy number in subject line. Blua is faster because submission is tracked automatically.
Sanitas reviews your submission. They check: document completeness, clarity of evidence, coverage for the treatment, eligibility under your plan. You may receive request for additional info if documents are unclear.
If approved, Sanitas calculates your reimbursement based on your plan (typically 70-90% of eligible costs). If denied or requesting more info, Sanitas contacts you within 48 hours with explanation.
Approved amount transfers to the bank account on file with Sanitas. You receive email notification confirming payment processed. Typical timeline: 5-10 business days from approval to money in account.
The Blua app is Sanitas' complete digital platform for claims. Available on iOS and Android, it makes submitting and tracking claims as simple as taking a photo with your phone.
Download Blua from Apple App Store or Google Play. Launch the app and log in using your Sanitas policy credentials. First-time setup verifies your phone number with an SMS code.
The home screen shows your past claims and a prominent "File a New Claim" button. Tap it to start. You'll see a menu of claim types to choose from.
Choose from: Medical/Doctor Visit, Dental, Pharmacy, Hospital, or Other. Each type has specific document requirements shown on screen. This helps guide what you need to upload.
Fill in: date of treatment, provider name and location, amount paid, brief description of service. The app auto-fills your policy number and validates all entries in real-time.
Tap "Add Photos" to access your phone camera. Take clear, well-lit photos of: receipt/invoice, medical report, proof of payment. The app checks photo clarity automatically and guides you through the process.
Review all details and documents one final time. Check that photos are clear and all required info is complete. Once satisfied, tap "Submit Claim." You'll receive a confirmation number and expected processing timeline.
Return to Blua home screen. Tap your claim to see status updates: Submitted → Under Review → Approved → Paid. Status changes appear in real-time. You also get email and app notifications at each milestone.
Take photos of receipts immediately after receiving them. Blua stores all your documents in the app. Future claims are faster because Blua suggests what you need and remembers your provider information from past claims.
Download Blua from Apple App Store or Google Play Store. Uses your Sanitas policy number and password to log in. Works offline for uploading documents—syncs automatically when you have internet connection.
Blua works anywhere you have internet connection. File claims from Spain, abroad, or at any time—24/7 submission available. Sanitas processes claims during business hours (24 hour assessment standard), but you can check status anytime.
Sanitas is committed to processing claims quickly. Here are typical timelines for different claim types and scenarios.
Sanitas reviews submission completeness, checks document quality, and verifies coverage. Most straightforward claims get initial assessment within 24 hours.
Once assessed, approval typically takes 3-7 business days. Complex claims (surgery, major procedures) may take up to 10 days for full review and approval decision.
From approval to payment, expect 5-10 business days. Payment goes to the bank account on file with Sanitas. You receive email confirmation when money is transferred.
Complete, clear documents submitted same day as treatment. No missing information. Receipt and medical documentation crystal clear. Treatment is covered service under your plan with no waiting periods.
Hospital or surgical claims requiring additional medical review. Documents submitted 2-3 days after treatment. Sanitas needs to coordinate with hospital on itemized costs and coverage eligibility.
Emergency or time-sensitive claims can be expedited. Call Sanitas directly at their claims line (English-speaking support available) to request urgent processing. Urgent claims are typically reviewed within 24-48 hours instead of standard 3-5 days.
Sanitas coverage is comprehensive but has limits. Here are real-world scenarios showing what is and isn't typically covered, based on standard Sanitas plans.
Occasionally a claim is denied or you disagree with a decision. Sanitas has a formal appeals process to review disputed claims, and there's also an ombudsman if needed.
About 80% of denied claims are denied due to missing documents. Simply re-submit with the missing paperwork, and Sanitas will reconsider immediately without delay.
If denied, Sanitas must provide written explanation. Check your Blua account or email for the denial letter. Review the specific reason carefully—this guides your appeal.
If missing documents were the issue, collect them now. If disagreeing with coverage decision, gather medical evidence supporting why treatment should be covered under your plan.
Email Sanitas claims department with "APPEAL" in subject line, include claim number, written explanation of appeal, and new documents. Sanitas has 15-30 days to respond with decision.
If appeal is denied, you can file a complaint with Spain's Insurance Ombudsman (Defensor del Asegurado). This is free and independent of Sanitas.
As authorized Sanitas agents with years of experience, we support you throughout the claims process, from filing to follow-up.
We walk you through what documents are needed, how to organize them, and the best way to submit. We answer questions about what's covered and what isn't before you need to file.
We help you gather and organize all necessary documents, take clear photos of receipts and reports, and ensure nothing is missing. We spot-check your submission before you send it to Sanitas.
We track your claim status in Sanitas systems, chase up delays, and respond to any requests for additional info. You don't have to manage the back-and-forth with Sanitas yourself.
All communication in English. We translate documents if needed, represent you with Sanitas, and ensure language never becomes a barrier to getting your claim resolved.
If your claim is denied, we build the appeal case with you, gather supporting documents, and submit appeals formally to Sanitas. We handle escalation to ombudsman if needed.
You have a dedicated contact at Spanish Health Insurance for all claims questions. We respond within 24 hours and are available by email, phone, or WhatsApp.
Got questions about Sanitas claims? Here are answers to the most common questions we receive from clients.
Need help filing a claim? Have questions about what's covered? Our Sanitas specialists provide free, personalized support for all claims questions.
Our English-speaking Sanitas specialists are here to help. Get personalized claims support in 24 hours.