Holidaymakers warned as Spain blocks EHIC usage Spain is not alone in blocking EHIC usage. Travellers in Greece and Portugal have also experienced problems. Both countries' health systems are under pressure following the crisis in public finances. But the Spanish health system is complex. It has state hospitals and private hospitals, and a third hybrid sector, which is run by private management but provides state-funded treatment. The EHIC card may not be accepted in private hospitals but should be valid in the other two categories. Problems of refusal have largely arisen in this third hybrid sector, where the card should be accepted. Worse still, the private managers are increasingly employing debt collectors to pursue outstanding bills after travellers have returned home. Ian Crowder of AA Insurance said: "Someone who falls ill, unfamiliar with the local systems, may well ask the hotel or a taxi driver to take them to the nearest outpatients department or whatever. We have learnt that hotel staff, taxi drivers and travel representatives may be taking backhanders from managers who operate part of the state-funded health-care system in Spain and from private hospitals and clinics so that they bring unwitting foreign tourists to them for treatment rather than take them to a state-run hospital. What's more, we understand these companies and hospitals are employing debt collectors in other EC countries to recover the cost of medical treatment that travellers were unable to pay for at the time, although we have heard of no instance where treatment has been refused if a patient has been unable to pay at the time. The Foreign and Commonwealth Office confirmed it has received complaints about UK citizens unable to use their EHIC cards in Spain, and has taken the matter up with the European Commission. It is in serious discussions with Spain and has warned the country that unless it stops blocking usage of the card, it could end with formal proceedings. Meanwhile, it warned travellers to be vigilant and to insist on treatment covered by public health-care finance. However, it points out that in some countries state health care may or may not be delivered in privately run hospitals, in which case it may depend on the rules of the system whether or not the EHIC card will be valid. This is the issue which is still to be resolved where the Spanish health-care system is concerned. All UK citizens can qualify for an EHIC card for free, which will allow them to enjoy the same medical treatment as the locals in EU countries plus Iceland, Liechtenstein, Norway and Switzerland. This does not mean they will receive universally free treatment as with the NHS. But they will be entitled to the same free or subsidised care that residents in those countries would receive. The Commission also points out that it does not necessarily mean you will not be asked to pay for treatment up front, if that is normal practice in the country where you are staying. If you do, the money should be claimed back from the NHS. The EHIC card has been seen as a good fallback for travellers who have not bought travel insurance, although the Association of British Travel Agents and the Foreign and Commonwealth Office both stress that it should not be considered an alternative to travel insurance. It will not, for example, pay for repatriation, or emergency recovery and other costs associated with an accident abroad. However, it can be invaluable for travellers with pre-existing medical conditions, which their insurers will not pay out on, or who are too old to buy cover in the open market at a reasonable cost. EHIC Plus, a low-cost policy which builds cover around the EHIC card, confirmed it had also received a number of complaints from customers whose card has been refused. A spokeswoman said: "We tell them that they must insist on it being used, because they are entitled to receive this treatment, which is paid for by the NHS. If in doubt we advise them to call the helpline number on their policy and the assistance company will help them resolve the issue. Eileen Dalrymple White of MIA Online, which specialises in insurance for patients with serious health complications who would struggle to qualify for a standard policy, said: "For our very sick patients, our cover is built around the EHIC card. But we always investigate where good cover will be freely available for them before they travel. For us, the question is quality of care. We wouldn't be advising very ill people to go to Greece at the moment, for example. Getting ill abroad can be an expensive business, ranging from a few hundred pounds for an overnight stay for a stomach upset to £12,000 for a heart attack. How do I get an EHIC card? The easiest way is online at one of the NHS EHIC websites or by telephoning 0300 3301350. You will need your National Insurance number. The whole process is easy and takes a couple of minutes. Be careful to use one of the official NHS sites, as there are a number of organisations which look official but charge a fee for the card. It is free and there is no need to pay anyone. What does an EHIC card cover? EHIC does not cover all medical treatment, only accidents, unexpected illness and some regularly required treatment for chronic conditions during short trips abroad. It does not cover treatment that can wait until the patient gets home. Nor does it provide cover if you are moving to work or study long-term in another country. Which treatment is free? You will pay the same as the nationals. For example, you will get free treatment in France, reimbursed up to around 70 per cent, up to a certain ceiling. What if something goes wrong? You can complain to the NHS and the Foreign and Commonwealth office on your return, or to the European Commission's SOLVIT service which can be reached at europa.eu/youreurope/citizens/help/index_en.htm - this is not a complaints procedure but will supply legal information concerning your rights, and support you should you make a complaint.