Outside-network clinic: is keeping the invoice enough for reimbursement?

Identify the procedure, professional and location

Start with the actual proposed procedure and the provider who will perform it. Do not rely solely on the clinic’s trading name: ask for the professional and procedure to be checked against your policy. An administrative contact may confirm appointment availability without assessing your insurance.

Fictional example: Beatriz wants a planned examination at a clinic she has chosen. Reception confirms that it can issue an invoice. Beatriz separates that information from the question of insurance reimbursement and asks the insurance support service about the relevant procedure before assuming the expense. The example does not advise delaying urgent care.

Ask about authorisation before proceeding

ASISA’s FAQ treats outside-network reimbursement and preauthorisation as separate questions. It defines the latter by reference to procedures and contractual terms. This illustrates one operator’s process; it does not make that process identical across all policies.

Ask whether the proposed procedure needs preauthorisation, who submits the request and what response you should receive. If a response already exists, check the procedure, location and conditions to which it applies. Submission alone does not prove approval. If information is missing, ask what comes next through the appropriate channel.

Sources: ASISA — FAQ, reembolso fora da rede e pré-autorização; consultado 20/10/2026 ↗

Clarify the calculation before estimating payment

Ask how the policy treats the actual outside-network expense: calculation basis, percentage, limits, your own costs and required records, where applicable. Do not turn an example in a benefits table into a promise of payment. A clinic’s estimate and an expected reimbursement come from different parties.

Keep the response reference with the contractual version considered. If the date, procedure or provider changes, check whether the request must be updated. Do not choose healthcare solely through an insurance calculation; clinical decisions belong with the professionals responsible for your care.

Use the correct process channel

For an existing policy, contact the support service listed in your contract or your intermediary. To compare a new quotation in Portugal, read the Health guide on rmachado.group and select Saúde in the website request. Explain your objective; medical records and personal information should only use the appropriate channel indicated, never public comments.