Direct Billing or Pay First and Claim Later? Confirm Costs and Documents Before Seeking Care in China

Before traveling to China for medical care, have your policy and the hospital’s estimate ready, and ask both your insurer and the hospital whether direct billing is available for this visit. With direct billing, the insurer settles eligible costs with the hospital under their agreement. With reimbursement, you pay first and then submit a claim. Both options require you to check coverage, and both may involve costs you must pay yourself.

Key Points

• A hospital being in your insurance network does not mean that every campus, service channel, or treatment can offer direct billing under your policy. Ask both parties to confirm this appointment.
• Preauthorization, a guarantee of payment, and the hospital receiving and accepting the direct billing arrangement are separate steps. Confirm the approved scope, validity period, and any costs you must still pay.
• Paying first and claiming later may also require prior approval. Until the expected reimbursement amount and payment date are confirmed, plan your funds around the amount you may need to pay upfront.
• Keep itemized bills, official receipts, payment records, and insurance settlement statements. If both you and the insurer pay the hospital, promptly check the balance and any refund.

Compare How Much Money You Need to Prepare

What to compare	Direct billing	Pay first and claim later
Payment process	The insurer settles costs covered by the agreement with the hospital; you pay your share as the hospital requires	You pay the hospital first, then submit a claim to the insurer
What you may need to pay upfront	Deductibles, copayments, excluded items, deposits, or other amounts, as confirmed by both parties	You may need to cover hospital costs for the entire treatment period, plus travel and living expenses
Providers and authorization	Confirm that the specific provider and service channel accept direct billing under this policy, and obtain any required authorization	Whether costs at your chosen provider can be reimbursed still depends on the policy; some treatments also require preauthorization
Main waiting periods	The payment guarantee, hospital confirmation, and final reconciliation	Gathering documents, the insurer’s review, and funds reaching your bank account

Ask the insurer to confirm in writing whether your policy covers planned treatment for which you travel specifically to China, preexisting conditions, and related complications. Check the coverage period, waiting periods, and conditions if treatment is postponed; coverage differs between products. Ask the hospital to list advance payments, possible additional charges, and settlement dates by payment stage. Ask the insurer about deductibles, coinsurance percentages, limits for individual services, exclusions, and remaining benefits. A deductible is the portion you pay first under your policy’s rules. Your contract determines the coinsurance percentage, the period over which it is calculated, and the order of calculation. Ask whether deposits can be applied to the bill, when they will be refunded, and to whom. Also ask the insurer whether you must submit documents for a deductible already paid to the hospital to count toward the cumulative amount specified in your policy.

List the amount due at each stage, reserve funds for medical expenses, and accommodation and transport costs. Compare these with the funds you can access at that time. List unconfirmed insurance payments and unknown additional costs separately; do not treat them as money already received or as zero. If the estimate has no definite upper limit, ask the hospital which items could increase the cost and how they are priced, and discuss possible treatment changes with the doctor. If you cannot cover the upfront costs, discuss backup arrangements with the hospital and insurer before making nonurgent arrangements.

If you are still comparing estimates from two hospitals, first align them by treatment scope, quantities, and currency, then work out the payment timing for each. EastMedGo’s Services and Fees page explains that medical costs, coordination, and optional services are confirmed separately. Ask the insurer separately whether each is eligible for reimbursement.

Confirm Direct Billing for This Appointment

Send the insurer or its claims administrator your policy number, the patient’s name, planned appointment date, treatment or test name, and the hospital’s billing entity, campus, department, and standard, special-service, or international care channel. Ask whether outpatient care, inpatient care, pharmacy services, tests sent to outside laboratories, and doctors who bill separately are each included. Use secure channels approved by the insurer to send personal information and medical records.

Ask the insurer to confirm in writing whether the care is covered, whether preauthorization or a referral is required, how to apply, and whether it will issue a guarantee of payment to the hospital for this treatment. Once approved, check the patient, hospital, services, dates, payment limit or other restrictions, your share of the costs, and the expiry date. Ask who must request an amendment if treatment changes, and what may happen if the final review approves less than expected. If the approved scope is unclear, ask the insurer to explain; do not assume the guaranteed amount is the final benefit payment.[1][2]

Then contact the hospital’s insurance or billing department with your appointment details and authorization number. Ask it to confirm that it has received and accepted the direct billing arrangement for this patient and service, and to provide written details of the identification documents to bring, amounts payable on site, and a contact person. The insurer saying it has sent the documents does not mean the hospital has completed the arrangements for this appointment. You can ask:

I have booked a service at your hospital’s specified campus and department. My insurer has provided an authorization number or guarantee of payment. Please confirm whether you have received and accepted direct billing for this visit, which costs I must pay on site, whether a deposit is required, and whom I should contact if the treatment plan or date changes.

What to Do If the Guarantee Is Delayed or Treatment Changes

Before departure or nonurgent treatment, record the contact details of the insurer’s case handler and the hospital’s billing contact, when they will respond, and any amount you must pay in the meantime. If the guarantee is delayed, patient details cannot be matched, the approved amount is insufficient, or services change, ask the insurer and hospital to check directly with each other. Ask when to expect a response and whether additional documents or updated approval are needed.

If you switch to paying first, ask the hospital what receipts it will issue and how the payment will be credited or refunded. Also ask the insurer whether you can claim reimbursement for that expense. If the insurer later pays the hospital too, ask both parties to reconcile the transaction records and confirm who will initiate the refund, who will receive it, when it will be processed, and whether any receipts need correcting. For additional nonurgent services, try to ask the doctor about the clinical plan first, then ask about costs and authorization. In an emergency, receive necessary care first and notify the insurer as soon as possible under your policy’s requirements. Confirm the specific deadlines in your policy.[2]

Pay First and Claim Later: Ask About Documents Before Paying, Then Follow Up

Ask the insurer for the claims checklist and deadlines that apply to your policy. Confirm preauthorization and referral requirements, submission channels, accepted languages, translation requirements, whether electronic receipts or originals are required or accepted, and payee and bank details. Ask the hospital when documents will be available and how to collect them. Common documents include:

• Policy and identity information, a claim form, and any required authorization or referral documents;
• The doctor’s diagnosis or treatment records, discharge summary, prescriptions, or procedure records, as required by the insurer;
• An itemized bill, official payment receipts, proof of payment, and any refund or correction records.

For example, Allianz Care states that relevant claims may require a diagnosis, invoices, and supporting documents. Its page also notes that treatment in China may require a tax invoice. Policies and receipt requirements differ, so ask the insurer to confirm the specific documents it will accept before you pay.[3]

After submitting your claim, keep copies of the documents, the submission receipt, and the claim number. Follow up on receipt, requests for additional documents, the review outcome, and the actual payment into your account. Once you receive the settlement statement, check each item’s eligible amount, deductible, cost sharing, limits, exclusions, and exchange rate. If anything is unclear, ask the insurer to explain the policy terms, appeal process, and deadlines. If the amount credited to your bank account differs from the notice, also ask the bank about fees or the transfer’s status.

Reconcile the Hospital’s, Insurer’s, and Your Records After Leaving

Ask the hospital for the final itemized bill, amounts you have paid and deposits applied, the status of insurance claims or payments, any outstanding balance, and refund records. Ask separately whether any bills remain from outside laboratories or pharmacies. Record the payments and refunds for each charge together:

Item / date	Hospital charge	Paid by patient	Insurer paid to hospital	Hospital refund	Insurer reimbursed patient	Items to check
Example: this examination	To complete	To complete	To complete	To complete	To complete	Transaction numbers, contacts, and response times

Use the amounts and currencies shown on the supporting documents. If both you and the insurer have paid the same charge, provide both transaction numbers and ask the hospital’s billing department and insurer to reconcile them. Do not assume a refund has been completed. Keep the original receipts and correction documents until any refund or additional payment has reached the recipient’s account and matches the settlement statement.

Check Once Before Discharge and Track Each Difference

If you know your expected discharge date, contact the hospital’s billing department in advance. Ask which charges have been posted, which tests or outside services will be billed later, and when you can expect the final itemized bill. Compare the insurer’s latest authorization with the hospital’s actual charges, item by item: do the service names, quantities, unit prices, service dates, and currencies match? For any difference, record the specific item, amount, person handling it, response date, and next step. Do not enter zero for amounts that are still uncertain. If treatment changes, ask the doctor to explain the clinical need, then ask the hospital and insurer to explain the costs and coverage respectively.

Keep deposit or advance-payment receipts, itemized bills, final settlement statements, official payment receipts, and refund records separately: they document different stages. If the hospital provides electronic receipts, ask how to obtain a verifiable electronic original. Confirm with the insurer whether the receipt, its language, and the other documents meet claim requirements.[5] Before making a payment or receiving a refund, use the hospital’s publicly listed official contact details to verify the receiving entity, account, and refund route. Ask what proof is needed if the person paying is not the patient.

If any bills, refunds, or claims remain pending after you return home, keep the related documents and correspondence, and record the contact person and next follow-up date. Confirm document-retention periods and appeal deadlines with the insurer and any other organization that needs the receipts. After receiving a refund, check the amount credited, currency, and original transaction, then ask the hospital to confirm whether any balance remains.

Frequently Asked Questions

If the hospital’s name is on my insurance card, can I use direct billing?

First confirm the specific campus, billing entity, department, service channel, and treatment for this visit. Then ask the hospital to confirm that it accepts your policy and guarantee arrangements. Network lists may change.

If I already have preauthorization, do I still need a guarantee of payment?

This depends on the insurer’s and hospital’s procedures. Ask the insurer whether its approval includes a direct billing guarantee, then ask the hospital to confirm that it has received and accepted it. Keep the authorization number and details of what it covers.

Why does the hospital still require a deposit if I have direct billing?

The hospital may require an advance payment for your share of the costs or for charges that are not yet confirmed. Ask what the amount is for and how it will be applied or refunded. Calling it a deposit does not, by itself, tell you how much you will ultimately have to pay.

Can I choose any hospital if I pay first and claim later?

Not necessarily. Your policy may restrict locations, providers, services, or the percentage it pays, or require preauthorization. Before choosing a hospital, ask the insurer to confirm in writing based on this treatment.

What if my condition or treatment plan changes?

Ask the doctor to explain the change and its urgency, have the hospital update the costs, and contact the insurer to confirm whether the authorization needs amending. Do not assume the original guarantee automatically covers additional services. In an emergency, receive care first.

Who should I contact if the insurer denies my claim or pays less?

First ask the insurer for an itemized explanation of the settlement, the applicable policy terms, and the deadlines for review or appeal. Check the charges and any additional medical records needed with the hospital. If a hospital balance remains, ask when it is due and how it will be handled, and keep both parties’ responses.

What if the insurer says it has paid, but the hospital is still asking me to pay?

Ask the insurer for the payment amount, date, and transaction number, and give these to the hospital’s billing department to check against the relevant bill and remaining balance. Also provide proof of any payments you have made. While the accounts remain unresolved, record both parties’ contacts and the next response time.

Sources

Date checked: 2026-11-06. The following are examples of insurers’ published procedures and do not represent all products or individual policies.

1. Allianz Care: Direct Settlement Process for Healthcare Providers: Eligible costs, guarantees of payment, and the patient’s share.

2. Allianz Care: Preauthorization Process: Treatments requiring preauthorization, emergencies, and possible consequences; rules vary for some products.

3. Allianz Care: Claims FAQs: Claim documents, Chinese tax invoices, and certain payment rules.

4. Cigna Healthcare: Global Health Plan Policy Rules, 2026: Examples of direct billing, deductibles, and proof of payment for a specific product.

5. Ministry of Finance, National Health Commission, and National Healthcare Security Administration: Comprehensive Reform of Electronic Medical Payment Receipt Management: Verification and archiving of electronic medical payment receipts; confirm receipt types and acceptable formats with the billing provider and insurer.