How do expat patients get a guarantee of payment for treatment

We often get asked about medical networks for the global health insurance providers we work with and how to obtain a guarantee of payment for a hospital claim. Unfortunately, when living abroad as an international citizen or expat, you may become ill or injured and require immediate medical attention at a hospital or urgent clinic.

Many hospitals are inside the medical network, and these facilities should accept your medical card and allow for near-instant approval of most urgent procedures, but global networks only go so far.

In many countries, the hospital may be outside the medical network or may not want to deal with an insurer, so you must request a Guarantee of Payment from the insurer.

What is a Guarantee of Payment?

A guarantee of payment is often referred to as a GOP or a guarantee letter. Such a letter to the hospital where an expat is seeking treatment confirms to the patient’s medical provider that their global health insurer will pay the claim. Hospitals don’t want to arrange a medical procedure unless they know they are going to get paid.

Using a Guarantee of Payment allows doctors and hospitals outside the insurer’s network to verify your coverage, eligibility and confirm benefits before you receive care. These arrangements either via a GOP letter or medical network help the insurer manage costs and allow for appropriate medical care with direct payment to the facilities.

What about Direct Billing Arrangements for Global Medical Providers

As per previous articles on the subject, many global health providers have large medical networks where they have direct billing arrangements. This means that instead of the patient settling the bill upfront, providers often have direct billing arrangements with insurers. This means that after the treatment, the insurer directly pays the provider according to the agreed terms after you show your card. It still makes sense to contact your international healthcare claims department in advance because:

The insurer may provide you with a second medical opinion
The global health provider may recommend a different procedure or hospital. Many expat insurers have checked hospitals for quality care in advance

How Do You Obtain a Guarantee of Payment for a Hospital Claim Abroad?

To request a GOP, the team requires supporting documentation to support medical necessity.

Patient name, date of birth
Policy number
Hospital name, phone, email and fax
Letter of medical necessity from the doctor to include the diagnosis
Patient’s history & physical findings, along with the diagnosis
Date of Service
Admitting doctor and or counsellor
Laboratory or radiology results, if applicable
Office notes describing services rendered on each date of service
Cost estimate with a breakdown – note that if a cost estimate is not received, the insurer may issue a Verification of Benefits (VOD) instead of a GOP. This means that no GOP is granted, and only coverage and benefits are approved.

The bottom line is that the more information, the better. In most cases, if the appropriate information is provided, most expat insurance companies can grant a GOP in a few hours.

Most expat insurance providers need written confirmation or a letter from the hospital guaranteeing that the expat patient will be received without any restriction and will ultimately get surgery as programmed.

Most global insurance carriers will not standardly grant a Guarantee of Payment without any restrictions. This is asking for an unconditional payment of any services received. To clarify, if services are needed outside the approval of an initial GOP, the hospital can submit updated bedside notes and medical documentation to extend the GOP. In one case we had to advocate on, the hospital did not want to be involved in these processes, which is likely why they refused a wire payment for the service upfront from the insurer.

Obtaining GOP Confirmations Before Planned Treatment

It is important that an expat patient obtains their guarantee of payment as soon as possible, especially in situation where you are getting a planned procedure or day surgery for example. We recommend you get the letter for authorization of medical produres at least 2 days before treatment. Some insurance companies will charge a fee if planned surgeries and treatment at a hospital are not pre-certified. Without a confirmation of coverage, some hospitals may charge a large hefty deposit or place an authorization on the patient’s credit card.

What If the Hospital Won’t Accept a Guarantee of Payment?

Without the appropriate documentation, the insurer’s medical team will not issue the GOP letter. The hospital will not accept the GOP letter as it will not show unrestricted coverage. In some circumstances, In my experience with this hospital, they will charge you upfront for the service. In addition, you may be challenged to promptly retrieve the correct final invoice with the mandatory symbol, which could significantly delay your reimbursement.

We should also note that these administration departments at hospitals are for doctors/hospitals, and typically, they do not respond to patients, so you will not receive a response. The congestion of multiple departments involved can also delay turnaround times.

If you are providing additional information, you can attach it to an email through the “contact us” feature in your insurer’s client management portal, then call their customer service center and advise of the urgency of the matter.

We should note that if you are unable to get a payment guarantee, you may need to pay the hospital and then submit the claim to get reimbursed by the insurer. Some hospitals simply don’t want to deal with an insurance company and want cash or payment upfront or for some reason may not like your insurance company because of past payment issues.

Why Do Expat Insurance Companies Decline to Issue a GOP?

We should emphasize that Guarantees of Payment are subject to the insurance contract that you have established but also the complex nature of the patient’s treatment or the hospital you are at. Here are a few reasons why a GOP letter won’t be issued:

Your coverage is not active because of non-payment of premium
You have an exclusion in your policy for the procedure you are obtaining
The claim will fall under the policy deductible
You have reached your policy maximum already for the policy year
The procedure is not covered, or maybe experimental
You are obtaining medically unnecessary treatment or maybe cosmetic surgery

I should note that additional reasons are not listed, as every contract and situation differs. We are experienced and knowledgeable expat insurance specialists who can advocate on your behalf if you are experiencing a medical claims dispute or difficulty.

Some Final Notes on the Guarantee of Medical Payments Abroad

Note that every insurer and policy is different and often has different coverage levels and procedures. Make sure you read the fine print and ask how you can claim inside and outside the network. These payment guarantees are a crucial element in international medical care. Insurers are businesses, and these procedures balance the needs of healthcare providers for financial security with the rights of expatriates to obtain timely and effective medical treatment.

Remember, if you are seriously injured or that you believe that your illness is life-threatening, please get immediate medical care.

Written By: David Tompkins – A highly experienced global insurance expert with over 30 years in the insurance industry. David has written extensively on global healthcare topics related to individual ex-pats and expat employer-based group plans.