Name the payment route
Preauthorization is the insurer’s review before care; direct billing or direct settlement means the provider and insurer arrange payment between them; reimbursement means the patient pays and later submits a claim. A facility’s willingness to send paperwork does not itself create coverage. Put the chosen route in writing.
Ask the insurer to identify the plan clause, service category, provider-network rule, deductible or co-insurance, currency, claim deadline, and required clinical or administrative documents. Ask the facility which team receives the guarantee or approval and whether it still asks for a deposit or patient share.
Preauthorization is a handoff
Send the insurer a concise request with the facility’s legal name, location, proposed dates, service description supplied by the facility, estimate or scope, and relevant policy identifiers. Ask for a case number, approval status, approved scope, validity dates, limits, exclusions, and next contact. Cigna states that precertification may be required and does not guarantee payment of every billed service.
Forward the insurer’s written response to the facility through an agreed secure channel, then ask the facility to confirm receipt and any mismatch. If the facility changes scope, dates, or provider, pause and ask whether the insurer must review again. Never treat a coordinator’s paraphrase as the insurer’s authorization.
Direct billing needs two yeses
Direct billing usually needs agreement from both payer and provider, plus a usable guarantee or approval. Bupa Global says direct settlement may depend on network status and that out-of-network preauthorization may still leave a shortfall. Ask who pays which component, how patient cost-sharing is collected, and what happens if direct billing fails.
Request a written fallback: deposit amount or method, invoice format, claim form, proof-of-payment standard, translation requirement, and submission address. Confirm whether the facility can issue the invoice in the patient’s name and whether it can provide itemised records after discharge. Keep the approved document and the fallback together.
If you must pay and claim
Before paying, ask the insurer whether reimbursement is possible for care in China, whether preauthorization is still required, and whether the plan limits out-of-network or foreign-currency claims. Ask which original documents are needed: invoice, receipt, medical report, prescription or referral, proof of payment, identity, and bank details.
Mark every document with the claim number and date, while keeping an untouched original. Ask the insurer to confirm the submission channel and deadline. European Union guidance on cross-border care describes prior authorization and reimbursement within EU systems; that is jurisdiction-specific and does not extend to treatment in China or to private plans.
Close the loop after discharge
Ask the facility for the final itemised bill, payment receipt, discharge or service summary, and any correction contact. Ask the insurer whether the claim is complete, what amount is admissible, what patient share remains, and how to appeal or query a shortfall under the policy. Keep the facility and insurer correspondence in one timeline.
ChinaCareAccess can prepare a minimum insurer-and-facility information pack. Wait for the payer and facility to confirm their respective parts before booking around the payment route.
