For planning only. A licensed clinician decides diagnosis and treatment. If symptoms may be urgent, use emergency services. Hospital access, fees, and insurance decisions come from the relevant organizations.
Three parties hold different pieces of the answer
The patient knows the policy and provides consent and documents. The hospital defines the medical service, estimate, dates, and billing route. The insurer interprets the plan, assesses medical and administrative requirements, and decides what it will authorize or reimburse. A complete plan needs information from all three.
Swipe horizontally to see all columns.
| Party | Information it controls | Information it usually needs |
|---|---|---|
| Patient or policyholder | Member identity, policy documents, consent, prior treatment history, and contact preferences | Hospital and service, likely dates, estimate, diagnosis or clinical information requested by the insurer |
| Hospital | Provider details, treatment proposal, estimate, deposit, clinical documents, and whether its billing office can use the insurer's route | Policy identifier, authorization or GOP, insurer contact, patient share, and billing instructions |
| Insurer or administrator | Eligibility, benefits, exclusions, authorization, network rules, deductible, co-payment, benefit limits, and claims requirements | Clinical records, medical-necessity information, itemized estimate, provider details, and completed forms |
Run the workflow in the right order
- 1
Check the plan for the exact service
Use the policy schedule and benefit guide, then contact the insurer with the country, hospital, outpatient or inpatient status, diagnosis or reason for care, and proposed service. General overseas coverage does not answer whether this episode is eligible.
- 2
Learn whether prior approval is required
Insurers use several names for this step: preauthorization, pre-approval, and prior authorization. Allianz, for example, states that its requirements are plan-dependent and commonly apply to inpatient or high-cost care. Follow the patient's own plan instead of copying another insurer's deadline or form.
- 3
Give the hospital the insurer's requirements
Give the hospital the insurer's form and document list. The billing or clinical team then supplies the requested treatment details, clinical information, estimate, or provider information. Record the billing-office contact and the exact provider entity that will appear on the bill.
- 4
Read the authorization line by line
Check the patient, hospital, diagnosis or service, dates, authorized amount or limit, room class, deductible or co-payment, exclusions, and validity period. A document can authorize one stage of care while leaving tests, medicines, or later admission outside its scope.
- 5
Reconcile the account after care
Collect the final itemized bill, proof of payment, clinical documents, prescriptions, and any insurer forms. Compare the hospital's final charges with the authorized scope and keep the file open until both the hospital balance and the insurer claim are settled.
Sources[1]Allianz Care: Insurance claims queries[2]Allianz Care: Pre-authorisation: what it is and when it may be required[4]Cigna Global: Member insurance and direct-billing questions
The terms that change what happens at the cashier
Swipe horizontally to see all columns.
| Term | Working meaning | Practical consequence |
|---|---|---|
| Preauthorization | The insurer reviews a planned service before it occurs under the rules of that policy. | Approval may be needed even when the policy lists the benefit; missing it can reduce or prevent payment under some plans. |
| Guarantee of payment (GOP) | A document or electronic instruction stating what the insurer intends to pay the provider, subject to its terms. | It may be limited by service, date, amount, patient share, or later verification. It is not a blank guarantee for the whole episode. |
| Direct billing | The hospital invoices an insurer or administrator rather than collecting the authorized portion from the patient first. | The hospital must be able to use that route for the specific plan and service; the patient may still owe a deductible, co-payment, exclusion, or deposit. |
| Deductible | An amount the member pays before or alongside plan benefits, as defined by the policy. | The hospital or insurer should state how it applies to this episode and currency. |
| Co-payment or coinsurance | A fixed amount or percentage left to the member under the policy. | It can apply even after authorization and may differ by service type or provider network. |
| Reimbursement | The patient pays the provider and later submits a claim. | Cash flow, document format, translation, filing deadline, and currency conversion become the patient's responsibility. |
Sources[1]Allianz Care: Insurance claims queries[2]Allianz Care: Pre-authorisation: what it is and when it may be required[4]Cigna Global: Member insurance and direct-billing questions
Direct billing and reimbursement are different projects
Swipe horizontally to see all columns.
| Issue | Direct billing | Reimbursement |
|---|---|---|
| Before care | Hospital and insurer exchange eligibility, authorization, estimate, and billing instructions. | Patient establishes coverage and claims requirements but prepares to pay the hospital. |
| At the hospital | Patient pays stated deductible, co-payment, exclusions, or deposit; unresolved authorization can still delay settlement. | Patient pays according to hospital rules and keeps proof of every payment. |
| After care | Hospital sends the authorized claim; patient follows any balance or additional-information request. | Patient submits the claim, itemized bill, clinical records, prescriptions, and proof of payment by the plan deadline. |
| Main risk | Assuming a network listing or membership card proves the exact service is ready for direct settlement. | Missing required originals, diagnosis information, translation, deadline, or proof that the bill was paid. |
Sources[1]Allianz Care: Insurance claims queries[3]Beijing Municipal Government: Medical Guide for Foreigners in Beijing[4]Cigna Global: Member insurance and direct-billing questions
Build an insurance file that survives handoffs
Name the insurer and any separate administrator; the company on the membership card is not always the team handling provider authorization in China. Store the case or authorization number as text, not only in a screenshot. When the hospital communicates directly with the insurer, record the sender, recipient, date, and subject of the exchange.
Send only the medical history requested through the insurer's designated channel. Record what was sent and retain the original. Several parties being involved is not a reason to place medical information in a casual group chat.
- Policy and member identifiers, benefit guide, and insurer contact
- Hospital legal name, service unit, billing contact, and proposed dates
- Clinical summary, diagnosis information, and treatment or test request required for review
- Itemized estimate and any completed preauthorization form
- Written authorization or GOP with scope, validity, limits, and patient share
- Final itemized bill, prescriptions, reports, invoices, and proof of payment
- Claim submission record and outstanding-information log
Sources[1]Allianz Care: Insurance claims queries[2]Allianz Care: Pre-authorisation: what it is and when it may be required[4]Cigna Global: Member insurance and direct-billing questions
When authorization stalls or the final bill changes
First locate the stalled handoff. The patient might owe a form, the hospital clinical details or a revised estimate, or the insurer a decision. A meaningful status update names the missing item, its owner, and the date it was requested. If the planned service changes, seek revised authorization instead of treating the old one as transferable.
Read a denial, partial approval, or request for more information against the policy and the insurer's stated reason. The hospital clarifies the medical service and charges; the insurer clarifies plan interpretation and appeal or review procedures. A coordinator keeps the exchange organized but does not decide coverage.
For cases involving a hospital and an overseas insurer
Sources[2]Allianz Care: Pre-authorisation: what it is and when it may be required[4]Cigna Global: Member insurance and direct-billing questions
