Guide to Direct Payment Integration with Commercial Insurance
外籍人士来华就医保险直付指南：
Commercial Insurance Direct Payment Service
(商保直付服务)
International patients with high-end commercial health insurance may access direct billing services when seeking medical treatment. If their insurer has a direct billing arrangement with the medical institution, patients can simply present their insurance card and passport for identity verification. They will not need to pay medical expenses upfront, as the hospital will settle claims with the insurance company directly.
(购买高端商业医疗保险的外籍患者，在医疗机构就诊时，如果所持商业保险与该医疗机构有直付合作，患者通过出示保险卡和护照核实身份信息后，可享受费用直接结算服务，患者无须自付医疗费用，由医院直接和保险公司进行理赔结算。)
MSH China, PING AN, AIA, Cigna & CMB, Allianz Partners, etc. are common commercial health insurance companies that have direct-billing cooperation with medical institutions. Please refer to the signed insurance company list of each medical institution.
(MSH万欣和、平安健康、AIA友邦保险、招商信诺、Allianz安联世合等均为常见的可直付商业保险公司，具体以各医疗机构签约名单为准。)
Pre-consultation Preparation 就诊前准备
- Contact your insurance company in advance to confirm your policy is valid, the target hospital is in the direct billing network, and the treatment is covered. Inform the hospital of using commercial insurance direct billing when making an appointment, and bring your passport and physical/electronic insurance card. 提前联系保险公司，确认保单在有效期内、目标医院在直付网络中，同时确认本次就诊项目属于保障范围，预约时告知医院使用商保直付服务，带齐护照、实体/电子保险卡。
- Contact the insurance company and the intended hospital in advance to confirm that the insurance policy supports passport application and the target hospital is within the direct payment network
提前同步联系保险公司和意向医院，确认保单支持护照投保、目标医院在直付网络内
- Clearly inform the insurance company of the itinerary and medical treatment items, confirm that all planned medical treatments are covered by the insurance, and retain communication records
明确告知保险公司行程、就诊项目，确认所有计划内诊疗内容在保障范围内，留存沟通记录
- Submit the guarantee letter application within 24 hours after obtaining the hospitalization form, allowing 3-5 working days for review
拿到住院单后24小时内提交担保函申请，预留3-5个工作日审核周期
- Confirm that the insurance policy covers the medical treatment area (including high-altitude areas such as Xizang), excluding sports-related exclusions
确认保单覆盖就诊地区（含西藏等高海拔区域），排除运动类免责条款
- Check whether the insurance policy covers the target hospital and confirm that it does not belong to the "expensive hospitals" agreed upon in the insurance policy
核对保单是否覆盖目标医院，确认其不属于保单约定的“昂贵医院”
Outpatient Direct Billing Process 门诊直付流程
- Go to the commercial insurance window for identity verification after arriving at the hospital, fill in the claim form, confirm the cost details on site after consultation, only pay the co-payment specified in the policy, and the rest will be settled directly between the hospital and the insurer. 到院后前往商保窗口核验身份，填写理赔单据，完成就诊后现场确认费用明细，仅支付保单约定的自付部分，剩余费用由医院与保险公司直接结算。
- When making an appointment, inform the hospital that you are a foreigner with direct payment through commercial insurance. Upon arrival at the hospital, promptly present your passport and insurance card.
预约时就告知医院你是外籍商保直付用户，到院后第一时间出示护照和保险卡
- Complete the claim within 48 hours after the consultation and settle the bill directly at the hospital's commercial insurance window (if the claim is submitted after the deadline, the insurance company will directly refuse the claim on the grounds of exceeding the deadline).
就诊结束后48小时内完成报案，同步在医院商保窗口完成直付记账 (就诊后超时报案，保险公司直接以超期为由拒赔)
- When filling out the claim information, ensure that the spelling of your name is exactly the same as the English notation on your passport.
填写理赔信息时，姓名拼写和护照英文标注完全一致
- Keep all receipts, medical records, confirmation information, passport, and insurance policy information throughout the process to ensure complete matching. (Missing materials: failure to properly keep medical invoices, medical records, and other materials will greatly increase the difficulty of sending them across borders later, directly affecting the progress of the claim.)
全程留存好所有票据、病历，确认信息和护照、保单信息完全匹配, (材料遗漏未留存：未妥善保管医疗发票、病历等材料，后续跨国补寄材料难度极大，直接影响理赔进度。)
- Confirm the 24-hour multilingual emergency contact number of the insurance company in advance and allow for a buffer time to account for time differences
提前确认保险公司24小时多语种救援电话，预留时差对接缓冲时间
Inpatient Direct Billing Process 住院直付流程
- After getting the admission note from the outpatient department, apply for the inpatient cost guarantee letter to the insurer within 24 hours. Check in after confirming the guarantee letter is delivered to the hospital, and only settle the self-paid part at discharge. 拿到门诊开具的住院单后，24小时内向保险公司申请住院费用担保函，确认担保函送达医院后办理入院，出院时仅结清个人自付部分即可。
- Clarify the deductible and out-of-pocket percentage with the insurance company and reserve the corresponding out-of-pocket expenses in advance.
和保险公司明确免赔额、自付比例，提前预留对应自付费用
- Confirm that the guarantee letter has been successfully sent to the hospital's designated email address, and verify with the hospital admission office again that the direct payment channel has been opened upon admission.
确认担保函成功发送到医院指定邮箱，入院时和住院处再次核对直付通道已开通
- When authorizing a representative to handle on your behalf, obtain an official authorization in advance to ensure that the representative's identity is recognized by both parties.
本人不在场委托代办时，提前办理官方授权委托，确保代办身份被双方认可
- Submit the direct payment application within the time limit specified in the insurance policy after consultation to avoid exceeding the claim acceptance period.
就诊后在保单约定时效内提交直付申请，避免超出理赔受理期限
- Proactively state your foreign commercial insurance direct payment status upon admission to prevent the hospital from entering the information into the system as a regular out-of-pocket payment
入院时主动说明外籍商保直付身份，避免医院按普通自费流程录入系统
Troubleshooting 异常情况处理
If the hospital is not in the direct billing network, pay the full cost in advance and keep all receipts for subsequent claim settlement. If the direct billing system fails, contact the insurer's 24/7 multilingual customer service immediately. 若医院不在直付网络内，全额垫付费用并留存所有票据，后续提交材料走事后理赔；若直付系统故障，第一时间联系保险公司24小时多语种客服处理。
Key Notes 核心注意事项
- Make sure the name spelling on the claim form is exactly the same as that on your passport, report the case within 48 hours after consultation to avoid exceeding the policy's claim time limit.
确保理赔信息的姓名拼写与护照完全一致，就诊后48小时内完成报案，避免超出保单约定的理赔时效。
- Confirm that the insurance policy is not a short-term travel insurance that only covers sudden acute illnesses, but also covers chronic disease follow-up visits, routine physical examinations, and other needs
确认保单不是仅保障突发急性病的短期旅游险，覆盖慢性病复诊、常规体检等需求
- Confirm that the medical treatment items do not fall within the scope of exclusions (such as non-essential cosmetic procedures, undeclared pre-existing conditions)
确认就诊项目不属于免责范围（如非必要美容类项目、既往症未告知部分）
- Confirm the communication timeframe between the hospital and the insurance company in advance to avoid delays in the delivery of direct payment confirmation letters due to time differences
提前确认医院和保险公司的对接时效，避免因时差导致直付确认函延迟送达
Common mistakes that are easily overlooked:
容易被忽略的常见错误
- Policy rule category: 保单规则类
Some people mistakenly regard ordinary inbound travel insurance as direct payment insurance that covers regular medical treatment. However, some short-term travel insurance only covers sudden acute diseases and does not cover chronic disease follow-up visits, regular physical examinations, and other items. They only find out after arriving at the hospital that they cannot receive direct payment.
误将普通入境旅游险当作可覆盖常规就医的直付保险，部分短期旅游险仅保障突发急性病，不覆盖慢性病复诊、常规体检等项目，到院后才发现无法直付。
- Regional adaptation: 地域适配类
When seeking medical treatment in high-altitude areas such as Xizang and Qinghai, if the insurance policy is not confirmed in advance to cover medical responsibilities related to high altitudes, the direct payment application will be rejected immediately after the occurrence of an accident.
前往西藏、青海等高海拔地区就医时，未提前确认保单是否覆盖高原相关医疗责任，出险后直付申请直接被拒。
- Material details: 材料细节类
When filling out the claim information, the spelling of the name was inconsistent with the English notation on the passport, leading to a failure in identity verification and a halt in the direct payment process.
填写理赔信息时，姓名拼写和护照上的英文标注不一致，导致身份核验失败，直付流程直接卡住。
- Communication time lag: 沟通时差类
Due to the time difference between the customer service of overseas insurance companies and domestic hospitals, and insufficient advance preparation time for communication, the direct payment confirmation letter could not be delivered to the hospital in a timely manner, affecting the arrangement of medical treatment.
境外保险公司客服和国内医院存在时差，未提前预留足够的对接时间，导致直付确认函无法及时送达医院，影响就诊安排。
- Hospital rules: 医院规则类
Some international departments of foreign-related hospitals only cooperate with specific overseas insurance companies. Foreigners may find out after arriving at the hospital that their insurance policies are not on the hospital's direct payment list without prior confirmation.
部分涉外医院的国际部仅和特定几家境外保险公司合作，外籍人士未提前确认，到院后才发现自己的保单不在医院的合作直付清单内。
- Cost boundary category: 费用边界类
It is mistakenly believed that all private hospitals support direct billing. However, some high-end private hospitals are listed as "expensive hospitals" on insurance policies, requiring additional policy upgrades for coverage. Failure to confirm in advance may result in significant out-of-pocket expenses.
误以为所有私立医院都支持直付，部分高端私立医院被保单列为“昂贵医院”，需要额外升级保单才能覆盖，未提前确认就会产生大额自付费用。
- Authorization process category: 授权流程类
When a foreigner is not present and entrusts someone else to handle the direct payment procedures without obtaining official authorization in advance, neither the hospital nor the insurance company will recognize the identity of the entrusted party, thus making it impossible to complete the direct payment settlement.
外籍人士本人不在场时，委托他人代办直付手续，未提前办理官方授权委托，医院和保险公司都不认可代办身份，无法完成直付结算。
- Billing time-sensitive: 账单时效类
After seeking medical treatment, if the direct payment application is not submitted within the time limit stipulated in the insurance policy, and the claim acceptance period has expired, the direct payment channel cannot be used anymore. The patient has to pay the full amount of the expenses on their own.
就诊后未在保单约定的时效内提交直付申请，超出理赔受理期限，无法再走直付通道，只能自行全额垫付费用。
- Give priority to insurance companies with 24-hour multilingual customer service: 优先选有24小时多语种客服的保险公司
To avoid language communication barriers and inability to receive services in case of sudden medical emergencies at night.
避免夜间突发就医情况时，出现语言沟通障碍无法对接服务。
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