Insurance, reimbursement and paying for treatment

Start by assuming you are paying yourself

Almost everyone we work with pays out of pocket and pursues reimbursement afterwards, if at all. That is the honest starting position. Some plans do reimburse part of a foreign claim, and it is worth finding out which category yours falls into before you make any decisions, but a plan that pays is the exception rather than the rule.

Be careful with travel medical insurance in particular. It is written for emergencies that happen while you are travelling, and it almost always excludes treatment you arranged in advance. Buying a travel policy does not make planned surgery covered.

What to ask your insurer, in writing

Phone answers are not much use in a dispute months later. Ask by email or through your plan's message portal, so you have a record of what you were told.

• Does the plan cover non-emergency medical treatment received outside the country, and under what conditions?
• Is pre-authorisation required, and can it be obtained for a foreign provider?
• At what rate would a foreign claim be reimbursed — the billed amount, or a domestic equivalent?
• What documentation is required: itemised invoices, diagnosis and procedure codes, operative reports, proof of payment?
• Does documentation need to be in English, and does translation have to be certified?
• Is there a deadline for submitting a claim after treatment?

If you are in the United States

Employer and marketplace plans commonly exclude non-emergency care abroad, though some PPO plans carry limited out-of-country benefits. Medicare generally does not cover care received outside the United States, with narrow exceptions that do not include elective treatment abroad.

HSA and FSA funds can usually be used for qualifying medical expenses even when care is received abroad, provided the treatment would be a qualifying expense at home. Your plan administrator sets the documentation requirements.

Medical expenses, including some travel and lodging costs, may be deductible if you itemise and your total exceeds the threshold set by the IRS. The rules on lodging in particular are narrow and capped. Ask a tax professional rather than relying on a summary, including this one.

If you are in Canada

Provincial health plans generally reimburse very little for care received outside Canada, and elective treatment arranged in advance is usually excluded outright. Some provinces will fund out-of-country care where a service is unavailable domestically, but that is a prior-approval process run through the province, not something that can be claimed retroactively after you have travelled.

Private and employer plans vary widely. The federal medical expense tax credit may apply to some out-of-country medical costs; the eligibility rules are specific and worth putting to an accountant.

Documentation to bring home

Whatever your plan says now, leave China with a complete paper trail. Reconstructing it later, across a language barrier and a time zone, is far harder than asking while you are still there.

• An itemised invoice showing each charge separately, not a single total
• Proof of payment for every amount paid
• The discharge summary and operative report
• Diagnosis and procedure coding, if the hospital can provide it
• Pathology and imaging reports
• English translations of each of the above

What we do

We provide itemised invoices and arrange English translations of your clinical documentation as a matter of course. We are not insurance advisers and we do not submit claims for you. If your plan is unlikely to reimburse, we would rather say so plainly than let you travel on an assumption.