Frequently Asked Questions
Find answers to the most common questions about our services and processes.
Can foreign patients use international health insurance for medical treatment in China?
Yes, but “my insurance covers China” does not mean that every hospital and every treatment in China can automatically be billed to your insurer.
You need to confirm four separate things:
- Does your policy cover mainland China?
- Is this specific hospital within your insurer’s medical network?
- Is this specific condition and treatment covered under your policy?
- Will the hospital use Direct Billing, or must you pay first and claim reimbursement later?
Beijing’s official guide for international patients states that some patients with high-end commercial health insurance can use Direct Billing at medical institutions that have billing agreements with their insurers. The exact participating-insurer list depends on the individual hospital.
Published insurer lists also differ between hospitals in Shanghai, including institutions such as Shanghai Tongji Hospital and Huashan Hospital.
So do not ask your insurer only:
“My insurance works in China, right?”
Ask:
“Does my policy cover this hospital, this diagnosis, and this planned treatment, and has direct billing been confirmed?”
Antu can help organize the target hospital, doctor, and expected treatment plan so that the patient can obtain a more specific answer from the insurer.
Can travel insurance cover medical treatment in China?
Possibly, but travel insurance and international health insurance are not the same thing.
Travel insurance is usually focused more on medical problems that arise during a trip, such as:
- unexpected illness;
- accidental injury;
- emergency treatment;
- medically necessary emergency hospitalization;
- and, under some policies, medical evacuation or repatriation.
However, if you are traveling to China specifically for surgery, cancer treatment, long-term care, or treatment of a condition already known before the trip, many travel insurance policies may exclude that type of planned medical care.
So do not assume that wording such as:
“Medical expenses up to USD 500,000”
means your planned surgery will automatically be reimbursed.
Check specifically:
- whether Planned Treatment is excluded;
- how Pre-existing Conditions are defined;
- whether prior authorization is required;
- whether there are restrictions on medical providers;
- whether coverage is limited to “medically necessary emergency treatment.”
If medical treatment is the main purpose of your trip, send the proposed treatment plan to your insurer before traveling instead of waiting until after the expense has occurred.
How do I know whether a Chinese hospital accepts my insurance?
Do not rely only on seeing your insurer’s logo on a hospital website.
Ideally, confirm with both the hospital and the insurer.
Ask the hospital:
“Do you currently have a Direct Billing agreement with [insurer name]?”
Then ask your insurer:
“Is [full hospital name and campus] currently an in-network/direct-billing provider under my exact policy?”
Why confirm both?
Because situations can occur where:
- the insurer has an agreement with the hospital group, but not the specific campus you are using;
- the hospital works with the insurer, but not with your exact insurance product;
- outpatient care is eligible for direct billing, while inpatient care requires additional approval;
- routine treatment can be billed directly, while certain medications or high-cost treatments require separate authorization.
Official international medical information from Beijing and Shanghai also shows that Direct Billing insurer lists differ between hospitals.
So the most reliable confirmation is not:
“I saw Cigna/Allianz on the hospital website.”
It is:
“Has direct billing been confirmed for my exact policy, at this hospital, for this specific treatment?”
What is Direct Billing?
Direct Billing means that the hospital bills the insurer directly for eligible medical expenses.
Normally, if the hospital has a direct-billing relationship with your insurer and the treatment has received the required authorization, the hospital can submit eligible charges directly to the insurance company instead of requiring you to pay the full amount first and claim reimbursement after returning home.
Beijing’s official international-patient guidance also states that eligible patients can use Direct Billing where the hospital and insurer have the relevant arrangement, allowing the hospital and insurance company to settle the covered medical charges directly.
However, Direct Billing does not mean:
“I show my insurance card and every medical cost becomes zero.”
You may still need to pay:
- the deductible;
- co-payments;
- items excluded by your policy;
- costs above your policy limit;
- treatment that was not authorized;
- elective room upgrades or other personal-choice expenses.
Before treatment, ask the hospital or insurer to confirm:
Which charges will be billed directly to insurance, and which charges will I still need to pay myself?
My insurer says treatment in China is covered. Why is the hospital still asking me to pay first?
Because:
“The treatment is reimbursable under my insurance”
and
“The insurer has approved Direct Billing with this hospital”
are two completely different things.
Common situations include:
- the policy covers China, but the hospital is out of network;
- the hospital and insurer do not have a direct-billing agreement;
- pre-authorization has not yet been approved;
- the insurer requires you to pay first and claim reimbursement later;
- only part of the treatment has been approved;
- the hospital has not yet received a Guarantee of Payment (GOP) or other payment-guarantee document.
So do not ask only:
“Is China covered?”
Ask:
“Has Direct Billing or a Guarantee of Payment been issued to this specific hospital for this treatment and these dates?”
If the answer is “the treatment is covered, but you must pay first,” you still need enough available funds to pay the hospital upfront.
Does Direct Billing mean I will have no out-of-pocket costs?
No.
Direct Billing changes who pays eligible covered expenses first, but it does not automatically eliminate every out-of-pocket cost.
Even when Direct Billing has been approved, you may still be responsible for:
- a deductible;
- co-payments;
- costs above annual or policy limits;
- medications excluded by your policy;
- services that do not meet the insurer’s Medical Necessity requirements;
- upgrades to a private or premium room;
- non-medical costs such as companion accommodation or meals;
- treatment that was not pre-authorized when authorization was required.
For example, an insurer may approve:
Direct Billing for surgery and a standard inpatient room
but not approve:
a VIP room upgrade, a particular high-cost drug, or an additional test.
Before admission, ask the insurer or hospital insurance office for a clear explanation of:
what the insurer is expected to pay and what the patient is expected to pay personally.
What is pre-authorization, and why is it often required before surgery?
Pre-authorization means approval from the insurer before treatment takes place.
In simple terms, the insurer reviews issues such as:
- the diagnosis;
- why the doctor recommends the treatment;
- whether the treatment falls within the policy benefits;
- whether it meets the insurer’s Medical Necessity criteria;
- the estimated cost;
- whether the hospital meets the insurer’s requirements.
It is especially common for major surgery, inpatient admission, cancer care, expensive medications, complex imaging, and long-term treatment.
The hospital may need to submit:
- the doctor’s treatment plan;
- diagnostic information;
- test results;
- a cost estimate;
- expected length of hospitalization.
It is important to understand:
Pre-authorization is not necessarily a 100% guarantee of final reimbursement.
If the actual treatment changes from what was originally submitted, or the final bill contains items outside the policy terms, the insurer may review those charges again.
Keep the authorization number, approved scope, validity dates, and written confirmation from the insurer.
My surgery is booked, but insurance pre-authorization is still pending. What should I do?
Do not assume that insurance will approve the treatment in time simply because the hospital has already scheduled the surgery.
Immediately confirm three things:
First, what information is the insurer still waiting for?
Is it the doctor’s report, pathology, imaging, cost estimate, or a response from the hospital?
Second, will the hospital keep the surgery date while insurance approval is still pending?
Third, if authorization does not arrive in time, are you willing and financially able to pay for the treatment yourself first?
Be particularly careful not to sign a document stating:
“The patient is responsible for all charges if insurance does not pay”
while still assuming that approval is guaranteed.
Antu can help coordinate the treatment plan, cost estimate, and medical documents required by the insurer and follow up on communication from the hospital side.
However, the insurance approval itself is decided by the insurer.
If the treatment is not an emergency and the amount is substantial, clarify who will ultimately be responsible for payment before the operation takes place.
What happens if my insurer approves only part of the treatment cost?
The remaining amount will usually need to be paid by the patient unless the insurer later approves additional coverage.
For example, if the hospital estimates RMB 200,000 but the insurer approves only RMB 120,000, possible reasons include:
- a deductible;
- a co-payment;
- excluded items;
- approval of only part of the expected hospital stay;
- a medication that requires separate authorization;
- costs exceeding the policy limit.
Do not look only at:
“Approved: RMB 120,000.”
Ask the insurer to explain:
Why was the remaining RMB 80,000 not approved?
Ideally, separate the difference into:
definitely excluded + not yet approved + additional documents required + patient responsibility.
These are very different situations.
Antu can help compare the insurer’s approval with the hospital estimate so the patient can understand exactly which items created the difference.
Who is responsible for the hospital bill if the insurer ultimately denies the claim?
From the hospital’s perspective, the patient generally remains responsible for the medical bill unless the hospital has received and accepted a valid payment guarantee from the insurer.
This is why:
“I have insurance”
should never be understood as:
“No matter what the insurer ultimately decides, I will never have to pay.”
If a claim is denied, first identify the reason:
- an explicit policy exclusion;
- a pre-existing-condition issue;
- lack of required pre-authorization;
- treatment at an out-of-network hospital;
- the insurer’s determination that the treatment was not medically necessary;
- incomplete documentation;
- costs exceeding the policy limit.
Some problems may be resolved by submitting additional documents or filing an appeal. Others may be clear exclusions under the policy itself.
For high-cost treatment, obtain written approval from the insurer whenever possible rather than relying only on a call-center statement such as:
“It should probably be covered.”
Could my insurer refuse coverage for treatment of a pre-existing condition in China?
Possibly, but it depends on the policy.
The key issue is how your insurance contract defines a Pre-existing Condition and whether your insurance product:
- excludes pre-existing conditions entirely;
- applies a waiting period;
- provides limited coverage;
- accepts the condition after Medical Underwriting;
- applies special conditions to certain chronic diseases.
Also, a pre-existing condition may not mean only:
“a disease that was already formally diagnosed.”
Some policies may also consider symptoms, abnormal test results, or previous treatment that existed before coverage began.
If you are already known to have cancer, heart disease, or another condition and are planning treatment in China, do not ask only:
“Is China covered?”
Ask:
“Is my diagnosed condition specifically covered under this policy, and is planned treatment for it in China eligible for reimbursement?”
Request the answer in writing whenever possible.
Why do cancer treatment, long-term care, and planned treatment often face more insurance restrictions?
Because these types of care are often:
- expensive;
- long-term;
- subject to changing treatment plans;
- dependent on high-cost medications;
- associated with repeated hospitalization;
- more likely to trigger policy rules relating to Pre-authorization, Medical Necessity, and Benefit Limits.
Cancer treatment, for example, may not be a single operation. It may involve:
pathology review → surgery → drug therapy → radiotherapy → follow-up → second-stage treatment.
An insurer may not approve every treatment expected over the next six months in one authorization. Approval may be issued stage by stage.
Patients should therefore ask:
Does this authorization apply only to the current admission, or does it also cover later treatment stages?
and:
Do I need a new authorization each time the treatment plan changes?
Antu can help organize medical plans and hospital documents for different stages of treatment, but one insurance approval should not be interpreted as approval for every future treatment related to the condition.
Will an overseas insurer accept Chinese-language hospital invoices and itemized bills?
Some insurers accept Chinese-language invoices and itemized bills, while others require an English translation or a specific format. It is best to confirm this before discharge.
Do not wait until you return home and then send a stack of Chinese documents to the insurer without checking the requirements.
Ask the insurer:
Do you accept hospital invoices and itemized bills in Chinese?
If not, ask:
Do you require a certified translation, a standard translation, or an English statement issued by the hospital?
At the same time, confirm which documents the hospital can provide, such as:
- official invoices or payment receipts;
- itemized billing statements;
- discharge records;
- diagnostic certificates;
- operative records;
- doctor treatment statements.
One of the most difficult situations is returning home and discovering that the insurer requires a document that the Chinese hospital does not automatically issue.
Antu can help compare the insurer’s documentation requirements with the records the hospital is actually able to provide before the patient is discharged.
What if my insurer requires English medical records but the hospital only provides documents in Chinese?
First confirm whether the insurer actually requires:
“medical records issued in English”
or:
“the original Chinese records plus an English translation.”
Those are not the same requirement.
Some International Medical Departments in China may provide certain documents in English, such as an English diagnosis or discharge summary. However, you should not assume that the entire inpatient medical record will automatically be issued in English.
If the hospital can provide only Chinese records, ask whether the insurer will accept:
- the original Chinese hospital document;
- an accompanying English translation;
- translation completed by a professional translation provider;
- a certified translation where required.
For complex medical records, the translation must accurately preserve:
- diagnosis names;
- medication names;
- procedure names;
- pathology findings;
- dates and dosages.
Antu can help organize and translate hospital documents, but the original Chinese hospital records should be retained so the insurer can verify the source material.
Can insurance reimburse interpretation, patient support, accommodation, and transportation costs?
Possibly, but you should not assume that all of these expenses are standard medical-insurance benefits.
Different policies may treat the following differently:
- medical interpretation;
- ambulance services;
- medical evacuation or transport;
- transportation for accompanying family members;
- hotel accommodation;
- recovery accommodation;
- ordinary taxi fares;
- patient-support services.
For example, emergency medical transportation may be covered while an ordinary taxi from your hotel to the hospital may not be reimbursable at all.
Some international health plans may also include benefits such as:
- Companion Benefit;
- Travel Benefit;
- Medical Evacuation;
- Accommodation Benefit.
So do not ask only:
“Are non-medical expenses covered?”
Confirm each expense separately and ask the insurer to identify the relevant policy provision.
Antu can provide applicable receipts or service descriptions, but whether these costs are reimbursable ultimately depends on the patient’s own insurance contract.
If a new treatment is added during hospitalization, do I need new insurance authorization?
Possibly, and for high-cost additions you should confirm immediately rather than assuming the original pre-authorization automatically covers them.
For example, the insurer may initially approve:
surgery + five inpatient days.
Later, based on new findings, the doctor may add:
- a specialized medication;
- an additional procedure;
- ICU care;
- radiotherapy;
- a high-cost diagnostic test;
- a longer hospital stay.
These items may fall outside the original authorization.
A safer approach is for the hospital insurance office or the patient to contact the insurer immediately and ask:
“Is this new treatment covered under the existing authorization, or is an additional authorization required?”
For non-emergency treatment, it is better to obtain confirmation before the new treatment is provided.
In an emergency, the medical team may need to prioritize patient safety first and deal with insurance communication afterward, but the costs may still be subject to later insurance review.
Antu can help send updated doctor statements, cost estimates, and treatment changes to the insurer promptly.
What documents should I collect before discharge to reduce insurance claim problems after returning home?
Do not leave the hospital with only a discharge summary and a payment receipt.
For patients who will file an insurance claim after returning home, check whether you have obtained or requested at least:
- the discharge record;
- final diagnosis;
- physician treatment statement;
- operative record, if applicable;
- pathology report, if applicable;
- laboratory results and important imaging reports;
- official invoices/payment receipts;
- a complete itemized bill;
- medication records;
- any section of the insurer’s Claim Form that must be completed by the doctor;
- any other documentation specifically required by the insurer.
Then confirm:
Which documents are available today? Which will be completed later? Who will follow up on them?
If an insurer requires a doctor’s signature or hospital stamp, it is much easier to arrange this while you are still in China.
One common cause of claim delays is:
the patient has already returned home when the insurer suddenly requests a Chinese doctor’s signature on a particular claim form.
Antu can help review the insurance document checklist before discharge and continue following up on documents that cannot be completed that day.
Can Antu help coordinate communication between the hospital and my insurer?
Yes, especially when information is not flowing clearly between the hospital, patient, and overseas insurer.
Antu can help organize and communicate items such as:
- hospital information;
- the doctor’s treatment plan;
- cost estimates;
- pre-admission information;
- admission dates;
- medical reports;
- additional documents requested by the insurer;
- updated information when the treatment plan changes.
Antu can also help clarify:
Which party has not responded yet?
What document is the insurer waiting for from the hospital?
What confirmation is the hospital waiting for from the insurer?
However, Antu’s role is coordination and information transfer. It does not make reimbursement decisions on behalf of the insurer and does not determine or alter the hospital’s medical charges.
If the insurer ultimately determines that a treatment is outside the policy coverage, Antu cannot require the insurer to reimburse it.
Can Antu guarantee that my insurance will reimburse my treatment?
No, and no cross-border healthcare platform should promise a patient:
“Your insurance will definitely reimburse 100%.”
Final reimbursement depends on:
- the patient’s individual insurance policy;
- pre-existing-condition provisions;
- benefit limits;
- exclusions;
- Medical Necessity review;
- pre-authorization requirements;
- the treatment actually provided;
- the insurer’s final claim decision.
What Antu can do is reduce avoidable claim problems caused by missing documents, unclear communication, hospital information not being submitted, or authorization not being followed up properly.
For example, before treatment Antu can help clarify:
whether pre-authorization is required, which documents are needed, and whether the hospital supports Direct Billing.
After treatment, Antu can help check:
whether medical records, itemized bills, and insurance forms are complete.
That is very different from guaranteeing that an insurer will approve every claim.
What should I ask my insurer to confirm in writing before traveling to China for treatment?
This is one of the most important questions in the entire insurance process.
For planned cross-border medical care, do not rely only on verbal answers from a call center. Ask the insurer to confirm the following by email, insurance app, or formal authorization document:
1. Whether mainland China is within your geographic coverage area.
2. Whether the target hospital and specific campus are in network.
3. Whether your specific diagnosis is covered.
4. Whether the planned treatment is covered.
5. Whether pre-authorization is required.
6. Whether Direct Billing has been approved.
7. Which treatment items and amounts have been approved.
8. Your deductible and co-payment obligations.
9. Whether there is a limit on room category.
10. Whether high-cost medication, specialized medical supplies, or ICU care require separate approval.
11. How additional authorization should be requested if the treatment plan changes.
12. Which documents will be required for the final claim after discharge.
Also keep:
the Case Number / Authorization Number / contact person / email record.
If a dispute later occurs, you will then have clear written evidence rather than only being able to say:
“I called before traveling and someone at the call center told me it should be covered.”
Antu can help organize the hospital information and expected treatment plan into materials suitable for submission to the insurer, allowing the insurance company to respond as specifically as possible to this hospital, this diagnosis, and this treatment.