Direct Billing & Guarantee Letters
When your insurer can pay the hospital directly, and how a guarantee letter works.
Direct billing means your insurer pays the hospital directly, so you pay little or nothing out of pocket. Here’s how it works.
When it’s available
- Your insurer must have a network agreement with the hospital (or its international department).
- It’s more common with large international insurers and their global medical networks.
- Not all hospitals are in every insurer’s network — confirm specifically.
How a guarantee letter works
If direct billing applies, your insurer issues a guarantee letter (a document confirming they’ll cover the cost). You present this at the hospital, and they bill your insurer directly.
What to confirm with your insurer
- Whether your hospital is in-network
- Whether a guarantee letter will be issued, and how long it takes
- Any deductibles, co-pays, or coverage limits
- What you might still pay out of pocket
⚠️ Direct billing is not universal. If your insurer isn’t in-network with your hospital, you’ll use pay-and-reimburse instead.
💡 We help: We can coordinate with the hospital’s international department to check direct-billing eligibility and handle the paperwork.