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Inpatient Treatment, Guarantee of Payment, and Your Health Insurance Policy

While a medical insurance card does usually allow you to receive covered treatments without having to worry about the amount of cash you have with you, that’s not always the case. Along with a medical card, a Guarantee of Payment (GOP) is oftentimes needed for inpatient treatments.

A GOP, otherwise known as a guarantee letter, confirms to the patient’s medical provider that their insurer will settle the hospital bill. It is important that a patient obtains their GOP in a timely manner; it is usually recommended that they request for authorization at least 48 hours before treatment. Without it, hospitals will usually charge a hefty hospital admission deposit (sometimes as much as RMB 50,000!), or place an authorization on the patient’s credit card before proceeding with treatment.

To simplify every step of our readers’ insurance journey, Pacific Prime answers some of the commonly-asked questions concerning GOP, inpatient treatment, and health insurance policies.

The Purpose of a GOP

A Guarantee of Payment is an assurance offered by the insurer to the medical facility confirming that they will settle the cost of inpatient treatment on behalf of the patient. This will typically involve background checks, e.g. to ascertain whether the patient has received any treatment(s) for the condition prior to joining their insurance scheme. Please note that every health insurance policy has a list of exclusions (i.e. what the plan won’t cover), meaning your plan is only valid for covered procedures and medical conditions.

What to Do in the Event of a Medical Emergency

The important thing to do in an emergency is to ensure you go to a nearby facility that will be able to provide emergency treatment. Then, contact your insurer as soon as possible. All the necessary contact information should be presented on your insurance card. The quicker your insurer is made aware of your emergency situation, the sooner they can arrange the GOP with the medical facility. If you work with an intermediary, like Pacific Prime, be sure to contact them as well, as they can help to speed up the procedure.

In the event of an unforeseen medical emergency, some hospitals – especially public ones – may require you to pay a hospital admission deposit upfront, or place an authorization on your credit card before treating you. This is simply because, without a GOP, deposit, or credit card, hospitals run the risk of never getting paid. Not to worry, though; as soon as your insurer has issued the GOP, you will be able to get your deposit or credit card back.

Can Hospitals Reject a Guarantee of Payment?

While uncommon, we’ve witnessed cases in the past where hospitals have rejected an insurer’s Guarantee of Payment, and – as a result – required patients to settle their bill in full. This usually occurs when hospitals are wary of an insurer’s reputation as it pertains to settling their policyholders’ medical bills. As such, it’s important to secure health insurance from a reputable, stable insurer with a good history of settling claims.

Under What Circumstances Would an Insurer Decline Issuing a GOP?

The issuance of a Guarantee of Payment is subject to various conditions, including policy terms, as well as the complexity and nature of a patient’s treatment. In some circumstances, a GOP will not be issued at all. This typically occurs when:

  • The inpatient procedure is treating an excluded condition (e.g. pre-existing condition, substance addiction)
  • The procedure is excluded from coverage (e.g. maternity treatment)
  • The claimable amount falls within the policy deductible
  • The procedure is deemed medically unnecessary (e.g. cosmetic surgery)
  • The policyholder has already reached their maximum annual benefits for the treatment in question

Please bear in mind that the above list is not exhaustive, as policy and GOP conditions vary between insurers and plans. Fortunately, there is help available. If you’re concerned about your current policy wording and its Guarantee of Payment procedures, or are in search of a suitable China health insurance plan, you’ve come to the right place!

As an experienced China health insurance intermediary, we have endeavored to assist our clients through every step of their insurance journey. Our consultants are standing by to answer your insurance- and healthcare-related questions, present you with plan options from reputable insurers, and give you a free quote. To get started with Pacific Prime, contact us today.

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Disclaimer: Pacific Prime solely represents, operates and manages locally regulated insurance products and services in the territory of PR China. Any references to Pacific Prime Global Company or Group, the international services, insurance products or otherwise stated written or verbally, is for introduction purposes about our overseas network only as each entity is fully independent.