How Does Health Insurance Direct-Billing Work in China?

Most health insurance providers in China have direct-billing partnerships with various medical providers in the country, where the insurance company can bill directly with hospitals within network without the insured having to pay upfront.

Such feature greatly reduced potential risks of not being able to afford a treatment due to its significant cost, however it does not mean you can enjoy this feature at every hospital in China, and not every insurance company would necessarily has direct-billing partnership with that particular medical provider.

So how does health insurance direct-billing work in China? What are the factors that would affect its availability?

Hospital network

Each health insurance provider has its own direct-billing hospital network, or they work with a third-party network provider for their insurance direct-billing. This is the pre-requisite of direct-billing eligibility; if you go to a hospital outside of your insurance company’s network, no direct-billing, period.

You could check whether if the hospital you visit has direct-billing with your insurance company via your insurance company’s website / app / WeChat official account. Sometimes you would need to login into their member portal to gain access to such information.

You could also check on the hospital’s website, where they will usually list out their partnering insurance companies if they have direct-billing arrangements with private health insurance companies.

Outpatient direct-billing

Some plans may not have direct-billing for outpatient care, including individual policies purchased by individuals and group policies purchased by employers. This means every time you visit the doctor for outpatient care, you will need to pay first and file a reimbursement claim later. You will normally need to provide fapiaos / invoices, medical reports when filing a claim.?

Outpatient direct-billing eligibility is normally written on the benefit table of your insurance policy, and you should be informed of such information during the quotation process.

Inpatient treatments should always be eligible for insurance direct-billing (unless if it is a plan that only accepts reimbursement claims).

Outstanding balance

Should you have any outstanding claims that you have not paid to the insurance company yet, most insurance companies will temporarily suspend your insurance direct-billing until you have paid off your remaining balance.

This could be a co-pay from your policy, an uncovered treatment, or amount that has exceeded your insurance benefit limit. Normally the insurance direct-billing will be restored after you have paid off all of your balances.

Change in hospital direct-billing partnership

Health insurance companies do not have permanent contracts with the hospitals; their networks change on a regular basis and they can terminate direct-billing partnership with a hospital at anytime.

Therefore if you find yourself not being able to access direct-billing at a certain hospital / clinic that used to have it, chances are your insurance company no longer cooperates with that particular medical provider.

Restricted / uncovered medical providers

Most health insurance companies will normally have a list of hospitals or clinics they refuse to cover, subsequently insurance direct-billing will also not be available if you visit one of those medical providers.

In a nutshell direct-billing access is not guaranteed at all times; it would depend on the various factors discussed above. It is important to check with your insurance company, the hospital and your insurance policy to make sure requirements for direct-billing are fulfilled before you visit a medical provider for treatment.

About the author

I'm an insurance broker at Mingya Insurance Brokers based in Beijing, and my company works with multiple insurance companies in China providing insurance plans eligible for expatriates in China. Our insurance partners include AXA, Allianz, AIG, Bupa, Cigna, GBG, MSH, Medilink, Ping An etc.

I specialise on insurance solution planning for expatriates in China, particularly health insurance. I have been assisting expatriates in China with their insurance solution planning since 2018, as well as group insurance planning for corporates and institutions' foreign employees.

I was born in Beijing, and am able to communicate in fluent English and Mandarin. I held a financial advisor's license issued by the Monetary Authority of Singapore (MAS) for 2 years, and I am currently holding an insurance broker's license issued by the China Banking and Insurance Regulatory Commission (CBIRC) since 2018.