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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 often times 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 very 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.

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

What is 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 (a.k.a. what the plan won’t cover), meaning your plan is only valid for covered procedures and medical conditions.

What do I do in the event of a medical emergency?

The most important thing to do in an emergency is to ensure you go to the closest facility that will be able to provide emergency treatment (for a list of Shanghai and Beijing emergency hospitals, click here). 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 have a broker, like Pacific Prime China, 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 critical to secure health insurance from a reputable, stable insurer with an exceptional history of settling claims. To learn more about how to avoid unstable insurers, check out our recent article on the topic here.

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 the best China health insurance plan, you’ve come to the right place!

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

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