Medical emergencies and your health insurance

Posted on Jun 11, 2015 by Rob McBroom

Imagine waking up one morning with high fever, pain in the lower-right side of your abdomen, and severe nausea. You make the decision to go see a doctor at the nearest international hospital. When you arrive, you are immediately whisked into surgery because the doctor determines that you have appendicitis and need to have surgery as soon as possible. Probably the absolute last thing on your mind at this point is how you are going to claim this with your health insurance provider.

The problem is, many insurance providers operate on a direct billing network in China, which means that you usually need pre-approval from the insurance company in order to receive coverage for any medical procedures. During an emergency, this isn’t always possible, so the question is: What exactly do you do?

Call your insurance emergency hotline ASAP - It is important to try to do this before you head to the hospital. Your insurance provider may be able to offer suggestions, including a better facility, and also start the claim process so as to ensure you get treatment confirmed more quickly. Also, many hospitals in China require you to pay before any treatment happens. If you have already been in contact with your insurance provider before you reach the hospital, they can help ensure you get treatment as soon as possible.
Take a taxi if possible to the nearest medical facility or preferred provider (avoid ambulances if possible) - In most parts of China, taxis are far more common than an ambulance, which means that as long as you are able to travel, taxis will likely get you to the hospital quicker. Beyond that, ambulance service in many cities is poor at best - you are usually expected to pay for ambulance service up front, and there are almost constant reports of ambulances simply failing to show up when called. Not to mention the fact that many are really nothing more than vans - most have little to no medical equipment in them.
Have your Dr or hospital contact your insurer - When you arrive at the hospital or clinic, try to get one of the staff members there to call your insurance provider with treatment details as soon as possible.
Receive treatment - If you can, it would be ideal to wait to receive treatment until you know what your insurance provider will cover.

During an emergency, it may not be possible to follow these steps. If this is the case, receiving treatment first would be advisable. Just be sure that you do not sign any payment forms before talking to your insurance provider.

Important things to be aware of, and do, before any emergency happens

Beyond knowing the steps to take during an emergency, there are a number of things you can do ahead of time to ensure that the emergency claims procedure goes as smoothly as possible.

First: Know the emergency contact for both Pacific Prime and your insurance provider

The motto for the Boy Scouts - Be Prepared - is relevant here. If you know the emergency contact information for both your insurance provider and Pacific Prime ahead of time, you can take some of the stress off of an emergency situation.

So, where can you find this information? For your insurance provider, the emergency number should be on the insurance card that was given to you when you signed up for the plan. If you can’t find the card, you can also find the emergency contact information for all of the insurance providers we work with in China on our website.

As for Pacific Prime, it is recommended that you contact us as soon as you can. Either call us during business hours at +86 (0)21 2426 6400 or email our claims department. We can help ensure the process goes smoothly while also provide support for any coverage questions that may arise, and help ensure you get the necessary documents.

Second: Be aware of the nearest emergency medical facility that is part of your network

Depending on the insurance plan you have purchased, there may be limitations on what medical facilities you can visit and receive full coverage at. As such, it would be a good idea to know where the nearest hospital or facility is located and the services they offer.

While this can be easy for expats living in larger cities in China, such as Beijing or Shanghai, those living in other cities need to be extra diligent when scoping out locations as the quality of care may not be up to western standards. This means that you may need to look further afield for care options, including in other locations such as Hong Kong. It would therefore be beneficial to identify first if your plan covers medical evacuation, and then some options in your city of choice.

Third: If you have children, be aware that not all facilities are equipped to efficiently handle them

Among many expats in cities like Shanghai, Beijing, and Shenzhen, there is a common notion that the international hospitals are the absolute best for all medical issues. While this is generally true, there are a number of hospitals that are not fully equipped at all hours to deal with children, while others specialize in different types of child care. This means that if you have children, it is important to identify your options and know where you can receive medical care should they get sick.

Fourth: Know if your employer offers ISOS, and the difference between it international health insurance

Many international companies operating in China offer their employees an International SOS service. These types of services are in place to offer help and support if you need to be evacuated or are in an emergency situation. While the usefulness of these services in China is beyond doubt, it is important to know that many only provide support during an emergency, they might not offer actual medical coverage. This means that if you are in an emergency, you can use them to get advice on where to go and how to get there, but you will be required to cover the hospital bills on your own. In other words, international health insurance is still necessary.

If you do need to be evacuated - which is usually at the discretion of the insurer and the doctor - both of these plans can offer options for different locations along with support for family members that will need to be evacuated as well.

Fifth: Be prepared in the event you are unconscious or unable to communicate

This can be a tough situation, especially in China where you may not be able to speak the language or may be unconscious when you are taken to the hospital. Therefore, we recommend having your insurance card on you at all times. If a friend or family member isn’t around at the time of your accident, your information should be kept in your wallet. Also, you can notify a friend or “Chinese speaking buddy” that you have an insurance plan and how they too can contact the insurer. What’s more, hospital staff are trained to look for medical insurance cards and the benefits covered in the event you are unconscious.

Sixth: Develop an emergency plan

Following the suggestions above will inevitably generate a fair amount of information that you need to keep track of. Not to mention the fact that it can be hard to plan everything - there is a good chance that you may forget something or miss some important steps. Limitless Laowai - a podcast for expats in China - actually recently released a podcast on what to do during an emergency. There are a number of interesting tips shared including resources that can help you find and centralize all of the necessary information you will need during an emergency.

Seventh: Work with a broker and insurer who has a CIRC code

The Chinese Insurance Regulatory Commission (CIRC) is the regulatory body in China that oversees insurance and licensing. Insurance companies and brokers (like Pacific Prime) who are compliant with CIRC regulations get a code that enables a number of things. Firstly, it drastically decreases the chance of the insurance plan being rejected by local and private hospitals in China. Secondly, it means that the provider is ‘onshore’ (they have offices in China) which allows for Direct Billing, not to mention the fact that the office will have Mandarin speakers who can help with talking to the hospital and doctors.

If you are looking to learn more about how your insurance plan will cover you during an emergency, contact our experts today.