How to Make an Expat Health Insurance Claim: A Step-by-Step Guide

Last updated: April 2026

Most expats buy health insurance and hope they never need to use it. Then one day they do — and they discover the claims process is nothing like they expected. Bills in a foreign language, forms that require a doctor signature, reimbursement windows that expire, and denials that feel arbitrary. This guide explains exactly how the process works, what to do at each stage, and how to protect yourself if a claim is rejected.

At a Glance: Key Things to Know Before You Claim

• There are two types of claim: direct billing (insurer pays the hospital) and reimbursement (you pay first, then claim back).
• For planned procedures, you almost always need pre-authorisation before treatment — not after.
• Cigna Global requires claims within 12 months of treatment; BCBS Global and IMG Global require submission within 90 days.
• The most common reason claims are denied is missing pre-authorisation for a procedure that required it.
• If a claim is denied, you have the right to appeal — and a well-documented appeal has a meaningful chance of success.

Step 1: Notify Your Insurer Before You Seek Treatment

The single most important thing you can do is contact your insurer before you receive care — not after. This applies to anything beyond a routine GP visit: specialist consultations, imaging (MRI, CT, PET scans), surgery, hospitalisation, or any course of treatment likely to cost more than a few hundred dollars.

Most international health insurers have a 24-hour helpline. Call it. Tell them what you need, where you are, and which hospital or clinic you are considering. They will tell you whether the facility is in their network, whether pre-authorisation is required, and whether they can arrange direct billing.

If you go to hospital in an emergency and cannot call first, notify your insurer as soon as you are able — ideally within 24 to 48 hours of admission. Delayed notification is one of the most common reasons claims are reduced or denied.

Step 2: Understand Which Type of Claim You Are Making

Every claim falls into one of two categories:

Direct billing is the smoother path. It is available at hospitals that have a contract with your insurer. You present your insurance card, the hospital contacts your insurer, and a Guarantee of Payment (GOP) is issued. At discharge, you pay only your deductible or co-payment — the insurer settles the rest directly with the hospital.

Reimbursement is more common for outpatient care, GP visits, physiotherapy, dental, and any treatment at a facility outside your insurer network. You pay the full bill at the time of treatment, then submit a claim to recover the covered portion.

Step 3: Get Pre-Authorisation for Planned Procedures

Pre-authorisation (also called pre-certification or prior approval) is a formal sign-off from your insurer confirming that a planned treatment is medically necessary and covered under your policy. Without it, you risk having the claim denied — even if the treatment is clearly within your plan scope.

You will almost always need pre-authorisation for:

• Any planned surgery, including day procedures
• Inpatient hospital stays
• MRI, CT, and PET scans
• Chemotherapy, radiotherapy, or other ongoing specialist treatments
• Mental health inpatient treatment
• Maternity care (in many plans, this requires notification within the first trimester)

The process typically works like this: your specialist sends a treatment plan, diagnosis, and cost estimate to your insurer. The insurer reviews it and, if approved, issues a Guarantee of Payment directly to the hospital. This removes you from the financial equation — the hospital knows it will be paid, and you know your costs are capped at your deductible.

Pre-authorisation is not a guarantee of full payment. The insurer will approve coverage up to the limits of your policy. If the actual cost exceeds the approved amount, you may be liable for the difference.

Step 4: Collect the Right Documentation

Whether you are claiming via direct billing or reimbursement, documentation is everything. Missing or incomplete paperwork is the second most common reason claims are delayed or denied.

For a reimbursement claim, you will typically need:

• An itemised bill from the provider — not just a receipt. The bill must show the patient name, date of service, a description of each item or procedure, and the corresponding charge.
• Proof of payment (receipt or bank statement showing the transaction).
• A written diagnosis or clinical notes from the treating doctor.
• The completed claim form from your insurer (most can be downloaded from their member portal or app).
• For medication claims: the prescription, the pharmacy receipt, and the medication name, dosage, and quantity.
• Your bank details for reimbursement — including SWIFT/BIC/IBAN codes for international wire transfers.

Keep a folder (physical or digital) for every medical interaction. Photograph receipts immediately — thermal paper fades quickly in heat. If your bills are in a language other than English, ask the provider for an English translation, or check whether your insurer accepts bills in the local language (most do, but some require translation for claims above a certain value).

Step 5: Submit the Claim Within the Deadline

Every insurer has a claims submission deadline. Miss it and your claim will be rejected regardless of its merits.

Submit claims as soon as possible after treatment. Do not batch them up at the end of the year. If you are unsure of the deadline, call your insurer claims team and ask. Most insurers now accept claims via an online member portal or mobile app. Keep a copy of everything you submit — screenshot the confirmation page, note the date and reference number, and save copies of all uploaded documents.

Step 6: Track the Claim and Respond Promptly

Once submitted, a straightforward claim with complete documentation is typically processed within 5 to 10 business days. Cigna Global and Now Health International both publish a target of 5 working days from receipt of complete documentation.

Your insurer will issue an Explanation of Benefits (EOB) — a document detailing how the claim was assessed: what was covered, what was excluded, what deductible was applied, and how much you will be reimbursed. Read it carefully. If the insurer requests additional information, respond as quickly as possible. The processing clock typically stops while they wait for the missing information.

Step 7: If Your Claim Is Denied

A denial is not the end of the road. Most international health insurers have a formal appeals process, and a well-documented appeal has a meaningful chance of success.

The most common reasons claims are denied:

• Missing pre-authorisation for a procedure that required it
• Treatment classified as a pre-existing condition
• Out-of-network provider used without prior approval
• Incomplete or incorrect documentation
• Treatment deemed not medically necessary
• Claim submitted outside the deadline

How to appeal:

1. Read the denial letter carefully. The insurer is required to explain the reason for the denial. Understanding the specific reason is essential before you respond.
2. Contact your insurer claims team. Sometimes a denial can be resolved with a phone call — particularly if the issue is a missing document or an administrative error.
3. Gather supporting documentation. If the denial is based on medical necessity, ask your treating doctor to write a letter explaining why the treatment was necessary, what alternatives were considered, and why they were not appropriate.
4. Submit a formal written appeal. Most insurers require a written appeal within 30 to 180 days of the denial. Include your policy number, claim reference, a clear statement of why you believe the denial is incorrect, and all supporting documentation.
5. Escalate if necessary. If the internal appeal fails, most insurers offer an external review by an independent third party. In some jurisdictions, you can also file a complaint with the relevant insurance regulator.

If you used a broker to arrange your policy, involve them at this stage. A good broker will advocate on your behalf with the insurer — this is one of the most valuable things a broker does, and one of the strongest arguments for using one rather than buying direct.

What a Broker Can Do That You Cannot

The claims process is one area where having a broker genuinely matters. Brokers have direct relationships with insurer claims teams, know which arguments are most effective in appeals, and can escalate internally in ways that individual policyholders cannot. If you are currently uninsured or comparing plans, use a comparison tool to see what is available — but before you buy, consider speaking to a broker who can explain the claims process for each plan and help you choose one with a strong claims track record.

Frequently Asked Questions

Do I need pre-authorisation for a GP visit?

Generally no. Most plans allow you to see a GP without pre-authorisation. Pre-authorisation is typically required for specialist referrals, planned surgery, hospitalisation, and high-cost imaging. Check your policy documents to confirm what requires approval.

What happens if I have an emergency and cannot call my insurer first?

Notify your insurer as soon as you are physically able — ideally within 24 to 48 hours of admission. Most insurers have provisions for genuine emergencies and will not deny a claim solely because you could not call first. However, failure to notify promptly can result in reduced reimbursement.

Can my insurer deny a claim for a pre-existing condition?

Yes — if the condition was excluded at underwriting, or if the policy has a moratorium clause that excludes conditions present in the years before the policy started. This is one of the most important things to clarify before you buy a policy, not after you need to claim.

How long does reimbursement take?

With complete documentation, most major insurers process claims within 5 to 10 business days. International bank transfers typically add 2 to 5 business days. If your claim is incomplete, the clock stops until you provide the missing information.

What is an Explanation of Benefits (EOB)?

An EOB is a document from your insurer explaining how a claim was processed. It shows what was covered, what was excluded, what deductible was applied, and the amount to be reimbursed. It is not a bill — it is a statement of how your claim was assessed.

My claim was denied. What are my chances of a successful appeal?

The strength of the appeal depends heavily on the reason for the original denial. Appeals based on missing documentation or administrative errors are often resolved quickly. Appeals based on medical necessity require a supporting letter from your treating doctor. If you used a broker, involve them — they can often resolve denials faster than you can alone.

Should I use a broker or buy direct?

The editorial position of ExpatHealth.org is to use a broker. The claims process is one of the main reasons. A broker can help you choose a plan with a strong claims track record, assist with pre-authorisation, and advocate on your behalf if a claim is disputed. The premium is typically the same whether you buy direct or through a broker.

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