One major difference with health coverage with international insurers is that you will almost always pay 100% out of pocket for the majority of medical visits in Mexico and other Latin American countries. You will then file your claim to go towards your deductible, or for reimbursement.
There are times when the insurer will arrange a direct payment directly to the doctor and/or hospital. If you are in an emergency accident that requires 24 hours or more of hospitalization, or if you have a planned surgery, the insurer will contact the facility to see about issuing a GOP letter. That is a Guarantee of Payment from the insurer that the doctor and/or hospital has the option to accept in lieu of payment from the client. Please keep in mind that the doctor or hospital are under no obligation to accept a GOP from any insurer and may request the client to pay directly. In this case, you can either find another facility that will accept the GOP, or pay out of pocket for reimbursement through filing claims.
Once the GOP is accepted, you will be responsible for paying any remainder of your deductible, as well as a copay if applicable. This information will be listed on the GOP and these payments will be made directly to the doctor/hospital. Another cost to expect when checking into the hospital is a deposit to start treatment. It is typically $20,000 pesos, but that number can vary. Again, this is something done by the hospital regardless of the GOP or your deductible. You will need to file that claim as well to be reimbursed.
We strongly recommend that you precertify any surgeries you have planned to either have the payment handled between the insurer and hospital, or to at least have the procedure approved. We go over the complete precertification process in this article.
Please contact your broker if you have any questions about direct pay and reimbursement.