Medical insurance pre-approval and direct billing: how to apply, what to bring on admission, and what you still pay before discharge
Pre-approval (commonly called ‘免找數’, ‘no bill to settle’) is a service offered by some insurers: you apply to the insurer before admission and, if approved, the insurer issues a ‘letter of guarantee’ to the hospital and pays it directly. The approved amount is an estimate, and before discharge you still pay charges not listed in the ‘letter of guarantee’, such as the deductible, co-payment and items outside the cover.
What are pre-approval and direct billing?
It is an arrangement in which the insurer pays the hospital directly: some insurers offer a pre-approval service in which the insurer pays the medical institution directly; the insured must apply to the insurer within a specified number of working days before admission and bring the ‘preliminary coverage assessment confirmation / letter of guarantee’ issued by the insurer when being admitted (Insurance Authority, January 2024).
The pre-approval service and the claim amount are estimates and may differ from the final actual medical charges; the claim amount is subject to the final claim settlement (Insurance Authority, January 2024).
For how medical insurance covers outpatient and inpatient care, see Using medical insurance for a private specialist.
How do I apply for pre-approval?
Apply to the insurer first; some hospitals can submit the application for you: the table below is the direct billing procedure published by St. Paul's Hospital. Hong Kong Adventist Hospital – Stubbs Road says that individual insurers may have other procedures and documents, and patients must contact the insurer before receiving services to ask about the cover and the charges payable, and apply for the payment arrangement in advance.
St. Paul's Hospital says that, because of the protection of the Personal Data (Privacy) Ordinance, the hospital will not check on your behalf whether a policy applies or what it covers; whether a ‘letter of guarantee’ is issued is decided by the insurer.
| Step | What to do (procedure published by St. Paul's Hospital) |
|---|---|
| Before admission | Ask the insurer whether the policy applies to pre-approval / direct billing, and what it covers and what charges you need to pay |
| Prepare documents | Get the ‘Pre-approval / Pre-authorization Form’ from the insurer and fill in the insured person's / patient's details; give it to the hospital together with a copy of the medical card (front and back) and the Patient's Authorization Letter for Handling Insurance Pre-approval |
| Hospital applies | After receiving the documents, the hospital applies to the insurer; if the application succeeds, the insurer issues a ‘letter of guarantee’ to the hospital |
| Admission registration | Show your identity card or passport and a valid medical card so that staff can check the details in the ‘letter of guarantee’ |
| Before discharge | Pay the charges not listed in the ‘letter of guarantee’, such as the deductible, co-payment and charges outside the cover |
How long does pre-approval take?
It depends on the insurer: the insured must apply to the insurer for pre-approval within a specified number of working days before admission, and should first ask the insurer how long it takes (Insurance Authority, January 2024).
Hong Kong Adventist Hospital – Stubbs Road says that the ‘letter of guarantee’ must be issued before discharge and confirmed as accepted by the hospital; otherwise the patient must pay interim bills during the stay and/or the final bill before discharge, and then claim from the insurer with the official receipts; for emergency admission or emergency surgery, the hospital will help contact the insurer.
Which insurers' letters of guarantee do hospitals accept?
Generally only those from insurers or employers that have an agreement with the hospital: the table below sets out the rules each hospital publishes.
How this list was put together: a hospital is listed when it publishes a rule of this kind on its own website and this site has checked the wording against that page. The rows are in a fixed order; this site does not recommend any hospital, the order says nothing about quality, and the list is not every hospital in Hong Kong.
| Hospital | Published rule |
|---|---|
| Gleneagles Hospital Hong Kong | Does not accept ‘letters of guarantee’ issued by companies or insurers that have no ‘hospitalisation guarantee’ arrangement with the hospital; if the documents the insurer requires cannot be provided, you may have to pay the charges and deposit in full yourself |
| St. Teresa's Hospital | Accepts only ‘letters of guarantee’ issued by employers or insurers that have a contractual agreement with the hospital, and does not accept ‘letters of guarantee’ or medical cards issued by overseas employers and insurers; otherwise a deposit must be paid on admission |
| Canossa Hospital (Caritas) | No deposit is needed, after the hospital's approval, if you show a ‘letter of guarantee’ signed by the insurer's Hong Kong agent (the policy cannot be used as proof), or a ‘guarantee of payment’ signed by an embassy, employer or the attending doctor |
| CUHK Medical Centre | Has signed direct billing agreements with some insurers and organisations; their clients or employees may not need to pay a deposit on admission |
| Hong Kong Adventist Hospital – Stubbs Road | If the insurer has not signed a direct billing agreement with the hospital, you can ask the insurer whether it can appoint a third-party administrator contracted with the hospital to issue a ‘letter of guarantee’; the hospital also accepts payment of the admission deposit or final bill by the insurer with its corporate credit card |
With pre-approval, do I still need to pay before discharge?
You may have to: St. Paul's Hospital says that patients still need to pay, before discharge, the charges not listed in the ‘letter of guarantee’, such as the deductible, co-payment and charges outside the cover; if the insurer finds additional charges after its review, the hospital will contact the patient for payment.
Hong Kong Adventist Hospital – Stubbs Road says that confirmation that you can use the direct billing service is not confirmation of the claim; the direct billing amount does not necessarily represent the claim amount, and after assessing the claim the insurer may collect from the patient the charges for items not covered, the co-payment and so on.
CUHK Medical Centre says that, in cases with a direct billing arrangement, some may still involve a deductible, co-payment or self-paid items, which must be paid before discharge.
Hong Kong Adventist Hospital – Stubbs Road says that, in the hospital's experience, when a patient upgrades the room some insurers require payment of additional charges, and some withdraw the ‘letter of guarantee’; Gleneagles Hospital Hong Kong also advises confirming the cover before admission or before changing wards.
What else should I watch for when paying with insurance?
The name must match: Hong Kong Adventist Hospital – Stubbs Road says that the name on the letter of guarantee issued by the insurer and on the medical card must be the same as on the identity document, unless the insurer issues a separate written confirmation bearing the identity document number; Hong Kong Baptist Hospital says that the name on the insurance policy must be the same as on the admission registration documents.
Hong Kong Adventist Hospital – Stubbs Road can arrange direct billing with only one insurer; if you have two policies, you must choose one insurer.
Policy holders of Voluntary Health Insurance Scheme certified plans can, before receiving medical services, ask the insurer to estimate the amount payable, attaching the hospital's and/or attending doctor's estimate; after receiving a fee estimate for a non-emergency procedure, the insurer should provide in advance an estimate of the amount payable for the whole procedure, and state that the estimate is for reference only and does not constitute final liability for the claim (Health Bureau Code of Practice, July 2022).
Before admission, you can ask the insurer: whether the policy applies to pre-approval / direct billing, which hospitals it has agreements with, how many working days before admission you must apply, the deductible and co-payment you will pay yourself, and the room class you can stay in.
For admission deposits and the documents to bring, see Private hospital admission deposits and preparation; for the basic rules of the Voluntary Health Insurance Scheme, see VHIS basic rules.
Frequently asked questions
How long does pre-approval take?
The insured must apply to the insurer for pre-approval within a specified number of working days before admission, and should first ask the insurer how long it takes (Insurance Authority, January 2024).
What does ‘免找數’ mean?
‘免找數’, as it is commonly called, means pre-approval and direct billing: the insurer issues a ‘letter of guarantee’ to the hospital and pays it directly, but before discharge you may still need to pay the deductible, co-payment and charges outside the cover.
Is the pre-approved amount the final claim payment?
No: the pre-approval service and the claim amount are estimates, and the claim amount is subject to the final claim settlement (Insurance Authority, January 2024).