Why Your Expat Staff Might Be Confused at the Hospital: Direct Billing vs. GOP Explained
For expat employees and HR teams alike, navigating health insurance at the point of care can be unexpectedly confusing – especially when terms like “direct billing” and “Guarantee of Payment (GOP)” are often used interchangeably or without proper explanation. The result? Delayed treatment, administrative stress, and frustrated employees.
Here’s a simple breakdown of the difference, and why it matters.
Direct Billing: The Easiest Path (When It Works)
Direct billing means the hospital or clinic has a direct billing arrangement or contract with your insurer. The provider invoices the insurer directly, and the insured employee walks away without needing to pay upfront (aside from any co-pay or deductible). This is typically only available at in-network hospitals – and not even all of them.
Best case scenario: The member shows their insurance card, signs a form, and the insurer takes care of the rest.
But not all services – or providers – offer this convenience. And sometimes, even a usually direct-billing provider may ask for payment upfront or ask for a gurantee of payment if the insurer’s system is down, or if the treatment falls outside pre-agreed services. For example, Bangkok Hospital nearly always asks for a GOP for out-patient treatment, even for those patients with health insurance from an insurance provider that they have a direct billing contract with.
In One World Cover’s experience, when employees travel outside their own country, they should expect that direct billing as described above will only work some of the time. And when that happens, they will either need to pay upfront (and submit a claim thereafter to the insurance provider for reimbursement) or – if they know ahead of time that direct billing won’t work – contact the insurance provider ahead of time to request a GOP (see below).
For this reason, it’s important to manage employee expectations as to whether or not direct billing will work seamlessly when people travel, because unfortunately most of the time, it doesn’t.
Guarantee of Payment (GOP): What Happens When Direct Billing Isn’t an Option
When direct billing isn’t available, a Guarantee of Payment (GOP) (also sometimes known as a treatment guarantee or payment guarantee) can bridge the gap. This is a written confirmation (usually in the form of an email) from the insurance provider to the hospital or clinic, promising to cover the cost of a particular treatment.
GOPs are most often used when:
- The provider isn’t in the direct billing network
- The treatment is elective or requires pre-authorization (please note that in-patient treatment nearly always requires pre-authorization ahead of time. And because in-patient treatment can be costly, it’s therefore doubly essential to ask the insurance provider to issue a GOP)
- The hospital doesn’t know the insurer and wants a payment guarantee
Important: GOPs are not instant. They often require 24–48 hours to be processed, especially over weekends or holidays.
Without a GOP in place – and no direct billing arrangement – your employee may be required to pay upfront and then submit a claim for reimbursement.
Why This Confuses Staff
Employees are often told “Your plan offers direct billing” – but no one tells them it’s only at certain providers, for certain treatments, during certain hours, and that it doesn’t always work as planned. The result? Mismatched expectations, and stressful surprises when someone is sick or in pain.
What Expat Employer HR Teams Can Do
- Educate at onboarding. Include a short, plain-language summary in your new hire pack explaining the difference between direct billing and GOPs – and when each is used.
- Provide a short list of recommended hospitals with direct billing arrangements and notes on when GOPs may be needed.
- Set expectations: Tell staff that for some services – like MRIs, surgery, or non-emergency admissions – a GOP might be needed even at a direct billing facility.
- Work with your broker or insurer to set up standard communication templates staff can use when requesting GOPs.
New in 2025: Smart Payment Cards Are Bridging the Gap
To address the uncertainty between direct billing and GOPs, some insurers are rolling out digital or physical healthcare payment cards that streamline the payment process – especially at out-of-network or unfamiliar hospitals. In 2025, solutions like PassportCard, AXA’s virtual payment card, and APRIL International’s Easy Pay card are helping insured members avoid upfront payments. These cards are pre-loaded with funds for approved treatments via the insurer’s app or service platform, allowing members to pay the provider instantly at the point of care – no paperwork, no reimbursement delays, and no waiting for a GOP to be issued.
For employers, these innovations are especially helpful in geographies where provider networks are inconsistent or evolving. They also represent a growing trend in international private medical insurance: empowering members to manage healthcare payments with the same ease as tapping a debit card.
At One World Cover, we work with all of these providers and can help companies explore which solution is the best fit for their needs. Whether you’re looking to improve staff satisfaction, reduce reimbursement stress, or simply modernize your claims experience, we’d be happy to provide guidance – and quotes – based on your current plan and goals.
Don’t Let Admin Confusion Derail Your ROI
At One World Cover, we help our clients not only negotiate competitive premiums – but also improve the employee experience through better education, onboarding materials, and year-round support.
A well-communicated insurance process saves your HR team time and dramatically improves staff satisfaction. After all, the best insurance plan in the world won’t help if your employees don’t understand how to use it.
To learn more please get in touch: [email protected] or click here to contact us.
