Pre-authorisation for planned treatment abroad: avoid surprises

What is pre-authorisation?

Pre-authorisation (also called pre-approval or prior authorisation) is a simple step: before a planned treatment, you or your doctor ask your insurer to confirm that it is covered. When the insurer agrees, it often sends the hospital a guarantee of payment, so the bill can be settled directly.

Pre-authorisation for planned treatment abroad protects both sides. The insurer checks that the treatment is medically necessary and covered by your plan. You learn before the treatment what will be paid and what will not, instead of discovering it on the invoice.

It is one of the most common reasons why claims are reduced or refused, and also one of the easiest to avoid.

Here is a typical situation. Your knee has been painful for weeks. Your doctor refers you to a specialist, who recommends an MRI scan and possibly keyhole surgery. Before booking either, you send the referral and the clinic's cost estimate to your insurer. A few days later, you receive written confirmation that the scan is approved and that the hospital can bill the insurer directly. If surgery is needed after the scan, you repeat the process with the surgeon's report. No guesswork, no large bill to pay yourself.

Which treatments usually need pre-authorisation?

Each insurer and each plan has its own list, so always check your policy documents or your insurer's app. As a general guide, pre-authorisation is often required for:

• Hospital admissions, whether overnight or as a day patient.
• Surgery, including many day-case procedures.
• Advanced imaging such as MRI, CT or PET scans.
• Cancer treatment, such as chemotherapy or radiotherapy.
• Longer courses of therapy, for example physiotherapy beyond a certain number of sessions, on some plans.
• Planned treatment in another country than the one where you live, if your area of cover allows it.
• Some maternity care, such as the hospital stay for delivery, on plans that include maternity.

Routine GP visits and simple prescriptions do not usually need it. If you are not sure, a quick message to your insurer costs nothing and can save a lot.

How to request pre-authorisation, step by step

1. Get the medical details from your doctor. The insurer needs the diagnosis, the proposed treatment and why it is needed. A referral letter or medical report usually covers this.
2. Ask the hospital for a cost estimate. It should list the main costs: room, surgeon, anaesthetist, tests and expected length of stay.
3. Contact your insurer. Use the app, the online form, e-mail or the assistance line, depending on your insurer. Many hospitals that work regularly with international insurers can send the request for you.
4. Allow time. Send the request as early as possible before the treatment date. Complex cases may need a medical review or further documents.
5. Read the answer carefully. Check what is approved, the dates, the hospital, and any amounts that will remain for you to pay, such as a deductible or co-payment.
6. Keep the confirmation and bring it, or its reference number, on the day of admission.

What happens if you skip pre-authorisation?

The consequences depend on the plan, but they can be costly. On many plans, treatment that needed pre-authorisation and did not get it may be:

• reimbursed only in part, with a reduction set out in the policy;
• refused, if the insurer would not have approved it, for example because it is excluded or not medically necessary;
• paid by you upfront, because the hospital has no guarantee of payment.

Even when the treatment is covered in the end, you may have to pay a large hospital bill yourself and wait for reimbursement. With pre-authorisation, a hospital that works with your insurer can usually bill it directly. Our guide on direct billing vs reimbursement explains how this works.

What about emergencies?

Pre-authorisation is for planned treatment. In an emergency, your health comes first: go to the nearest suitable hospital and get treated.

Then, as soon as you reasonably can, you, a relative or the hospital should contact your insurer's assistance line. Many plans ask to be informed within a set time after an emergency admission. Check what yours says. The insurer can then follow your case, confirm cover and arrange payment with the hospital.

If your condition needs a transfer to another hospital or country, the assistance team will also be the one to organise it. Read more in medical evacuation explained.

Practical tips to avoid surprises

• Check your plan before booking. Make sure the treatment is a covered benefit and is not subject to an exclusion, such as a pre-existing condition excluded when you joined.
• Check the hospital. Ask whether it works with your insurer and accepts direct billing.
• Watch the dates. Approvals are usually linked to a specific treatment and period. If the date changes, tell your insurer.
• Ask about extras. Items like a room upgrade or a companion's bed may not be covered.
• Tell your insurer about changes. If the surgeon finds something unexpected and the treatment changes, the hospital or you should update the insurer.
• Keep everything in writing: the request, the approval and any e-mails.

Planning treatment in another country?

Some expats prefer to have planned surgery in their home country or in a regional medical hub. Whether this is covered depends on your area of cover and on your plan's rules for treatment outside your country of residence. Travel costs are often not included. Ask your insurer before you book flights, and request pre-authorisation for the specific hospital you plan to use.

Get a plan that makes this easy

Some insurers make pre-authorisation simple, with good apps, responsive assistance teams and wide hospital networks. At Be Protected Abroad, we compare plans from 20+ international insurers and can tell you how they work in practice. Our advice is free. Talk to an advisor about your situation or any treatment you are planning.

Useful resource: World Health Organization: universal health coverage