Guide
Network hospitals and direct billing: who the bill goes to
By Covered Abroad Research Desk · Last verified July 2026
Network, non-network, and what 'cashless' means
A network hospital is one with a direct-settlement arrangement in place: the insurer has agreed terms with it, so an approved admission is billed to the insurer and you leave without paying the invoice — what some markets call cashless treatment. A non-network facility has no such arrangement; you pay, keep the receipts, and claim reimbursement afterwards. Both routes can be fully covered; the difference is cash flow and paperwork, not eligibility.
Some insurers restrict you to their network. Others let you go anywhere and settle directly where they can. The plans we arrange are the second kind: the insurer's FAQ describes free choice of any appropriate medical practitioner or facility, with direct billing once treatment is pre-authorised.
How it works on the plans we arrange
For a planned admission or outpatient surgery, pre-authorisation is mandatory; once it is given, the insurer contacts the hospital and pays it directly — no pay-and-reclaim. In an emergency, you or someone on your behalf notifies the insurer as soon as possible after admission and covered invoices are settled directly. For outpatient consultations there is no pre-authorisation and no direct billing: you pay, then submit the claim form and receipts, with settlement in a wide range of currencies through a 24-hour settlement service.
The deductible line is where the network matters most on paper: the wording defines the deductible as the amount deducted from reimbursement for treatment outside the direct-settlement network. Claims go through an independent adjudication company and must be submitted within two months of the event; our claims guide walks the form.
60-second check
Not sure the policy you have meets your destination's written rule? Run it through the policy check now, before you build the rest of the file around it.
Check my policyThe question to ask before you buy
The useful question is not "how big is the network?" but "is the hospital I would actually use in it?" — the private hospital nearest your new address, the one your future GP refers to, the one an ambulance would take you to. Our doctor-finder guides for Spain, France and Portugal cover how to find that hospital in the first place.
Bring the name to the quote call. We cannot publish a network list here — it is the insurer's and it changes — but a specialist can check a named facility before you commit, which is worth more than any list.