Today’s global health insurance landscape is more complex than ever before, with increasing numbers of patients from different countries seeking treatment abroad. This creates both opportunities and challenges for hospitals and insurers. One key challenge is navigating international payments, with currency fluctuations, differing regulatory environments and the need for fair and transparent processes presenting complexities along the way. Modern payment solutions play a key role in streamlining cross-border transactions, while guarantees of payment (GOPs) promote transparency, benefiting providers and insurers alike. However, a lack of a gold standard with GOPs complicates matters. “Just as there are different healthcare systems and standards across the world, the same goes for guarantees of payment, which vary across regions and according to local healthcare practices,” explained Lynn Pina, Chief Marketing Officer, GeoBlue. “The more specifics that can be given to the provider about member eligibility, benefits, applicable cost shares (e.g. copays and deductibles), as well as dollar limitations, will help align everyone’s expectations and reduce the risk of provider and/or member abrasion.” This level of detail can help provide clarity for stakeholders, ensuring everyone is on the same page.

Coordinating payments

Healthcare costs and payment structures can vary country by country, with implications for healthcare providers and insurers. ITIJ asked Nico Nabholz, Corporate Communications Manager of Swiss health and accident insurer Helsana, about challenges associated with coordinating payments in different countries. “We primarily have contracts with our customers, who generally pay in Swiss francs (CHF); larger and more expensive treatments abroad are handled by our emergency call centre 24/7, as is the case with most health insurers in Switzerland,” he shared. “Treatment by public service providers in European Union (EU)/European Free Trade Association (EFTA) countries can be processed via the back of the insurance card. This means that the service provider receives payment from the foreign health insurance fund, which in turn makes the payment to the Swiss health insurance fund via the Gemeinsame Einrichtung [Common Institution under the Health Insurance Act], which handles the currency conversion for all Swiss health insurers. Due to financial sanctions, disbursements to certain countries are not possible.”

ITIJ also spoke with James Page, Chief Administrative Officer and Head of Assistance and Claims at Travel Guard, who discussed evolving challenges with cross-border payments from the perspective of a multinational insurance company with a treasury department. “Previously, the most common problem we had with cross-border payments was when we were sending cheques, because it brought a high risk of fraud. Currently, though, we no longer send any form of cheques across country borders; it’s either a wire payment or some other form of electronic payment, unless the customer won’t accept a wire and requires some form of local payment. In that case, we find creative solutions to meet the needs of the customer with our third-party administrator (TPA) as necessary,” he stated. Indeed, TPAs can play an important role as local partners that can facilitate payments in the provider’s country.

Levelling the field

Page said that Travel Guard’s existing process of medical bill review has built-in elements to ensure a fair and transparent payment process. “From both a claims and medical point of view, we will perform a medical bill review to make sure that the details we require in order to make a payment are in place. If there’s anything that we feel is out of place, then we will attempt to negotiate that rate with that particular provider,” he underlined. “Our detailed billing invoices are one key step, and we also (especially with larger providers) enter into direct contracts with medical providers to provide us rates that are in accordance with normal business practices. It’s a step that’s ultimately beneficial to both the provider and us.”

We enter into direct contracts with medical providers to provide us rates that are in accordance with normal business practices

Ensuring security and compliance with regulations when dealing with international healthcare payments is also crucial. Vitesse offers options designed to assist with this. “Vitesse performs sanction checks against payer and payee on all transactions using world-check data. These checks are conducted after the payment is submitted but before they are processed explained Dan Andrews, Insurance Director at Vitesse. “Vitesse has a dedicated compliance function to review and investigate all alerts to establish any true or false matches. As part of the investigation, it may be required to contact a client to obtain further information (RFI) on the payer or payee. All sanction investigations are completed before the payment is released for processing.”

Currency fluctuations

Managing currency fluctuations presents challenges for insurers, in the processing of international claims and settling of payments with healthcare providers. When processing claims, changes in exchange rates can impact the cost of claims and profits. “In countries where the currency is known to fluctuate widely, we pay benefits based on the US dollar, so their benefit structure (and their payment amount) is based on the US dollar,” Page asserted. “This provides consistency to the customer around the amount of benefit that they have, and we know that we’ll have the amount of benefit necessary to pay promptly. But as a rule, in most cases, we buy the currency at the time that we need it.”

When settling payments with healthcare providers across borders, there are similar currency-related risks. Pina spoke to ITIJ about how the international health insurer manages this. “Our aim is to align our foreign exchange (FX) translation and resulting reimbursement to the date of service to make the provider and customer ‘whole’ based on the day that services are incurred. Since the vast majority of provider claims are settled in the local currency, the insurer is absorbing the FX risk,” she explained. “To manage that fluctuation, insurers typically manage their currency holdings based on expected claim reimbursement in each currency. If there are predictable and material currency volumes, effective currency management can offset any FX gains or losses.”

Foreign or local currency?

Nabholz provided an insight into how Helsana manages the impact of currency fluctuations when negotiating medical costs or making payments in foreign currencies. “If there is limited cost coverage, our emergency call centre will deduct a 10% safety margin in each case. The customer may then receive an additional payment,” he stated. “As soon as our customers have the appropriate supplementary insurance, our customers have full cost coverage so that we bear the currency fluctuations. Our financial institution processes our payments abroad in CHF. Currency conversions are carried out by the recipient bank and differences are borne by the recipient. If Helsana is the recipient of payments that show currency differences, small claims may remain outstanding. These receivables will continue to be managed by Helsana.” 

Paying healthcare providers in local currency can help manage currency risks, and insurers will often work with local partners to facilitate these payments. Page said that, in most cases, Travel Guard pays providers from one of its regional service centres using electronic payment tools. “But if there were a case that we did not have a relationship with that facility, or they would not accept the payment vehicle (be it credit card or wire, etc.), we do have relationships with local TPAs that we can pay, and then they would subsequently go in and physically pay the bill on our behalf,” he pointed out.

Electronic payment tools

Digital payment platforms are among the innovative solutions available that can simplify international payments between insurers and healthcare providers. ITIJ asked Andrews about the impact of these platforms. “Application programming interfaces (APIs) enable real-time access to foreign exchange rates, a variety of payment methods, and seamless integration with existing systems such as claims management systems (CMSs). Digital platforms can provide greater visibility into payment statuses and transaction details, as well as control of claims floats or loss funds that are used to fund claims settlements and offer more efficient cross-border payment options,” he highlighted. 

In addition to boosting efficiency and reducing costs for providers and payers, these advances benefit patients, improving the overall experience. “As the healthcare industry shifts towards more holistic and preventative care, payment technologies are becoming strategic levers,” Andrews said. “Fast and seamless digital pay-out systems can enhance patient experiences and improve revenue cycles for healthcare providers. By adopting these innovative solutions, insurers and healthcare providers can achieve faster, more secure and more transparent international payments, ultimately improving their operational efficiency and patient care.”

As the healthcare industry shifts towards more holistic and preventative care, payment technologies are becoming strategic levers

GeoBlue harnesses artificial intelligence (AI), data analytics and automation to assist with expediting the claims process. “By leveraging AI-driven tools, we can process claims faster, regardless of the language or region, ensuring that both providers and customers receive timely and accurate reimbursements,” Pina highlighted. “We are also using data analytics to detect and prevent fraudulent claims, which also allows us to expedite payments to legitimate claims more efficiently. This dual approach of leveraging automation and data-driven fraud detection ensures that we maintain high levels of service for our customers while protecting the integrity of our payment systems and improving overall operational efficiency.”

Streamlining the payment process

Vitesse’s solutions assist healthcare providers and insurers with navigating the complexities of international payments. “We offer a comprehensive treasury and payment solution providing TPAs and insurers with a real-time view on claims funds, a robust safeguarding framework to hold insurers’ claim funds and a great payment experience,” Andrews confirmed. “Our solutions and services are widely adopted by insurers around the globe. Our partnership with insurers is very much focused around treasury management (placement of claim funds in a controlled and regulated environment) and enhanced payment experiences for their claimants. Travel and healthcare firms, such as medical assistance companies, leverage Vitesse’s payment network to support their cost containment strategies and provide a better payment experience to both network partners and policyholders.”

Software and fintech solutions play a critical role in streamlining international payments between healthcare providers and insurers. “At GeoBlue, we leverage a strong set of integrated systems and digital solutions to connect with our robust global network of providers,” Pina commented. “This integration allows them to validate eligibility in real time, request pre-authorisations, issue GOPs, facilitate direct settlement with providers, and track payments, among others, through secure APIs and cloud-based solutions, reducing provider and customer burdens.

“In terms of payments, our platforms are integrated with international banking services, enabling us to process payments in any currency without relying on local intermediaries. This not only reduces costs and complexities but also ensures providers are reimbursed in their local currency at the exchange rate prevailing on the day the service was incurred, protecting them from currency fluctuation risks.”

Innovations assisting international payments

Vitesse offers a faster domestic settlement network whereby insurers can make domestic and international payments from a single platform. “The expedited payment process (leveraging a variety of payment solutions) enables them to secure favourable rates and terms, contributing to overall cost savings and improved client experience,” said Andrews. “This streamlined approach ensures that services are delivered with optimal efficiency, reducing the likelihood of claimants incurring additional hospital care or travel-related expenses due to extended claim settlement periods. This becomes particularly crucial as, in many cases, travel and healthcare companies may not fund upfront and can be held up waiting for the insurer to send the invoice amount before treatment is initiated.”

Healthcare companies may not fund upfront and can be held up waiting for the insurer to send the invoice amount before treatment is initiated

The international health insurance market continues to grow and so these challenges will persist, but by harnessing payment technologies, leveraging partnerships when needed and with a shared commitment to transparency and fairness, smooth financial transactions across borders that benefit all stakeholders are fostering trust and satisfaction among patients, providers and insurers.