Like all travel insurance policies, the billing process is at the discretion of the provider. It depends on the billing practices of the provider the insured person chooses to visit. Usually for bigger medical situations (hospitalization, surgery, etc.), providers tend to bill the insurance companies directly. For smaller situations, like doctor's consultations, they sometimes ask the insured person for upfront payment first, which can be reimbursed. For claims to be processed, the insured person would need to send in the claimant information form and the bills (if they have to pay up front) to the insurance company. Direct billing is more common within preferred provider organization (PPO) networks. One plan which offers a widely known and accepted PPO network is CoverAmerica - Gold. The PPO Network for the CoverAmeria - Gold Plan is United Health Care. It is one of the most extensive PPO networks in the USA, and it is easy to find providers anywhere in the country. For more information, please feel free to call us at 1.866.384.9104 or email us at support@visitorscoverage.com.