Direct billing means the insurer’s assistance company confirms cover and gives the hospital a guarantee of payment, so the hospital invoices the insurer rather than the family. It is set up by the phone call to the assistance line, not by the hospital, and not automatically. Where a hospital will not wait, as Ottawa’s Queensway Carleton states it will not for non-residents, pay against an itemized receipt and claim it back.
The call itself is covered on emergency: what to do first. This page is about what happens between the insurer and the hospital after it.
What do you need before you start?
An open claim file with the assistance company, the file number, and the name and direct line of the hospital’s patient accounts or billing office. The parent’s passport and the certificate are needed at registration.
| Item | Why |
|---|---|
| Claim file number from the assistance line | The hospital will ask for it; the guarantee is issued against it |
| Assistance company’s name and number | Hospitals know Active Care Management, MSH, Global Excel, Allianz and GMS by name |
| Hospital billing office contact | The guarantee of payment goes to them, not to the ward |
| Certificate showing the underwriter | Billing offices sometimes ask which insurer stands behind the brand; see underwriters explained |
| A credit card, in case | Some hospitals require it at registration regardless |
How do you set up direct billing, step by step?
Six steps. The assistance company does the work; the family’s job is to connect the two offices and keep the paper.
- Open the claim with the assistance line within 24 hours of admission. Ask the agent, in those words, to “confirm coverage to the hospital and arrange direct billing.” Get the file number.
- Give the hospital’s registration or patient-accounts office the insurer’s name, the assistance company’s name and number, and the file number. Ask them to call it.
- Ask the assistance company when the guarantee of payment was sent and to whom. Note the date and the name.
- Confirm with the billing office that the guarantee has arrived and that it covers physician fees as well as hospital charges. Give every treating physician the file number too.
- If any charge is paid by the family in the meantime, get an itemized receipt showing the service, date and amount, and send it to the assistance company within the week.
- At discharge, ask billing for an itemized statement and whether anything remains outstanding, including the deductible.
Wording on what the insurer will do: Manulife’s Assistance Centre will “arrange to have your covered expenses billed directly to us where possible” per the Manulife policy; MSH provides “direct billing coordination” for Secure Travel per PolicyAdvisor; GMS’s Robin Assist runs a direct-billing network per GMS. “Where possible” is the operative phrase at every insurer.
What if the hospital demands payment anyway?
Pay the minimum the hospital requires, against an itemized receipt, and claim it back. Do not sign a lump-sum estimate, do not pay cash without a receipt, and do not let the dispute delay treatment. Queensway Carleton’s published policy is the clearest example of a hospital that will not direct-bill a non-resident.
| Hospital statement (Queensway Carleton, Ottawa) | What it means for a super visa family |
|---|---|
| “Payment is required when you are admitted or when outpatient care is provided.” | Expect to be asked at the desk |
| “Non-resident patients must provide a credit card at the time of registration and pay for their hospital charges directly.” | A card will be taken even with insurance |
| “The Hospital will not accept private insurance for non-resident patients with out-of-country insurance companies.” | A home-country policy is useless here; a Canadian insurer’s guarantee is a separate conversation with billing |
| Canadian private insurers are billed directly “only for inpatient room accommodation.” | Other charges may be billed to you for reimbursement |
| Physician fees “are billed by each physician involved in your care.” | Each doctor is a separate bill; give each the file number |
Source: Queensway Carleton Hospital. Other hospitals differ; ask. If the family pays, the insurer reimburses eligible expenses on the same terms as if it had paid the hospital, less any deductible and any late-call penalty.
What does the hospital charge?
Non-resident rates, which are roughly three times the uninsured-Canadian rate at Queensway Carleton. Niagara Health’s rates are lower per day but due “prior to receiving treatment.” Either way, a week in ICU without a guarantee of payment is a six-figure credit card problem.
Non-resident hospital rates, Ontario, published 2026 — physician fees extra at both — verify with the hospital.
| Service | Queensway Carleton, from 1 Apr 2026 | Niagara Health, from 1 Jul 2026 |
|---|---|---|
| Emergency visit | $1,242 | $850 (emergency or clinic) |
| Ward, acute care, per day | $4,005 | $3,750 |
| Intensive care, per day | $15,642 | $4,500 |
| Day surgery | $3,612 to $45,372 by level | $3,300 |
| CT scan | $2,739 | $1,850 per image |
| MRI | $2,664 per time block | $1,800 per image |
| Payment terms | Credit card at registration | “Due prior to receiving treatment” |
Sources: Queensway Carleton fee schedule and Niagara Health rate schedule. The full picture, including the $96,311 Hamilton case, is on hospital bills without insurance.
How does the deductible interact with direct billing?
The deductible is the family’s share before the insurer pays, and a hospital may collect it at discharge or the insurer may net it from a reimbursement. A $0 deductible keeps direct billing clean; a $5,000 deductible means the first $5,000 of every claim is a hospital bill in the family’s name.
| Deductible | Effect at the hospital |
|---|---|
| $0 | Insurer’s guarantee covers the eligible bill in full |
| $500 to $1,000 | Hospital or insurer collects it; small relative to a $4,005 ward day |
| $5,000 to $10,000 | Family pays up to that amount first; premium saving 35 to 45% |
The trade-off is set out on deductibles. For a parent with a realistic chance of admission, weigh the saving against a cheque to the hospital at discharge.
What if it goes wrong?
| Problem | What to do |
|---|---|
| Guarantee of payment has not reached the hospital after 48 hours | Call the assistance company for the send date and recipient; ask billing to check spam and fax |
| Hospital will not accept the guarantee | Pay against itemized receipts; tell the insurer in writing; claim back |
| Physician bills arriving at the host’s address | Send each to the assistance company with the file number; do not ignore them |
| Insurer says the claim is “pending stability review” and will not guarantee | The hospital may bill you meanwhile; gather the home-country records fast; see denied claim, what next |
| Home-country insurer named on the certificate | Not a Canadian plan; expect no direct billing and an IRCC problem; see requirements 2026 |
SuperVisaDirect helps with receipts, reimbursement claims and billing disputes after the event: [email protected] or a callback, Monday to Friday, 8:00am to 6:00pm Eastern Time. Ottawa-area hosts can read the city page at super visa insurance Ottawa.
Questions people ask
What is direct billing in super visa insurance?
An arrangement where the insurer's assistance company, such as Active Care Management, MSH Assistance or Global Excel, confirms cover and tells the hospital it will pay the eligible charges. The hospital then invoices the insurer. Manulife's wording is that the Assistance Centre will 'arrange to have your covered expenses billed directly to us where possible.'
Do all hospitals accept direct billing?
No. Most Ontario hospitals deal routinely with the major assistance companies, but each sets its own policy. Queensway Carleton Hospital in Ottawa states that non-resident patients must provide a credit card at registration and pay directly, and that it bills Canadian private insurers only for inpatient room accommodation. Ask the billing office what it will accept and tell the insurer.
What if the hospital demands payment before cover is confirmed?
Ask billing to call the insurer's file number and wait for the guarantee. If the hospital insists, pay what you must against an itemized receipt, never a lump-sum estimate, and send the receipt to the insurer the same week. The policy reimburses eligible expenses whether paid by the hospital or by you.
Does direct billing cover doctors' fees too?
Usually the assistance company's guarantee covers both hospital and physician charges that are eligible, but hospitals bill physician fees separately. Queensway Carleton lists physician fees 'as billed by the Physician and are in addition to Hospital fees' and lets patients pay doctors at the bedside. Give every physician the insurer's file number.
Will the deductible be collected at the hospital?
It depends on the arrangement. The hospital may collect the deductible at discharge, or the insurer may net it from a reimbursement. A $0 deductible avoids the question; a $5,000 deductible means $5,000 is yours before direct billing starts. See the deductibles page before choosing a high deductible for a parent who may be admitted.
What does the hospital charge if there is no insurance?
Non-resident rates. From 1 April 2026 Queensway Carleton charges $4,005 per ward day, $15,642 per ICU day and $1,242 per emergency visit; Niagara Health from 1 July 2026 charges $3,750 per ward day, $4,500 per ICU day and $850 per emergency or clinic visit. Physician fees are extra at both.
Talk to a licensed advisor
Mon–Fri 8:00am–6:00pm ET
Sources
- Manulife CoverMe, Travel Insurance for Visitors to Canada policy (direct billing wording)
- Queensway Carleton Hospital, Patients without Ontario health insurance (credit card and billing policy)
- Queensway Carleton Hospital, Fees for patients without health insurance (April 2026)
- Niagara Health, Rate schedule effective July 1, 2026
- GMS, GMS welcomes Robin Assist (direct billing network)
- PolicyAdvisor, Secure Travel (RIMI) Visitor to Canada Insurance Review (MSH direct billing)