Payment, Cancellation and Refunds

The single most useful rule in medical travel is this: pay the hospital, into the hospital's official account named in your written contract, and never pay an individual. Not a coordinator, not an agent, not a driver, not a relative of somebody at the clinic, and not a personal account belonging to anybody however senior they sound.

Almost every story of money disappearing in this sector comes back to that rule being broken, usually with a plausible explanation attached — the hospital's account is being audited, a transfer to a personal account is faster, a discount is available for cash. Those explanations are the mechanism, not an exception to it.

Our own position follows from the same reasoning. We do not take payment for treatment. Your money goes from you to the hospital, and the hospital issues the invoice and the receipt. We are not in the middle of it, which means we cannot lose it, cannot delay it, and cannot be the reason a refund is difficult.

It also means something about incentives that is worth saying out loud. An intermediary that holds patient funds has a commercial interest in the treatment going ahead regardless of whether it should, because it is sitting on the money. Not holding it removes that pressure entirely.

If we ever charge for something of our own, we tell you the amount and what it covers in writing before you commit, and you can say no. We will never take a payment you were not told about, and we will never take one out of a sum you believed was going to a hospital.

Most centres ask for a deposit to hold a surgical date, and that is reasonable — theatre time and a team are being reserved. What varies enormously is the cancellation policy behind it — what happens to that deposit afterwards — and the variation is not covered by anything you will find on a hospital website.

So ask about the refund of a deposit specifically, and about the two situations that genuinely occur.

The first is that the centre reviews your case and declines it. This is common, and it is not a failure — a programme saying no after reading your imaging properly is behaving well. But a deposit paid before a full review is a deposit paid before anybody knew whether the operation was possible, so ask whether it comes back in that circumstance, and get the answer in writing. A centre that keeps a deposit after refusing a case has told you a great deal about itself.

The second is a visa refusal. Patients from several of the countries our readers write from are refused medical visas regularly, for reasons that have nothing to do with them. Very few contracts address it. Ask before you pay.

There is a third situation worth asking about even though it is less common: you become too unwell to travel. It happens in exactly this population, because these are people with failing organs, and a contract that treats it as a no-show is a contract to think twice about.

One practical suggestion. Ask for the cancellation terms before you ask for the price. It reveals more about how a centre treats patients than the number does, and you will be reading it without the pressure of having already decided.

A price is a number and a currency, and the second half is the part that moves.

Establish which currency binds the contract. If a quotation is given in one currency and the invoice arrives in another, the exchange rate on the day decides what you actually pay, and over the weeks between agreeing and travelling that difference can be substantial. Where a centre will fix the price in a stated currency with a written expiry date, that is worth having.

International transfers carry costs that no quotation mentions: the sending bank's fee, intermediary bank charges that can be deducted mid-route, the receiving bank's fee, and the spread your bank applies to the exchange rate, which is usually larger than the visible fee. Ask your own bank for the all-in cost before you assume the quoted figure is what leaves your account.

Keep every receipt, from the first appointment onwards. Insurance claims, tax relief where a country allows it, and any later dispute all depend on documentation you can only gather at the time. Assembling it during the trip is easy; reconstructing it six months later is not.

And put one person in charge of paying and keeping records, even when the money is coming from several members of a family. Split responsibility is how receipts go missing, and a missing receipt can cost a reimbursement you were entitled to.

Finally, the budget rule from our cost pages, which belongs here too: hold a reserve outside the money you are prepared to spend. Running out mid-treatment is the worst position in medical travel, because the decisions taken from there are financial rather than clinical.

These recur in the accounts patients give us, and every one of them is visible before any money moves.

A request to transfer to a personal account. This is the single clearest sign, and no legitimate explanation for it exists. A hospital has a bank account in its own name.

A firm price before anyone has read your file. A serious centre cannot quote a case it has not seen, so a confident figure given in the first message is a marketing number that will change — and it will change when you are in a weaker position to argue.

Artificial urgency. "This price ends tomorrow" has no place in a surgical decision. Real medical urgency is explained by a clinician with reasons from your file; commercial urgency is repeated by a salesperson with no reasons at all.

A refusal to put things in writing. Somebody who answers everything on the phone and declines to send the same answers in a message knows those answers will not hold up.

A discount for paying in cash. Cash exists to leave no record, and a transaction with no record is one you cannot later prove happened.

A price far below everybody else's for something everyone describes as difficult. Real cost differences between countries exist and are large. A price that makes no sense usually means something has been left out of the quotation, or something is wrong with what is being offered.

And the one that ends the conversation entirely: any payment described as being for an organ, or for a donor, or as compensation to a donor's family. That is not a fee structure, it is a crime, and our ethical sourcing policy explains what to do about it.

Ask your insurer or your national health system in writing before you pay anything, not afterwards. This is the single most common avoidable loss we see, and the reason is procedural rather than medical: many schemes require prior authorisation, and an approval that had to be obtained before travel cannot be granted retrospectively however sound the medical case was.

Request the list of required documents in writing too, and at the first contact. Most refusals are caused by a missing document rather than a rejected treatment, and the list is rarely volunteered in full.

Read two clauses in a private policy specifically: exclusions, and prior authorisation. Many policies exclude treatment outside an approved network, or require notice a set number of days in advance. Also check whether medication after discharge is covered separately from the procedure — it often is, and after a transplant that distinction is expensive.

Where a public system may fund treatment abroad, the route usually runs through a formal referral rather than a personal application, and the timescales are long. Start early, because the process is slower than the illness in a good number of cases.

Keep every piece of correspondence, and note who told you what and when. Coverage decisions are frequently resolved on what was documented at the time rather than what anybody remembers, and the person you spoke to may not be there later.

And if you are funding this yourself, as most people reading this are: ask the centre whether it offers a payment schedule, what is refundable at each stage, and whether the currency is fixed. Those three answers change the real cost more than any negotiation over the headline figure.