Guess it depends on your insurance. I have a card issued by the insurance company, which I show to the doctor, hospital or pharmacy. Any and all bills are sent directly to the insurance company and is paid directly by the insurance company. I have to pay all amounts up to my deductible and 10 percent of any medical bills. Accidents are fully covered and I have to make zero payments. This also includes any bills in foreign countries. I am covered by Sanitas .