A Dutch traveler receives a $168,000 hospital bill after a bike accident in the United States. Their insurers confirm coverage, then drop a bombshell: the money will be deposited into the traveler’s personal bank account, and they must pay the US hospital themselves. The transaction fees alone could cost €1,400. The due date is February 1st. This is not a hypothetical scenario, this is exactly what happened to a Dutch citizen in May 2025, and it exposes a critical flaw in how Dutch insurance handles massive foreign medical claims.
The Dutch Insurance Safety Net Has a Giant Hole
The Dutch healthcare system operates on the principle that no one should face financial ruin from medical costs. Your zorgverzekering (health insurance) covers domestic treatment, and a decent reisverzekering (travel insurance) with medical coverage supposedly protects you abroad. In theory, this dual-layer system works perfectly. In practice, when US hospitals charge $168,000 for three days and surgery, the payment mechanics become a nightmare.
Here’s how the coverage actually breaks down: your Dutch health insurer pays up to what the treatment would cost in the Netherlands. For a broken leg surgery and hospital stay, that might be €15,000-€25,000. Your travel insurance is supposed to cover the remaining $140,000+. The problem isn’t the coverage, it’s the payment process.
The Payment Process Trap
Both Zilveren Kruis (health insurer) and ASR (travel insurer) told the traveler they’d transfer the funds to his personal Rabobank account. He would then be responsible for wiring the money to the US hospital. This creates several absurd situations:
- You’re suddenly managing six-figure international transactions between entities that speak different financial languages. The US hospital expects payment in dollars via specific channels. Dutch insurers work in euros through IBAN transfers. You’re the middleman.
- Transaction fees eat into coverage. A €140,000 international transfer via Rabobank costs around €1,400 in fees. Services like Wise offer better rates, but you’re still paying out-of-pocket to move insurance money.
- You’re exposed to currency fluctuation risk. Between receiving euros and sending dollars, exchange rates could shift, leaving you short.
- The timeline is impossible. The hospital gave a February 1st deadline. Dutch insurance claims processing can take weeks. If you miss the deadline, the bill could go to collections, affecting your credit score internationally.
Why Insurers Push the Payment Burden to You
This isn’t accidental. Insurers have structured their processes to minimize administrative overhead. Direct international payments require:
– Verification of foreign banking details
– Compliance with international financial regulations
– Currency conversion management
– Follow-up on payment receipt
By making you the paymaster, insurers avoid this entire workflow. They simply deposit money into a Dutch account and close their file. The US hospital gets paid, or doesn’t, and you’re left managing the fallout.
Many international travelers report similar experiences where insurers deposit funds rather than paying providers directly. One traveler who faced hospitalization in the Dominican Republic described how the hospital demanded credit card details before treatment, while the travel insurer created a dossier number promising payment. Weeks later, the hospital still sent a bill for thousands of dollars to a family member’s address, causing panic until the insurer confirmed they’d pay “in their own time.”
The Itemized Bill Isn’t Your Savior
Standard advice for US medical bills is to request an itemized bill and negotiate. The cyclist did this, the US hospital’s MyChart system generated a detailed breakdown, and every procedure listed was legitimate. The problem wasn’t billing errors, it was the astronomical US pricing structure.
Negotiating yourself is also problematic when insurers are involved. Your zorgverzekering has already calculated their payout based on Dutch tariffs. If you negotiate the US bill down from $168,000 to $100,000, does your insurer reduce their payout accordingly? The policy language is often vague on this point, creating a potential conflict of interest.
The Real Solution: Force Insurers to Handle Direct Payment
You can push back against the deposit-and-pay-yourself model. Here’s what actually works:
- 1. Insist on direct payment upfront. When you contact your reisverzekering after an incident, explicitly request they handle all payments directly. Some insurers, like ASR in the cyclist’s case, will manage the process if you establish this expectation immediately. The key is timing, ask during initial contact, not after bills arrive.
- 2. Submit the US bill as a claim, not an invoice. Rather than treating the hospital bill as something you must pay, submit it to your insurer as a third-party claim. The insurer should settle directly with the hospital, as they would with a car repair shop after an accident.
- 3. Use the insurer’s emergency assistance line. Most Dutch travel policies include 24/7 assistance services like Eurocross Assistance. These services have experience with international providers and can often arrange direct billing. The cyclist’s ASR policy includes this, but he didn’t activate it during the emergency, a common mistake.
- 4. Escalate to the financial complaints authority (Kifid). If your insurer refuses direct payment, file a formal complaint with the Kifid (Klachteninstituut Financiële Dienstverlening). The argument: forcing customers to manage six-figure international medical payments creates unreasonable financial risk and violates the principle of insurance.
Prevention: What to Do Before Your Next Trip
This nightmare is entirely preventable with proper preparation:
- Get explicit written confirmation from your reisverzekering about their payment process for large medical claims. Ask specifically: “If I incur medical costs exceeding €50,000 abroad, will you pay the provider directly or reimburse me?” Get the answer in writing.
- Choose insurers with direct payment guarantees. Some Dutch travel insurers market themselves on handling direct payments. Compare policies not just on coverage amounts, but on payment mechanics. A €10 million coverage limit means nothing if you can’t access it without fronting the cash.
- Activate medical coverage assistance immediately. The moment you’re hospitalized abroad, call your insurer’s emergency line, not just to report the claim, but to activate their provider network and direct billing arrangements. This single call can shift the entire payment workflow.
- Consider a medical cost guarantee card. Some premium travel policies provide a guarantee card that foreign hospitals accept like insurance, triggering direct billing. This is different from standard travel insurance and worth the extra premium for high-risk destinations like the US.
The Bottom Line: Don’t Let Insurers Make You the Bank
The Dutch cyclist’s situation reveals a systemic problem: insurers are offloading payment risk onto customers while collecting premiums for “comprehensive coverage.” A $168,000 bill should never land in your personal bank account. The entire point of insurance is risk transfer, not risk management training.
If you’re facing this situation now: refuse to accept the deposit. Submit the hospital bill to your reisverzekering as a third-party claim and demand they settle directly. Reference their duty of care under the Wet op het financieel toezicht (Financial Supervision Act). If they resist, immediately file a Kifid complaint and contact the Consumentenbond for legal support.
For future travelers: treat the payment process as a policy feature as important as coverage limits. Ask the hard questions before you travel, not after you’re staring at a bill that costs more than your house.
