There are 2 types of international health insurance plans: an indemnity plan which does not participate in the PPO network and a PPO plan which has participating providers within the network. In any case, you can use any provider you like. There are also a few PPO plans in which you can still go to any doctor outside the network without any decrease in coverage.

When you make a purchase, you instantly get the id card, and by the next business day your regular medical insurance id card is mailed to you (in most plans). That card contains necessary information such as your name, id number, claims filing address and toll-free number to call and verify the coverage. When you go to the provider, present the card to them. They may accept the card and agree to bill the insurance company, and the insurance company will pay them directly for all eligible expenses. If they don't accept the card, you will have to first pay them and then file the claim with the insurance company for reimbursement. In either case, you are still responsible for your deductible and co-insurance (in a scheduled benefit plan, any amount beyond what is covered for each procedure.)

For larger expenses such as hospitalization and surgery, the insurance company is generally willing to make arrangements with the hospital for direct payment to them.