Most Americans assume their premium credit cards cover medical emergencies abroad. They don't. The Amex Platinum won't pay your hospital bill. The Capital One Venture X offers zero medical coverage. And the Chase Sapphire Reserve—the only major card that does—caps benefits at $2,500 and legally cannot pay until your home insurer formally denies the claim first. In Japan's pay-first healthcare system, that means floating a five-figure bill on your personal credit limit for months while the bureaucracy grinds through denial letters across the Pacific.

We assume that because Japan is a wealthy, advanced nation, its hospitals operate like they do in the West. They don't. From the cash-only clinics to the systemic reality of emergency refusals (tarai mawashi), here is why your credit card isn't enough to get you through the door.