The "Secondary Payer" Nightmare: Why Your US Credit Card is a Ghost in Japan
The Assumption
Americans trust their premium credit cards. You pay $550 a year for the Chase Sapphire Reserve, flash it at the Amex Platinum lounge, and assume you are covered. "Travel Insurance" is listed in the benefits. You check the box and forget about it.
But here is the uncomfortable truth I discovered after digging through the actual certificates of insurance: Most US premium credit cards offer zero medical coverage. And the one card that does? It legally cannot pay you until you have first filed a claim with your home health insurer—even if that insurer has never covered a single dollar outside the United States.
Welcome to the bureaucratic purgatory of "Secondary Coverage."
The Ghost Benefits: What Your Card Actually Covers
Let's be forensic about this.
The Capital One Venture X—a $395/year premium card—provides no medical or evacuation coverage whatsoever. It covers your death. It does not cover your hospital bill.
The Amex Platinum—$695/year—offers "Global Assist Hotline," which sounds reassuring until you read the fine print. They will coordinate your evacuation. They will not pay for your doctor, your hospital stay, or your prescriptions. That is explicitly excluded.
The Chase Sapphire Reserve is the only major US premium card that reimburses emergency medical expenses abroad. The cap? $2,500, with a $50 deductible. That might cover an ER visit for stitches. It will not cover the $30,000 cardiac event.
And here is the structural trap: Chase's coverage is "secondary and payable on an excess basis." Translation: They cannot legally pay you a cent until your primary health insurance has first processed the claim.
The Denial Letter Dance
Imagine you are in a Tokyo hospital room. You call Chase's benefits line. They tell you to file with your home insurer first—Blue Cross, Aetna, UnitedHealthcare, Medicare.
You call your insurer. They tell you: "We don't cover international claims. Send us the itemized bill in English, and we will issue a formal denial."
How long does that denial take?
Insurer Time to Denial Letter Medicare File Form CMS-1490S, wait for quarterly MSN Blue Cross / Aetna / United 30–90 days Cigna Global 5 business days
You are now floating a $20,000 hospital bill on your personal credit limit for one to three months—just to get the paperwork required to start your credit card claim.
And once you file with Chase? Real-world claimants report timelines ranging from two days (best case) to nine months (documented nightmare). One traveler documented 39 emails and 22 phone calls over six months for a $7,000 claim that was ultimately denied.
The Medicare Trap
For retired travelers, this system is especially brutal.
Medicare provides zero coverage outside the 50 states, DC, and US territories—except in three narrow border emergency scenarios that do not apply to Japan. You must still file the claim. You must still wait for the denial. You must still prove to Chase that Medicare said no before they will consider your $2,500 benefit.
Meanwhile, that coronary bypass in Tokyo costs $30,000–$40,000. Your credit card coverage, after the denial dance, reimburses less than 10% of the bill.
Japan's "Pay First" System Compounds Everything
In the US or UK, hospitals bill insurers directly. In Japan, tourists pay 100% upfront. No exceptions. No negotiations.
Japanese hospitals require security deposits before admission—typically ¥100,000 (~$700). They do not bill foreign insurance companies. They do not accept "we'll sort it out later." If accounting is closed on a Sunday, some facilities will refuse to admit you for non-emergencies until Monday.
A simple ER visit runs $140–$350. A 45-day stay with surgery? Over $20,000. And you are paying this out of pocket, on your card, while the secondary coverage bureaucracy slowly grinds through denial letters and document requests across the Pacific.
One traveler reported a £57,500 (~$73,000) hospital bill for cardiac stents. They paid £11,500 (~$14,600) upfront just to be discharged—before insurance settled the remainder weeks later.
The Fix: Primary Coverage That Bypasses the Bureaucracy
Primary travel insurance pays first. It does not require a denial letter from your domestic insurer. It does not require you to file with Medicare and wait for a quarterly summary notice. It processes your claim directly.
Better yet, some primary insurers offer direct billing—contracts with hospitals worldwide that allow them to pay the facility directly. You show your policy, they call the insurer, a Guarantee of Payment is faxed, and you owe nothing upfront except your deductible.
This is not a minor administrative convenience. This is the difference between navigating a medical emergency and navigating a medical emergency while simultaneously managing a months-long, multi-party insurance claims process from a hospital bed in Shinjuku.
Preserving Your Peace
Preserving your peace in Japan is an intentional act. If you have spent years saving for this trip—the temples, the izakayas, the bullet trains through mountain passes—do not let a medical emergency become a financial crisis compounded by bureaucratic paralysis.
I've found that the best way to bridge the gap between "secondary coverage purgatory" and "immediate financial protection" is to carry a Primary Travel Insurance policy with direct billing capability. Your credit card coverage can serve as a backup for lost luggage. It should not be your lifeline for your health.
Conclusion
The assumption that your premium credit card covers you abroad is, for most Americans, a dangerous fiction. The Amex Platinum does not pay medical bills. The Capital One Venture X does not pay medical bills. The Chase Sapphire Reserve pays a maximum of $2,500—after you have spent months collecting denial letters from insurers who never covered Japan in the first place.
In a country that demands payment upfront, secondary coverage is not coverage. It is a reimbursement promise buried under paperwork, float periods, and the hope that your credit limit can absorb a five-figure hospital bill while you wait.
Buy a real policy. Travel with certainty.
