On the SXM travel page (https://stmaartenehas.com/travel-requirements/ ) it indicates that you have to have health insurance. Does that mean you have to have insurance that they can bill? The reason I ask is that we use SOS travel insurance which provides $100,000 medical insurance per person but it is based on us paying the bill and then being reimbursed. My wife has United Health insurance and I have an AARP supplemental which covers foreign travel but again both require us to pay the bill and then get reimbursed. Am I being overly concerned about the meaning of health insurance?

I don't think that should be a problem.

I would suggest using the "CONTACT" link on the government page and post the question there as nobody on here has the authority to give a concrete answer. What someone else has experienced may be totally different from what you experience.

Personally, I doubt any foreign country would bill any US based insurance company.

My experience on SXM was I had to pay the hospital but then got reimbursed once I filed the claim with my insurance back home.