Travel insurance and medical evacuation

In case a traveler is injured abroad, medical care will be necessary and all initial care will be local. The quality of care can and will vary greatly, and if the trauma is severe, hospitalization and surgery may follow. Not every case demands evacuation; high-class medical care can be obtained in many developing nations. The difficulty lies in finding or making one’s way to such care when sick or injured.

There are many common misconceptions regarding medical care while traveling. The most common one regards health insurance: domestic American insurance does not pay for the care while abroad nor repatriation home from foreign facilities, and it reimburses only for emergency care. Furthermore, Medicare does not cover medical problems during international travel.

Another assumption is that the traveler’s credit card will cover care. This usually applies only to platinum-level cards which provide assistance; cards of other levels may or may not have advice services.

Travelers also erroneously believe that the U.S. embassy, tour leader or cruise line will take care of them, which is not normally true. Also, young travelers believe in their own indestructibility and don’t believe they need travel health insurance.

Few countries provide reciprocal health care services, and America is not one of them. Medical care in many nations, while far cheaper than in the USA, is a cash business, and a credit card may be required as a guarantee of payment. A domestic insurance card from one of the multitude of American insurance companies will be worthless when one needs care abroad.

Before traveling, it is vital that every traveler prepare for the need for evacuation despite the inherent tendency, present in most people, to deny the possibility.

While insurance may be the most overpriced of all travel services, it may be the most valuable. There are various types of travel insurance providers, ranging from referral services to insurance firms to medical assistance companies.

Referral Companies can provide the names of local physicians and facilities for medical care during the journey. Insurance companies typically offer coverage for evacuation and medical expenses (which are always “pay and claim” and not a guarantee of medical expenses), trip cancellation, lost luggage, trip interruption, liability and death & dismemberment.

Insurance Companies generally do not provide any pretravel information nor supervise medical care. A traveler will need to submit the original receipts for reimbursement once back home, and the patient may have to provide a translated version with it. A study revealed that, because of poor documentation and preexisting illness, only two-thirds of travel insurance claims made by Australian travelers were fully met.

Medical Assistance Companies are the highest level of provider, offering all of the above and typically including evacuation and repatriation, medical referral, medical monitoring, replacement of medication, travel and communication service, translation services and even legal assistance.

Evacuation home may be done through commercial airline flights or private flying ambulances. The timing and mode of evacuation is up to the evacuation company, which must balance the danger of transport to the patient, the necessity of evacuation, the feasibility and the cost. Aircraft ambulances are typically small and, unlike commercial airliners, require frequent refueling during long-distance transport.

Not all insurance is equal, and companies differ widely in their health care delivery, which sometimes fails to even approach the standard of care you are used to at home. Insurers and medical evacuation companies have a responsibility to provide high-quality care efficiently to their customers, but, remember, they are out to make money.

All travelers should learn about the need for comprehensive travel insurance, particularly during their pretravel consultations as they get their vaccines and education about specific travel health issues.

Evacuation and repatriation back to the United States is very costly, usually requiring specialized aircraft with medical and nursing escorts as well as having Customs and Immigration complications. It could easily cost as much as $100,000 and so ought to be purchased in advance. Without a proper travel insurance policy, the traveler is personally responsible and liable to pay for evacuation. Remember that neither domestic U.S. health insurance nor Medicare will cover either evacuation or repatriation.

If the traveler thinks pretravel purchase is too expensive, he should consider the cost of not having bought a policy. It could be argued that if a traveler cannot afford insurance, then that traveler can’t honestly afford to travel.

When purchasing travel health insurance, one should opt for the highest level when possible, which should include all medical, dental and surgical costs as well as personal liability, the cost of evacuation, and miscellaneous costs such as travel rearrangements, lost wages or income and transportation of relatives if restricted from traveling while hospitalized abroad. One should note carefully the exclusions for preexisting health conditions. It is the traveler’s responsibility to read any policy carefully.

This topic highlights the importance of seeking professional and expert help before travel. A travel medicine specialist can help you learn about this topic and keep it in perspective. You can find a list of such specialists on the worldwide Web at two places: www.istm.org and www.astmh.org.

Healthy travels!

—Travel & Health is written by Alan M. Spira, M.D., DTM&H, FRSTM