Emergency Medical Evacuation 101 — what overseas travelers need to know

By Wayne Wirtanen
This item appears on page 66 of the May 2009 issue.
This is subscriber only post.
Get one year of online-only access — only $15!
Below is a sample of the article.
Please login or subscribe to ITN to read the entire post.

by Wayne Wirtanen

Overseas emergency medical evacuation services, or “medevac,” are extremely rarely needed, but they can be extremely expensive and are unlikely to be provided by your at-home medical policy.

These services will provide required transportation (but not the cost of medical care) for any client who experiences a serious medical emergency while at least 150 miles from home. There are usually no preexisting-condition limitations. There may be some destination limitations (strangely enough, Medex does not presently provide service from Iraq or Afghanistan).

The service consists of two levels of transportation: 1] transport to the nearest appropriate medical facility (involving some 80% of calls for assistance) and 2] repatriation, or transport to a home-city hospital.

If the nearest appropriate medical facility cannot suitably treat a problem, an attempt will be made to stabilize a condition before any further transportation is scheduled. Meanwhile, the evacuation provider will monitor the medical condition and supply additional support and advice, sometimes even flying a companion to the patient’s bedside. An “800” phone number or other notification instructions of policy holders are provided.

The medevac provider must make all of the above-described arrangements.

Medevac services are generally provided in a full travel insurance package or can be purchased individually for individual trips or for annual coverage. Amounts of coverages run from $25,000 to unlimited.

Overseas medical emergencies

Letters that I’ve received over the years from travelers who have described the experience of a serious overseas medical emergency have invariably included the word PANIC!

In a medical emergency at home, they would have known exactly what to expect: an ambulance would take the victim to a nearby familiar hospital; the condition and treatments would be explained, and there likely would be family or friends to call on for support.

Even at home there would be a level of stress, of course, but family would be able to leave the patient at the hospital, when appropriate, and go home confident that things were well in hand and that their health insurance or Medicare would handle the expenses. We’ve probably all had some variation of this experience involving a relative or a loved one.

Hopefully, you have not, however, experienced this level of medical emergency in a foreign country. Stop for a minute and consider the possible contrast with the above description.

You probably do not speak the language well, if at all. In a relatively sophisticated city you can expect to be provided with reasonable ambulance service; a tour guide or even strangers would likely assist in getting the victim to a nearby hospital. But if you were in a rural or remote location, say Machu Picchu, what then? If you are on a tour, it is going to go on without you.

How do you know what level of medical care is available in your location? (For example, even in relatively modern western Russia, the last time that I checked, emergency medical evacuation providers routinely flew seriously ill patients to nearby Finland for first-world medical treatment.)

How do you communicate with medical personnel? How do you pay for medical services? Where can you stay while treatment is under way? How can you contact friends or family back home? How do you get your spouse or companion home if further medical treatment is necessary? If you were on a tour or a cruise, hopefully a guide would stay with you at first, but you are likely to quickly be on your own. Does the word “panic” sound appropriate?

Advertisements for travel insurance companies frequently use the above scary scenario to urge you to buy an expensive and sometimes what is not always a cost-effective travel insurance package. The medical emergency evacuation coverage is usually only a small fraction of the coverages in a travel insurance package; fortunately, this potentially very important medevac service can be purchased separately at a small fraction of the cost of a full travel insurance package.

Medevac services are prepared to step in and take charge of your emergency. It is your responsibility to stay in touch with the provider if there are any communication problems.

What are the odds that you’ll experience an overseas medical emergency?

My research has indicated that the likelihood of having a medical emergency overseas that requires a visit to a hospital is about one or two in one thousand trips, and most commonly it is for a problem that is not life-threatening.

If you’ve traveled some, you probably have occasionally noticed that a tour member required a hospital visit. The most common cause of overseas travel accidents is a fall. (Do I have to remind you to wear only well-broken-in, comfortable and sensible shoes with nonslip bottoms on a trip where you are likely to be walking on unfamiliar paving? Watch where you are walking and don’t forget to use hand railings whenever they are available. Minimize your chances of being a statistic. End of lecture.)

Generally, minor broken-bone problems can be temporarily treated satisfactorily anywhere. A broken bone can be painful and can disrupt a trip but generally is considered to be a manageable crisis. You are only slightly more likely to have some other medical emergency on a trip than you are at home.

If most overseas hospital visits are for relatively minor problems, then my calculations and travel observations suggest that the likelihood of experiencing a serious and genuinely panic-generating medical emergency is in the ballpark of one or two per 2,000 trips.

(Travel insurance companies have not been very forthcoming in providing these kinds of statistics when requested. However, in writing my many travel insurance articles that have appeared in the pages of ITN, I have submitted most of them to someone in the travel industry to review statements and statistics for accuracy before publication. My emergency-evacuation statistics have not been challenged by these travel insurance companies.)

However remote the possibility, these serious medical emergencies do occur, and when you or your companion happen to become the statistic, “panic” may be your first reaction. It pays to consider the odds, but the Boy Scouts have it right when they recommend “be prepared.”

An example of an evacuation gone slightly wrong

Evacuation services INSIST that they are the ones to make evacuation arrangements — and only after they have determined that the medical condition requires some evacuation transportation. (No evacuations for blisters, headaches or splinters, etc.)

Recently, an ITN subscriber had a medical emergency in a remote area of Mexico. She called the “800” number provided by her evacuation service and explained her situation. There was a heavy snowstorm on its way that probably would have delayed or prevented timely assistance that would have to come to her location. She said that she could quickly arrange for a local vehicle to get her to a hospital.

The person whom she spoke to approved her plan and told her to get receipts and to submit them when she got home.

When she did submit the claim (about $800), it was refused. The evacuation service she spoke to in Mexico was only a broker, which used another company to actually provide evacuation services. When she protested the rejection of the claim, which eventually had gone to the actual evacuation provider, she was told that she had not allowed the provider to make the evacuation arrangements. The broker service denied having told her to make her own arrangements.

She was incensed because she had done exactly what her policy had instructed. It boiled down to a “he said, she said” standoff. Persisting (at my recommendation) with correspondence and many phone calls, she finally had her attorney threaten to file a lawsuit. The company settled and paid her claim; it probably was cheaper for them than dealing with a lawsuit.

There are some lessons to be learned here. 1) Remember that the evacuation arrangements must be made by the evacuation provider. 2) If you should find yourself in a situation as described above, get one or two additional people to speak to the rep at the “800” number to confirm the instructions, preferably someone with some level of medical qualifications, so that you will have someone to back up your claim. 3) If you feel you must make any emergency medical transportation arrangements on your own, be prepared to pay for them.

Who provides “stand alone” emergency medical evacuation services?

Compare providers and their features and costs at InsureMyTrip.com (800/487-4722, www.insuremytrip.com). If it’s important to you, pay attention to whether the customer or the company will make the choice of evacuation hospitals.

The following were a couple of medevac providers that I found stood out for their desirable features:

Med Jet Assist (800/527-7478, www.medjetassist.com) has some of the most attractive text. Their motto is “ Medical evacuation from anywhere in the world to the hospital of your choice!”

Required transportation will be medically supervised in their own aircraft. They claim to be able to come get you from any hospital or accessible airstrip. (I was told that there was one evacuation that required the hiring of Chinese laborers to build a one-time-use airstrip in a remote area.) Costs for individual trips starts at $95 per person.

Check their website for examples of unusual emergency medical evacuation stories, including the one where a successful emergency medical evacuation began with the first leg of the journey beginning with transportation in a wheelbarrow.

Travel Guard (800/826-4919, www.travelguard.com) is unusual for including $25,000 for medical expenses plus dental coverage.

• An economical alternative, but one not listed by InsureMyTrip, is Divers Alert Network, or DAN (800/446-2671, www.diversalertnetwork.org). This is the medevac coverage I use, except if I were to travel to a way-off-the-beaten-path destination. Their cost for a family for one year is $44.

Sample emergency evacuation costs

The MedJet Assist website provided the following samples of what you’d have to pay, yourself, for emergency medically supervised evacuation transportation:

Transportation from Durban, South Africa, to Boston, $125,000, and from Rochester, Minnesota, to New York City, $16,000.

Other sources of medevac coverage

• The American Automobile Association (800/922-8228, www.aaa.com), actually some 77 different organizations across the US and Canada, has varying packages of upgraded services that include medevac with their “plus” or “premium” memberships. If you are an AAA member, check to see if your organization offers medevac coverage.

• The American Express “Platinum” card also offers some medevac coverage.

Final recommendations

Check with your at-home health care provider to see if they provide for medical expenses overseas and whether or not they pay for emergency medical evacuations. The last time I checked, Kaiser does provide for medevac on a “case-by-case basis.”

For any overseas trip, my “be prepared” recommendation for any kind of emergency is to have, at minimum, medevac and medical coverage, a generous amount of cash in money belts and two credit cards with healthy balances.

Reminder — Medicare does not cover destinations outside of the USA.

Also, “Medigap” policies are all the same regardless of the company used. Policies are rated letters “A” through “K.” All the policies “C’ through “K” have an “Emergency care received outside of the US” clause that pays 80% of medical expenses after a $250 deductible (up to a lifetime maximum of $50,000). These “Medigap” policies could protect their holders from catastrophic overseas medical expenses.

Quite a few travel insurance companies offer “stand-alone” short-term medical coverage. If you need information regarding these policies, contact travel insurance broker Dan Drennan at World Travel Center (800/786-5560, ext. 3131, or, more directly, 402/343-3621). He can provide advice and policies from a large number of companies.

If you would like to explore the medevac topic further, order a reprint of my article “The Ins and Outs of Emergency Medical Evacuation Coverage” (Dec. 1999, pg. 64) by sending $2 to Wayne Wirtanen, 4341 Shangri-la, Placerville, CA 95667.

Please login or subscribe to ITN to read the entire post.

by Wayne Wirtanen

Overseas emergency medical evacuation services, or “medevac,” are extremely rarely needed, but they can be extremely expensive and are unlikely to be provided by your at-home medical policy.

These services will provide required transportation (but not the cost of medical care) for any client who experiences a serious medical emergency while at least 150 miles from home. There are usually no preexisting-condition limitations. There may be some destination limitations (strangely enough, Medex does not presently provide service from Iraq or Afghanistan).

The service consists of two levels of transportation: 1] transport to the nearest appropriate medical facility (involving some 80% of calls for assistance) and 2] repatriation, or transport to a home-city hospital.

If the nearest appropriate medical facility cannot suitably treat a problem, an attempt will be made to stabilize a condition before any further transportation is scheduled. Meanwhile, the evacuation provider will monitor the medical condition and supply additional support and advice, sometimes even flying a companion to the patient’s bedside. An “800” phone number or other notification instructions of policy holders are provided.

The medevac provider must make all of the above-described arrangements.

Medevac services are generally provided in a full travel insurance package or can be purchased individually for individual trips or for annual coverage. Amounts of coverages run from $25,000 to unlimited.

Overseas medical emergencies

Letters that I’ve received over the years from travelers who have described the experience of a serious overseas medical emergency have invariably included the word PANIC!

In a medical emergency at home, they would have known exactly what to expect: an ambulance would take the victim to a nearby familiar hospital; the condition and treatments would be explained, and there likely would be family or friends to call on for support.

Even at home there would be a level of stress, of course, but family would be able to leave the patient at the hospital, when appropriate, and go home confident that things were well in hand and that their health insurance or Medicare would handle the expenses. We’ve probably all had some variation of this experience involving a relative or a loved one.

Hopefully, you have not, however, experienced this level of medical emergency in a foreign country. Stop for a minute and consider the possible contrast with the above description.

You probably do not speak the language well, if at all. In a relatively sophisticated city you can expect to be provided with reasonable ambulance service; a tour guide or even strangers would likely assist in getting the victim to a nearby hospital. But if you were in a rural or remote location, say Machu Picchu, what then? If you are on a tour, it is going to go on without you.

How do you know what level of medical care is available in your location? (For example, even in relatively modern western Russia, the last time that I checked, emergency medical evacuation providers routinely flew seriously ill patients to nearby Finland for first-world medical treatment.)

How do you communicate with medical personnel? How do you pay for medical services? Where can you stay while treatment is under way? How can you contact friends or family back home? How do you get your spouse or companion home if further medical treatment is necessary? If you were on a tour or a cruise, hopefully a guide would stay with you at first, but you are likely to quickly be on your own. Does the word “panic” sound appropriate?

Advertisements for travel insurance companies frequently use the above scary scenario to urge you to buy an expensive and sometimes what is not always a cost-effective travel insurance package. The medical emergency evacuation coverage is usually only a small fraction of the coverages in a travel insurance package; fortunately, this potentially very important medevac service can be purchased separately at a small fraction of the cost of a full travel insurance package.

Medevac services are prepared to step in and take charge of your emergency. It is your responsibility to stay in touch with the provider if there are any communication problems.

What are the odds that you’ll experience an overseas medical emergency?

My research has indicated that the likelihood of having a medical emergency overseas that requires a visit to a hospital is about one or two in one thousand trips, and most commonly it is for a problem that is not life-threatening.

If you’ve traveled some, you probably have occasionally noticed that a tour member required a hospital visit. The most common cause of overseas travel accidents is a fall. (Do I have to remind you to wear only well-broken-in, comfortable and sensible shoes with nonslip bottoms on a trip where you are likely to be walking on unfamiliar paving? Watch where you are walking and don’t forget to use hand railings whenever they are available. Minimize your chances of being a statistic. End of lecture.)

Generally, minor broken-bone problems can be temporarily treated satisfactorily anywhere. A broken bone can be painful and can disrupt a trip but generally is considered to be a manageable crisis. You are only slightly more likely to have some other medical emergency on a trip than you are at home.

If most overseas hospital visits are for relatively minor problems, then my calculations and travel observations suggest that the likelihood of experiencing a serious and genuinely panic-generating medical emergency is in the ballpark of one or two per 2,000 trips.

(Travel insurance companies have not been very forthcoming in providing these kinds of statistics when requested. However, in writing my many travel insurance articles that have appeared in the pages of ITN, I have submitted most of them to someone in the travel industry to review statements and statistics for accuracy before publication. My emergency-evacuation statistics have not been challenged by these travel insurance companies.)

However remote the possibility, these serious medical emergencies do occur, and when you or your companion happen to become the statistic, “panic” may be your first reaction. It pays to consider the odds, but the Boy Scouts have it right when they recommend “be prepared.”

An example of an evacuation gone slightly wrong

Evacuation services INSIST that they are the ones to make evacuation arrangements — and only after they have determined that the medical condition requires some evacuation transportation. (No evacuations for blisters, headaches or splinters, etc.)

Recently, an ITN subscriber had a medical emergency in a remote area of Mexico. She called the “800” number provided by her evacuation service and explained her situation. There was a heavy snowstorm on its way that probably would have delayed or prevented timely assistance that would have to come to her location. She said that she could quickly arrange for a local vehicle to get her to a hospital.

The person whom she spoke to approved her plan and told her to get receipts and to submit them when she got home.

When she did submit the claim (about $800), it was refused. The evacuation service she spoke to in Mexico was only a broker, which used another company to actually provide evacuation services. When she protested the rejection of the claim, which eventually had gone to the actual evacuation provider, she was told that she had not allowed the provider to make the evacuation arrangements. The broker service denied having told her to make her own arrangements.

She was incensed because she had done exactly what her policy had instructed. It boiled down to a “he said, she said” standoff. Persisting (at my recommendation) with correspondence and many phone calls, she finally had her attorney threaten to file a lawsuit. The company settled and paid her claim; it probably was cheaper for them than dealing with a lawsuit.

There are some lessons to be learned here. 1) Remember that the evacuation arrangements must be made by the evacuation provider. 2) If you should find yourself in a situation as described above, get one or two additional people to speak to the rep at the “800” number to confirm the instructions, preferably someone with some level of medical qualifications, so that you will have someone to back up your claim. 3) If you feel you must make any emergency medical transportation arrangements on your own, be prepared to pay for them.

Who provides “stand alone” emergency medical evacuation services?

Compare providers and their features and costs at InsureMyTrip.com (800/487-4722, www.insuremytrip.com). If it’s important to you, pay attention to whether the customer or the company will make the choice of evacuation hospitals.

The following were a couple of medevac providers that I found stood out for their desirable features:

Med Jet Assist (800/527-7478, www.medjetassist.com) has some of the most attractive text. Their motto is “ Medical evacuation from anywhere in the world to the hospital of your choice!”

Required transportation will be medically supervised in their own aircraft. They claim to be able to come get you from any hospital or accessible airstrip. (I was told that there was one evacuation that required the hiring of Chinese laborers to build a one-time-use airstrip in a remote area.) Costs for individual trips starts at $95 per person.

Check their website for examples of unusual emergency medical evacuation stories, including the one where a successful emergency medical evacuation began with the first leg of the journey beginning with transportation in a wheelbarrow.

Travel Guard (800/826-4919, www.travelguard.com) is unusual for including $25,000 for medical expenses plus dental coverage.

• An economical alternative, but one not listed by InsureMyTrip, is Divers Alert Network, or DAN (800/446-2671, www.diversalertnetwork.org). This is the medevac coverage I use, except if I were to travel to a way-off-the-beaten-path destination. Their cost for a family for one year is $44.

Sample emergency evacuation costs

The MedJet Assist website provided the following samples of what you’d have to pay, yourself, for emergency medically supervised evacuation transportation:

Transportation from Durban, South Africa, to Boston, $125,000, and from Rochester, Minnesota, to New York City, $16,000.

Other sources of medevac coverage

• The American Automobile Association (800/922-8228, www.aaa.com), actually some 77 different organizations across the US and Canada, has varying packages of upgraded services that include medevac with their “plus” or “premium” memberships. If you are an AAA member, check to see if your organization offers medevac coverage.

• The American Express “Platinum” card also offers some medevac coverage.

Final recommendations

Check with your at-home health care provider to see if they provide for medical expenses overseas and whether or not they pay for emergency medical evacuations. The last time I checked, Kaiser does provide for medevac on a “case-by-case basis.”

For any overseas trip, my “be prepared” recommendation for any kind of emergency is to have, at minimum, medevac and medical coverage, a generous amount of cash in money belts and two credit cards with healthy balances.

Reminder — Medicare does not cover destinations outside of the USA.

Also, “Medigap” policies are all the same regardless of the company used. Policies are rated letters “A” through “K.” All the policies “C’ through “K” have an “Emergency care received outside of the US” clause that pays 80% of medical expenses after a $250 deductible (up to a lifetime maximum of $50,000). These “Medigap” policies could protect their holders from catastrophic overseas medical expenses.

Quite a few travel insurance companies offer “stand-alone” short-term medical coverage. If you need information regarding these policies, contact travel insurance broker Dan Drennan at World Travel Center (800/786-5560, ext. 3131, or, more directly, 402/343-3621). He can provide advice and policies from a large number of companies.

If you would like to explore the medevac topic further, order a reprint of my article “The Ins and Outs of Emergency Medical Evacuation Coverage” (Dec. 1999, pg. 64) by sending $2 to Wayne Wirtanen, 4341 Shangri-la, Placerville, CA 95667.