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Medical Assistance on a Trip Abroad

by Peter Savage

Two critical issues are often overlooked by both business travelers and tourists when they plan a trip:

  • If you are ill, injured or incapacitated, who is going to care for you or your traveling companions?
  • Who is going to pay for the care that you require?
Implicit in these questions are the underlying problems--finding a responsible source of care, and making sure that the costs incurred are reasonable. A traveler should make provisions for care and proper coverage before the trip. One does not want to be faced with these issues during a crisis in a foreign land, especially if emergency medical air evacuation might be involved.

People about to travel may feel that nothing will happen to them, that they will be staying with friends who can take care of them, that they have made the trip many times without a problem, or that their company will handle any mishap. However, rarely can they answer important questions. Does your health care cover your medical expenses if you are injured crossing the street in Madrid? Who would see to your immediate treatment or deal with getting you back home? Equally important, who would see that you NOT receive treatment or care that you SHOULD NOT GET if you were hospitalized and under the care of local doctors (often in a foreign language).

Reliable Medical Assistance

Once you are resolved to obtain emergency medical assistance coverage for your trip, you need to determine which assistance company is right for you. Unfortunately, there are few travel agents, insurance brokers or travel guides that have completed the research necessary to provide good information. For this reason, it is NOT a good idea prior to a tour just to "check the box" on the travel agent's tour package for travelers' health insurance.

Richard Wallach, an insurance broker who covers the travelers' market, says, "A traveler's first concern should be finding a good medical emergency assistance company that has the experience in medical evacuation. Worry about insurance coverage second. A good assistance company isn't going to wait from Saturday to Monday to figure out what your policy covers - they are going to get you help or fly you to the nearest facility competent to handle your medical crisis. There are several good companies with established reputations. Make sure that you sign on with one of them."

The Questions to Ask

A corporate travel manager or human resources officer of a U .S. -based multinational corporation who has responsibility for many international travelers is likely to be more diligent than a tourist flying to Bermuda for a weekend in seeking answers about emergency assistance. However, if you, and not an insurance company, are paying the bill, there is more reason for you or your broker to ask the appropriate questions. How long has the assistance company been in business? Has it changed ownership or senior management frequently? Most good companies have been in business for more than a decade under a consistent management policy and have a verifiable record. This can usually be ascertained by calling the company's 800 number.
  1. What are the resources devoted to emergency response?
  2. How many response centers around the world receive calls?
  3. Are there areas of the world or countries where the company does not provide service?
  4. Are there areas where the company has little experience or expertise?
  5. Do they respond 24 hours a day, 365 days a year with personnel on duty?
  6. Do those who receive calls have the authority to respond to a medical crisis?
  7. How quickly can they contact a doctor or specialist for counsel and guidance?
  8. Are the emergency response centers owned and operated by the company or are they under subcontract from another company?

    While these are not the sort of questions an individual traveler is likely to ask, you should expect a travel agent offering a particular emergency assistance company and insurance policy to find the answers.
  9. When an emergency call is made, who is responsible for taking what action?
    A good company will select a doctor and medical facility from their database. Their physician will remain in touch with those caring for you, as well as contact your personal physician at home. They will see to it that risk of non-payment does not delay access to medical care. The company will maintain contact with your family at home - perhaps send a family member to your location.

    Check with your travel agent or corporate travel manager for an answer to this question. You should know what is supposed to happen when you call the emergency number on your medical assistance card. Keep in mind that if an insurance company is covering the expenses, the policy will certainly have a ceiling for each category of coverage. You should key your expectations to those limits.
  10. Is the assistance company a U. S. -based company with assets in the U.S.?
    If there are problems, it is reassuring to know that there is legal recourse at home, and not from an entity on some offshore island.

Assistance Covered by Insurance

Our focus has been on emergency medical assistance without regard to insurance coverage. For corporations which do not self-insure, individual business travelers or tourists whose health insurance does not cover medical assistance abroad, insurance policies which include emergency medical assistance should be a priority.

Start by calling the travel insurance companies about individual traveler's insurance coverage or extended stay programs. It may be that you do not qualify for their traveler insurance policies because of your destinations; length of stay; planned activities such as mountain climbing, skydiving, or scuba diving; your age or some other exclusion under the policy. If that is the case, secure the services of an insurance broker who can provide a package that gives you the coverage you require and, most importantly, includes the emergency medical assistance of one of the reliable assistance companies. If you are over 65, be apprised that Medicare does not cover overseas costs, and additional coverage should be arranged. Information about medigap policies is available from the American Association of Retired Persons (AARP) at (800) 532-5800 or the National Council of Senior Citizens at (800) 596-6272.

A word of caution. Assistance covered by insurance always operates under the constraints of the policy's limitations on expenses. Excellent assistance companies respond to the crisis at hand without preoccupation about the details of expense or whether your heart attack was due to a pre-existing condition excluded under your policy. One good measure of an assistance company is the quality of service that can be provided within the cost of your coverage. After all, any overage will be borne by you.


Several credit cards, including MasterCard, VISA and American Express offer emergency assistance "referral" services to traveling cardholders. The services may include trip insurance, lost baggage coverage, legal service referrals and referrals for medical assistance. These services should NOT be confused with the kind of medical assistance described in this article, since a call to a credit card emergency number will refer you, on your own initiative, to a designated doctor, medical facility, lawyer or financial assistance. They are a less expensive alternative, but not designed nor promoted as a service comparable to emergency assistance, which takes over for you if you are incapacitated in a medical crisis.

There are also companies which claim to be able to provide the services listed above, but do not have the trained personnel or worldwide network to respond to a full caseload of critical emergency calls. One company, for example, states that it excludes countries if there is a political crisis - with no advance notice as to which countries they are referring. Another simply does not have the personnel or phone lines to handle a major crisis if both corporate and individual clients are faced with a disaster affecting many.

As Richard Wallach said, "When you want reliable performance in a medical emergency, you do not want a provider who is going to cut costs at the expense of your well-being. You want a provider who is in the business for the long-term."

A crisis management planner for major multinational firms, Peter Savage is the author of the highly acclaimed The Safe Travel Book, Lexington Books, 1996. A regular columnist for travel and security management publications, he has frequently appeared on CNN as an expert on travel security. Savage is a former Foreign Service Officer in Latin America.

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