When Diana first fell into a coma after her subdural hematoma one of our hindsight regrets was not having purchased travel insurance. In a study by AAA, only 38% of Americans plan to or have purchased travel insurance for international flights. Our family has had little experience with international travel. Diana’s ticket was purchased by a family friend to bring her out to Portugal for a visit. Often, it is during the process of booking a ticket where travel insurance is purchased, their coverage can be decent, but at times more expensive than purchasing it separately, and with fewer options than what can be acquired through a more tailored plan.
Since she fell into a coma we have researched deeply into travel insurance to see how it could have helped us, and to help others avoid the same situation. With the most expensive problem, international air medical repatriation, there seems to be only 2 specialized options that would have helped. However, We do want to highlight where general travel medical insurance would have been valuable to us. In this post, we will explore the different options for travel insurance, and where it would have had the most impact in our situation.
International Air Medical Repatriation is Only Covered by 2 Providers
Travel insurance can cover air medical evacuation and repatriation, but very narrowly. The plan you choose will have limits, these vary wildly from around $10K to $1 million. The Air Medical Evacuation is distinct from repatriation in this context. Evacuation is specifically for getting a patient in immediate medical need to a hospital in country, that is to say, not to your home country. Which is, of course, the biggest expense, ranging from $50K if the patient is well enough to fly commercial, to around $180K if they need to fly privately.
The only 2 special providers that cover medical repatriation are:
- Medjet, which is the most transparent provider, is a travel security subscription, with short term options.
- MedjetAssist Membership Costs range from $99 to $315
- if you become hospitalized internationally or domestically – 150 miles or more from home – Medjet will arrange medical transportation to a home-country hospital of your choice for inpatient care.
- MedjetHorizon Membership Costs range from $189 to $474
- Adds worldwide travel security, crisis response and evacuation services powered by FocusPoint International. Terrorism, kidnapping, natural disaster, violent crime and other safety concerns can be handled.
- MedjetAssist Membership Costs range from $99 to $315
- The other is WorldTrips, under their Atlas Journey Premier plan. The link to WorldTrips is to the full list of coverage, which is a little buried in the site.
- WorldTrips plans charge in the same way Airline travel insurance does, based on the cost of the trip, and by age, which can range from $43 to $1114, and higher for trips over $5000.
*Call any provider to confirm medical repatriation is covered prior to your trip.
It is also important to note that some providers do offer support for bringing a family member out to where the patient is as support, often called an Emergency Reunion benefit. US health insurance plans have been forced by the No Surprises Act, which went into force in 2022, to stop balance billing for air medical transport within the US, and may cover that transport (after your deductible) once you make it back to the states. However, as far as we can find, no type of standard travel insurance covers medical repatriation with an air ambulance internationally, so it is out-of-pocket. Above we have listed the 2 that do cover medical repatriation, and below we link to a company that does reference a medical repatriation benefit, however we have not found any provider offering the service as they refer to it.
This is why most families end up crowd funding, or taking one of the low interest emergency medical loans from the government, or in some cases spreading the debt across multiple credit cards, which is clearly a terrible situation to be in. A bill from the Air Ambulance is usually due within 5 days of landing. We have heard stories, though they haven’t been corroborated, that some failure to pay cases end up with a lien on their home.
Repatriation is Distinct from Medical Repatriation, and Only for the Deceased
When travel insurance mentions repatriation, it is also very limited, in this case to only the deceased. Medical repatriation involves an air ambulance to return patients home, often called bed to bed transport, repatriation is for the deceased. Flying a deceased family member home without insurance can cost a few thousand dollars. So, while this benefit is useful, it is not the same as repatriating a patient to their home. It is important to note one air ambulance company, Medical Air Service International, references a benefit called complimentary medical repatriation insurance, which appears to cover medical repatriation. However, we have found no travel insurance that uses this terminology, only the 2 providers listed above cover medical repatriation.
Medical Care Costs while Abroad
Where travel insurance would have been helpful in our situation is in regards to the accrual of medical bills from in country. In our case over 51K Euros has been billed. Diana has medicare, and Humana Worldwide coverage. Medicare will not cover any out of country expenses. Humana requires patients to pay out-of-pocket and seek reimbursement. Which is to say, that they do not want to pay. How many people can afford 10’s of thousands of dollars of medical bills out-of-pocket? How long is the process for reimbursement? Recently, Megan emailed the CEO of Humana and they reached out to say they are willing to discuss the situation to see if there is anything to be done.
While this practice is legal, and seems to be across the board with US health insurance providers, it is clearly a burden to the already stressed family. Prior to reaching out to the CEO, Humana had ended the dialogue with the reimbursement only statement, only through Megan’s diligent attempts to reach the top of their hierarchy has the issue seen any movement. They haven’t been willing to provide a letter to the hospital that promises payment so far, but we are hopeful an arrangement can be made. Luckily the hospital in Braga, Portugal has been very patient.
If we had purchased travel insurance, depending on the limits of the coverage, the insurance would have taken care of these costs, so long as they are not related to a pre-existing condition, which Diana’s subdural hematoma clearly wasn’t. There are travel insurance providers from whom you can purchase an exclusion waiver that allows them to cover pre-existing conditions.
Portugal has been very good to us so far, and with help from ex-pats in country we are hoping to find ways to continue her care there while we raise the money to bring her home. However, this is a tricky situation, which could be far worse in other places, as US citizens clearly do not have the same rights as their citizens. We have been lucky to meet great people that are helping support Diana’s care. Though there have been intense instances where, separately, a doctor and a nurse have pushed to stop her care on the grounds that we have no rights. Luckily these attempts have been thwarted by better health care professionals higher up in the hierarchy.
General Cost and Types of Travel Insurance
Travel insurance purchased from an airline can range between 4% to 15% of the cost of your trip, with 6.7% being the average. This coverage is generally sufficient for most cases. However, there are other options you should consider if the traveler has deeper needs. If flight cancellation, baggage loss, and the other non-medical benefits aren’t as important to you, than a medical travel-insurance provider can be up to a third the cost with the same medical coverage. There are also comprehensive travel insurance providers that offer deeper benefits, with higher limits, and can even provide more specific benefits like pet insurance.
Conclusion
Essentially, we would recommend those with medical issues or disabilities that are travelling internationally consider looking into travel insurance separate from that offered by the airlines, and check out the 2 special providers that cover medical repatriation. Always call to confirm what is covered, as their websites are typically provide incomplete information. It is also important to see what your credit card offers. Some include travel insurance when tickets are purchased on the card. We have posted resources here to help with this research, and to help find providers. While a medical transport within Portugal wasn’t necessary for Diana, it very well could have been, as subdural hematomas are often a death sentence, especially if not treated immediately. The medical insurance would have really helped us as our US health insurance, though we are now a little more hopeful that Humana, will try to solve this problem. Travelling is expensive, as is health insurance in the US. However, if you can afford to, travel insurance provides vital peace of mind and support when a trip goes truly wrong. Research your options, and read the fine print, especially when it comes to a loved one with medical issues or disabilities.