Seeking Health Care Abroad

Preparation

In addition to ensuring that all necessary travel documents are complete before departure, travellers should learn what medical services their health insurance will cover overseas, as well as any policy exclusions. While some major health insurance carriers in the United States may provide coverage for emergencies that occur while travelling, most do not cover medical expenses due to exacerbations of pre-existing medical conditions while abroad. It is also important to know the insurance company's policy for "out-of-network" services, pre-authorization requirements, and need for a second opinion before obtaining treatment. Travellers should carry claim forms and a copy of their insurance policy card, if their insurance policy does provide coverage abroad. The Social Security Medicare programme does not provide coverage for medical costs outside the United States. Furthermore, very few health insurance companies cover the cost of medical evacuation, which can vary widely, ranging from a few thousand dollars to over $100,000, depending on the circumstances. Travellers who will be outside the United States for an extended period of time, who have underlying illnesses, or who are participating in activities entailing risk for injury, are encouraged to consider a supplemental health insurance policy that provides guaranteed medical payments, assistance via a 24-hour physician-backed support center, and emergency medical transport, including repatriation. A list of travel insurance and medical evacuation companies is available at the U.S. Department of State website (travel.state.gov/travel/index.html). A brief list of additional assistance companies is also included below; this list is not inclusive:

International SOS: www.internationalsos.com. International SOS offers comprehensive 24-hour physician-backed medical and security assistance, for which members pay a fee. Membership provides access to on-line services, including medical and safety travel advisories, pre-travel itinerary-based recommendations, and computerised medical records. Insurance policies include medical evacuation and repatriation coverage, access to international clinics that provide primary care, diagnostic, and emergency services, and voluntary patient support programs to assist with medication compliance while abroad.

MEDEX: www.medexassist.com. MEDEX travel assistance services include 24-hour access to coordinators who can help locate appropriate medical care providers, coordinate direct payment of covered medical expenses, and assist in other medical, legal or travel situations. Insurance policies include medical evacuation and repatriation services, emergency dental coverage, and assistance with replacement of medications. For an additional fee, subscribers also have access to itinerary-based destination reports, which cover practical topics from local transportation and cultural norms to medical and security alerts.

International Association for Medical Assistance to Travellers: www.iamat.org. IAMAT is a nonprofit organisation established to provide medical information to travellers and to make competent medical care available to them worldwide. IAMAT maintains an international network of physicians, hospitals, and clinics who have agreed to treat IAMAT members in need of medical care while abroad. Membership is free, although a donation to support IAMAT efforts is appreciated. Members receive a directory of participating physicians and medical centers and have access to a variety of travel-related informational brochures.

Travellers with underlying medical conditions also should consider choosing a medical assistance company that allows them to store their medical history before departure, so it can be accessed worldwide if needed. Alternatively, they may carry a letter from their physician listing underlying medical conditions and current medications (including their generic names). Each travel insurance companies differ in their policies with regard to coverage for exacerbations of underlying medical conditions. Travellers are encouraged to research this carefully and understand the fine print. See also the Travel Health Kit section in this Chapter for more suggestions on travel preparation.