Seeking Health Care Abroad
In addition to ensuring that all necessary travel documents are complete before departure, travelers 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 traveling, 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.
Travelers should carry claim forms and a copy of their insurance policy card, if their insurance policy does provide coverage abroad. The Social Security Medicare program does not provide coverage for medical costs outside the United States, except under very limited circumstances; some Medigap plans available to people enrolled in the original Medicare plan provide limited coverage for emergency care abroad. 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. Travelers who will be outside the United States for an extended period of time, who have underlying illnesses, or who are participating in activities involving greater risk for injury are encouraged to consider purchasing 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. A brief list of additional assistance companies is also included below; this list is not all-inclusive:
* International SOS: http://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 computerized 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: http://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 Travelers: http://www.iamat.org. IAMAT is a nonprofit organization established to provide medical information to travelers 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.
Travelers 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). Travel insurance companies differ in their policies with regard to coverage for exacerbations of underlying medical conditions. Travelers are encouraged to research this carefully and understand the fine print. See also the Travelers’ Health Kit section in this Chapter for more suggestions on travel preparation.
If an American citizen becomes seriously ill or is injured abroad, a U.S. consular officer can assist in locating appropriate medical services and notifying friends, family, or employer. Additional resources include the clinic where the traveler received pre-travel health advice and immunizations, embassies and consulates of other countries, hotel doctors, credit-card companies, and multinational corporations, which may offer health-care services for their employees. For informational purposes, Travel Health Online (https://www.tripprep.com) provides a list of travel medicine providers from around the world. Wherever they are posted, lists of providers are obtained from a variety of sources, and the quality of services and the expertise of the providers are not guaranteed. The Inter-national Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene also have directories of travel clinics available at their websites (www.istm.org and www.astmh.org, respectively). Although many of these clinics may only provide pre-travel services, some are located outside the United States and can see ill travelers.
The quality of health care from overseas medical centers can be variable, particularly in developing countries. Some foreign hospitals may have out-of-date facilities, while others have highly sophisticated diagnostic and therapeutic equipment similar to that found in the United States. Joint Commission International (JCI) is a division of Joint Commission Resources (JCR), a subsidiary of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits hospitals in the U.S.. JCI helps to improve the quality of patient care in more than 60 countries. Since 1998, 93 health-care facilities have been accredited by JCI in Europe, Africa, Asia, the Middle East, and the Americas. In 2005, WHO designated JCAHO and JCI as the world’s first WHO collaborating center dedicated solely to patient safety. A list of accredited international health-care facilities is available at the JCI website: http://www.jcrinc.com.
Physicians, hospitals, and most entities in other countries usually require payment in cash or credit card for services rendered rather than bill an insurance company. Travelers with health insurance coverage should carry their insurance card and claim forms, and they should obtain copies of all bills and receipts. If one needs financial assistance, the U.S. consular office can assist with transferring funds from the United States. In extreme circumstances, they may even be able to approve small government loans until private funds are available. Travelers must be aware, however, that they are responsible for paying all medical expenses they incur while abroad, including evacuation expenses.
In many developing countries, virtually any drug, including antibiotics and anti-malarial medications, can be purchased without prescription. Travelers should be advised, however, not to buy these medications unless they are familiar with the products. The quality of these drugs may not meet U.S. standards, and they may even be counterfeit or potentially hazardous because of contaminants. In addition, travelers requiring an injection overseas should consider bringing their own injection equipment (see Travel Health Kit section). At the very least, they should ask if the injection equipment is disposable and insist, if possible, that a new needle and syringe be used.
By CDC Chapter 2 of Yelow Book of International Travel
Pre- and Post-travel General Health Recommendations