Whether it's a wide-scale natural disaster, a serious illness or a debilitating sports injury, Americans should check with their health plan or employer before assuming they're covered for any medical emergencies or evacuations they may need while traveling outside the United States, said Larry Akey, spokesman for America's Health Insurance Plans, which represents 1,300 member companies such as Aetna, Cigna, UnitedHealthcare and Blue Cross/Blue Shield plans.

    "Increasingly, health insurance is covering emergency procedures overseas, but it's one of those items that's going to vary policy to policy, and once a tragedy like this has struck it's too late" to add coverage, he said. "Hopefully people who have been hit by this will have the coverage they need, but it's going to vary plan to plan."

    Most health plans generally cover emergency treatment for Americans abroad, with the possible exception of some smaller HMO plans, said Martha Temple, vice president of Aetna's global benefits, which insures expatriates and those who travel internationally for long periods. In fact, some people may have overlapping coverage, she said.

    "You might have some sort of emergency evacuation coverage in your long-term disability insurance," Temple said, noting such measures can take the form of commercial or private flights. "It depends where you are and the health situation you're in. Even an ambulance trip is quite expensive and will be covered" typically either by long-term disability or medical insurance, or both, she said.

    Evacuations, while rare, still happen. Aetna coordinated an estimated 300 this year out of 13 million members with its evacuation partner MedAire. The causes range from car accidents and plane crashes to infections, gunshot wounds and heart attacks, Temple said.

    "In certain parts of the world, you might get an infection that ravages your body quickly and you need to get out of there," she said. "We even have evacuations for just normal babies being delivered where [women are] in a part of the world where they need a C-section and a C-section couldn't be done there."

    Bob Hunter, director of insurance the Consumer Federation of America, was able to negotiate his own evacuation out of Kenya four years ago when he tore a ligament. A local doctor did X-rays and put him in a flexible cast, all of which cost him the equivalent of $300 to $400. Then his airline bumped him up to business class to allow space for his hurt leg, Hunter said. "The evacuation costs weren't there because British Airways was willing to change seats at no charge due to the situation."

    Hunter then had surgery when he got back to the States, he said. "These kinds of events are obviously rare, but you could still, like me, get hurt in another country and have to pay something out of pocket. If you have a history of illness or something that could recur, that would increase your possible need for that kind of policy."
Almost all the 80 million people -- or one in three Americans -- covered by Blue Cross/Blue Shield plans have access to BlueCard, which helps connect traveling members with local medical services, according to Bob Lada, Director of Interplan Programs for the Blue Cross Blue Shield Association.

    Preauthorization doesn't apply in cases of emergency, he said. Sick or hurt travelers should seek care at the closest facility and at some point call the insurer's 24-hour customer service line either on the toll-free number or one designated for collect calls. Members typically don't pay any money up front for their care, Lada said.
The association contracts with World Access, a part of financial services giant Allianz (AZ: news, chart, profile), based in Richmond, Va., not only for multilingual services on the ground, but also for preventive help such as giving a traveler who has a history of heart problems a list of local cardiologists' phone numbers just in case, chief executive Jon Ansell said.

    Another frequent problem vacationers encounter is losing or forgetting needed prescriptions back home, he said. "They're in a strange place and in many parts of the world like Western Europe, health care is fine," Ansell said. "But you still have to speak a different language. You have a language issue, you have to get the bill paid and in many parts of the world such as the tsunami situation, the health-care system is not good. Outside Thailand, the health-care system is not great."

    To assist in the tsunami relief, World Access has moved 10 to 12 doctors from all over the world to aid medical efforts in Thailand, he said. "When you get to that part of the world, it's not uniformly good as it is here in the United States."
 

1. Call your health plan before you leave the country to see what is included should you need emergency care abroad. Should you expect to pay anything out of pocket at the time of service, or will the insurer bill you upon your return home? What number should you call if you have additional questions or an emergency while abroad, and what are the hours of operation?

2. Are medical evacuations covered in either your health or long-term disability policy? Do you need to get a travel insurance policy to supplement that cost? Some credit card companies offer riders for such an expense, Temple said. "Check with your credit card company or buy travel insurance if you're that worried."

3. Don't assume an industrialized country with national health insurance will pick up the tab for your care. For example, American tourists injured in Germany are typically billed later, German embassy spokesperson Martina Nibbeling-Wriessnig said. "They will receive medical attention, they but will have to pay for it. They usually have to pay for it after services are rendered."