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Need Medical Travel Insurance?

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By MARY BILLARD

The New York Times

Published: January 4, 2009

It all started because we didn't want to eat dinner for a second night at the Oberoi resort in Lombok, Indonesia. Admittedly, it was a stunning setting, overlooking the Bali Sea, but a tad formal.

So my husband, Barry Cooper, and I took an hour's cab ride through steep and winding hills, to the beach town of Senggigi.

We were wandering down the main street, reading menus, when the lights went out. A few more steps and, suddenly, Barry disappeared from my side. I looked down into an open concrete ditch about four feet deep, and there he was at the bottom, getting to his hands and knees.

A crowd of men gathered around. Barry, gripping the sides of the ditch to raise himself, showed me a cut on his forearm. It was so dark I used a cell phone light to see a bleeding wound - a little nasty, but not hospital worthy. Then he felt a pain in his ankle. OK. We definitely weren't going trekking to the foothills of the Mount Rinjani volcano the next day.

And so, our real adventure in paradise began. Over the next eight hours, as we learned the ankle was fractured, I tried frantically to find out the answers to two pressing questions: How would we get home to New York? How much would it cost?

Hooray For Cell Phones

Our cell phones, a BlackBerry and an iPhone, turned out to be the most valuable things we could have packed. We used my BlackBerry to call the Oberoi to find the nearest clinic and then to have the concierge direct our cab driver there. Barry used his phone to call the number on the back of his American Express card to find out what kind of medical help they could provide and to start exploring our trip home.

In the subsequent hours, we were on the phone almost constantly as Barry lay in a bed in the bare-bones clinic - no ice for his swelling - reaching an orthopedic surgeon and internist in New York, a podiatrist friend, a friend with a brother in the U.S. Embassy in Singapore, family and American Express, which monitored the diagnosis and care provided. (After we had been home a couple of weeks, I got a phone bill for $902.82.)

A decision was made: Barry would have the local doctor put a cast on his broken ankle, and then we would travel back to New York City. He would not have surgery in rural Indonesia - although, urged by a couple of friends, we briefly contemplated having the surgery in Singapore, where there are world-class medical facilities. However, that option was quickly dismissed.

Now, how to get him home?

As premium American Express card members, we are eligible to receive emergency medical transportation assistance, but a fractured ankle does not require an air ambulance, I was informed. So, I explored the idea of paying for that airlift, to get us back to New York. The bill? A stunning $120,000! We rejected that idea.

Instead, I worked with American Express to book a commercial flight from Lombok to Singapore - a strong luggage handler helped Barry up the steps to the plane - to connect with a direct flight from Singapore to New York.

First-Class Airfare: $9,177.90

First or business class were the only options for someone in Barry's condition: We had to make sure that he had enough room to stretch out during the 20-hour flight. There was no business class on the next flight, so we had to spring for first class. Barry's ticket was a staggering $9,177.90.

We did not have medical travel insurance. Would special travel insurance coverage have made it cheaper or easier? Although medical evacuation is normally included with most comprehensive travel policies, it is doubtful a fractured ankle would have merited an air ambulance.

"Typically, evacuation requires the traveler to be hospitalized," explained Nicole Beach of Medex Global Group ( www.medexassist.com), which sells medical travel insurance.

Another option is a prepaid air medical transport program, which allows its members to choose a hospital. MedjetAssist ( www.medjetassist.com), for example, will transport a member hospitalized more than 150 miles from home to another hospital of his choice.

MedjetAssist's annual membership rates start at $250 a year for an individual and $385 for a family for travel in the continental United States only. For an overseas trip, short-term plans start at $95 a person for seven days.

Would any policy have paid for a first-class ticket on the spot? Maybe.

The travel insurer would have determined if it were a medical necessity for someone with a fractured ankle requiring surgery to fly home within a specific time frame, leg elevated in a manner only a first- or business-class ticket could have provided. Beach, of Medex, stated it is possible that concern over bruising and swelling in some instances might allow for upgrades or the purchase of two seats.

One thing is clear. Our credit card did not provide trip cancellation coverage. If we had bought a comprehensive policy, including medical and medical evacuation policies, as well as trip cancellation and interruption insurance, we wouldn't have had to worry about deposits made for the next week of our trip. Fees for that coverage typically equal 5 to 7 percent of trip costs, said Ed Walker, president the U.S. Travel Insurance Association.

(American Express and the Oberoi helped us recoup costs for the unused portion of our trip, including airfares.)

Insurance can be bought through insurance or travel agents and tour operators. The Internet has made it easy to research and purchase insurance.

Before embarking on an overseas vacation, travelers should check their medical policy to see what is covered. American health care providers may not cover costs out of the country. Medicare generally does not provide coverage unless a supplement is purchased.

Next trip, we are definitely buying a comprehensive trip insurance policy - and bringing a flashlight.

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