Medical evacuation: who pays for it, and how do you obtain approval from the paying body?

Who can fund a medical evacuation?

There is no single model. The person organising the transfer first needs to identify who, in the patient’s situation, is likely to pay, and under what rules.

Health insurance and assistance contracts

International health insurance, travel insurance or an assistance contract may cover a medical repatriation or evacuation. Conditions vary widely from one contract to another: ceilings, exclusions, countries covered, conditions that existed before the contract. Many assistance contracts require the transport to be organised or approved by their own assistance service, and the destination to be chosen by their medical team.

Employers and company health schemes

Some companies, government departments and international organisations cover the care of their employees and dependants, either directly or through a health scheme. The procedure often goes through the human resources department or the occupational physician.

Public health-cover bodies

In several countries, a public health insurance body or a national committee can authorise a medical evacuation abroad when the care is not available locally. Criteria, forms and timescales are specific to each country and each body: only the body’s official procedure is authoritative.

The patient and their family

When there is no cover, or in addition to partial cover, the patient or their relatives fund all or part of the care pathway. A written cost estimate then becomes essential before any decision.

Why is prior approval essential?

A paying body rarely reimburses a transfer it has not authorised. Prior approval sets out what is covered, for what amount, in which facility and for how long. It protects the patient against unexpected expense and allows the receiving facility to prepare the admission knowing the payment arrangements.

How long approval takes depends on the body and on how complete the file is. An incomplete file is the most frequent cause of delay: a medical report that is too old, an overall estimate with no breakdown or a missing identity document is enough to put the application on hold.

What documents does a paying body usually ask for?

The exact list is set by each body. The following items, however, are often requested:

• a recent medical report from the treating doctor or the department caring for the patient, explaining the diagnosis, the current condition and the reason for the transfer;
• the main supporting tests: imaging reports, laboratory results, pathology if available;
• an estimate from the receiving facility, itemising the planned hospital stay, procedures, tests and medical fees;
• an estimate for medical transport when it is needed: ambulance, commercial flight with medical escort, stretcher or air ambulance;
• a valid identity document or passport, and the certificate of entitlement or membership number;
• the body’s own application form, completed and signed.

When the body has a medical adviser, they may ask additional questions about the indication, the level of care required or the choice of transport.

What does cover include, and what might it exclude?

Cover does not necessarily include the whole care pathway. Before departure, the following items should be checked in writing:

• the outward transport, including ground transfers between the airport and the facility;
• the hospital stay, the planned procedures, tests and medical fees;
• medicines and devices used during the stay;
• the companion: ticket, accommodation, living costs;
• any extension of the stay if the patient’s condition requires it;
• the return to the home country and follow-up care.

A complication, an additional test or a longer hospital stay than planned may exceed the approved amount. The procedure to follow in that case, often a request for additional funding, should be known in advance.

And in an emergency?

A life-threatening situation is treated on site first: looking for funding must never delay stabilising care. At the same time, the insurer or paying body must be informed as early as possible. For assistance contracts, calling the assistance service at the very start of the episode is often a condition of transport cover. Exchanges, case numbers and approvals obtained by phone should be confirmed in writing.

Frequently asked questions