Administration and Leadership, EMS Insider, Operations

Supporting Patients Overseas: A Guide to Repatriating Patients Back to the U.S.

You may be hearing more about patients being repatriated back to the United States after a medical emergency abroad. This summer alone, two American tourists were medically evacuated and transported to Florida for care following two separate shooting incidents in Turks and Caicos. Although these specific instances are irregular, critical injuries and illness overseas are unfortunately a regular problem for travelers who are often woefully ill-prepared.

What is repatriation?

Named after the Latin word ‘repatriate’ that means to return to one’s country, repatriation is the process of returning a person to their country of citizenship. In the case of medical repatriation or air evacuation, patients are generally flown by air ambulance to the nearest available facility in their country of origin.

Sounds easy enough, right? Not so fast, transporting patients back for care in the United States can actually be extremely difficult due to insurance coverage, protocol at regional facilities and the patient’s condition.

Why is it so difficult to repatriate patients from abroad?

Most American tourists don’t plan for an emergency while traveling outside of the country. Unfortunately, most of these travelers haven’t heard of air medical coverage or researched their insurance policy in advance to see whether air medical evacuation is covered in a crisis. When a critical care patient is in need of an air evacuation, they must first see what’s covered by their insurance plan.

Insurance Coverage

Some plans like Medicare don’t provide any coverage for international air medical. If the patient’s health insurance plan doesn’t cover air medical, their travel insurance or premium credit card memberships might. For instance, the Platinum card from American Express and the United Club Card from Chase both cover emergency air medical evacuations.

When repatriation benefits are included by the patient’s insurance plan, coverage may be limited to transporting the patient to a higher level of care, not to their nation of origin. When the insurance does cover repatriation back to the United States, most plans only cover flights to the nearest receiving facility from the airport at the closest border state with exceptions made at times when specialty treatment is required for the patient’s injury or condition.

Regional Complications and Protocol

Insurance coverage isn’t the only variable involved in getting patients back to the states for continued care. Depending on where the patient is, it may be challenging to navigate language barriers. These types of issues in communication can make it more difficult for patients and receiving facilities to speak with physicians and nurses on staff. For patients, these gaps in communication can mean that they aren’t receiving the right level of care or pain management.

Air medical companies frequently use translators to receive the details needed from the sending facility and interface directly with insurance companies to obtain all the necessary details.

Other regional complications include the cost of care. It isn’t uncommon for facilities in many countries to charge visitors thousands and require payment in full before they can be discharged to depart for the receiving facility in their country of origin. Patients facing medical debt can contact the State Department for emergency financial assistance to help them get home.

What are other regional factors? Depending on the patient’s travel destination, the air medical provider transporting the patient back to the U.S. may need to obtain a visa. This can usually be done the same day, but may take one to two business days to complete for more distant countries.

Patient’s Condition

Finally, patients need to be stable enough to fly in order to be repatriated back to their country of origin. It’s important to repatriate patients back as quickly as possible before their condition declines and they become unable to return for treatment. Because of this urgency, finding an accepting receiving facility and handling any necessary paperwork should be addressed as quickly as possible.

Before being repatriated back to the U.S., the air medical provider should examine the patient’s medical chart from the sending facility and a bedside evaluation of the patient’s physical and mental condition to ensure they are stable enough to fly.

Important Resources

While repatriating patients back from overseas has its challenges, having the right resources in place can make the process faster and more manageable. Using public government resources can help patients and their families navigate financial and cultural barriers by consulting the local U.S. embassy and using the resources provided by the State Department online.

The right air ambulance company can work with the insurance provider to qualify the patient, bridge any language gaps with the sending facility, and help to complete any paperwork necessary. The air medical provider should also work with the sending facility’s physician and staff onsite to determine that the patient is stable enough to fly.

Time is of the Essence

Accessing the right resources to repatriate patients quickly can save lives. Too much time spent in going back and forth between facilities or with the insurance company can have a devastating impact on the patient’s wellbeing and personal finances. Acting quickly is the most important best practice in bringing patients back from abroad. If you are unable to find a receiving facility, you can work with your air medical provider to find alternatives.