MEDEVAC Reality Check.
In our years of experience coordinating Medevac Flights for US Citizens and other nationalities, we see many people make assumptions about having certain rights or privileges to return to their home country during a medical crisis based on their citizenship. Things like "they have to let me in, I am American" or
"I don't have insurance, I'll just pay for the flight and go to the ER when I arrive there".
This page is meant to help you understand how these common misconceptions can block you from re-entering the USA, Canada or other countries of origin when you are in need of a medevac flight, regardless of your citizenship. Below, we will outline the situation from the perspective of a US Citizen in Haiti, however please know that most countries have the same protocols surrounding these issues.
It is not advised that you try to navigate any of this on your own during a crisis, even if you have all of the "right" documents and coverages in order.
Always contact us immediately when you, a loved one or colleague is admitted to a hospital so we can get this process started correctly from the beginning, even if you are unsure yet whether or not a medevac is necessary.
The 2 Most Common Misconceptions
"I am American. They have to let me back in."
If you are a US Citizen traveling abroad and something happens that requires you to return to the USA in a Medevac Charter Aircraft, you have no right to return to the USA just based on your citizen status alone. You must have full hospital acceptance that is verified by the medevac flight operator and submitted to US Customs and Border Patrol with request for the flight plan. So, if you are an American and you can afford to pay for a medevac but you have no hospital acceptance in USA due to a low level health insurance (or no health insurance) you will not be eligible to medevac. On the other hand, if you are not a US Citizen and you don't even have a Visa, but you have high quality health insurance in USA with full hospital acceptance, you will be eligible to medevac to the USA. Entering the USA from abroad with a medical crisis is more an issue of health insurance and hospital clearance than it is about citizenship.
"I have great health insurance."
You might have a coverage that gets you quick acceptance in a South Florida hospital without any issue. However, based on our many years experience in coordinating medevac's for US Citizens...this tends to be a common misconception. Your health insurance may work perfectly for you while you are inside the USA, but when it's time to use your insurance coverage involving an illness or injury which took place abroad, you can be in for an unfortunate surprise. While you are in a hospital bed in Haiti, our team will attempt to get acceptance for you in a Florida hospital. The FL hospital international receiving dept will review the medical needs of your case and balance those needs with whatever insurance policy you have (assuming you have one). If the hospital is not able to clearly see how they will be paid in full for the anticipated costs of your care, you will be denied acceptance. Unless we can find another hospital to work with your specific coverage, your medevac will be denied, and you will not re-enter the USA.
How to Get Yourself Covered
Choosing the right Health Insurance
Choose a Health Insurance that you independently confirmed is contracted with at least 1 major trauma hospital in South Florida, AND make sure you have a policy with that insurance company which covers catastrophic injuries and illnesses which will require long term medical intervention including rehabilitation. (For example: If you choose the "right" insurance company but you opt for a cheap policy, you could still be denied acceptance if the hospital anticipates your medical needs to exceed your policy coverage.)
Religious and other "healthcare sharing" plans will NOT work for you in these scenarios and you will not be eligible for a medevac.
If you have an HMO in the state you normally reside, outside of Florida, that HMO covers you only in your home state (with some emergency exceptions). If you are needing a hospital to accept you in FL because of an illness or injury that occurred abroad, it can be difficult to utilize this HMO in FL and you may not get acceptance.
The USA county in the state that you legally reside in has a duty to accept you regardless of your insurance situation, however you may reside in a location that is too far for any medevac coverage or budget to reasonably fly you to, and you will have massive medical bills levied upon your recovery. Also your county may not have a hospital at all, or one without the ability to medically manage the case you present with, making this option the worst one to rely on and should not be considered a plan.
Can I layer coverages to be extra safe?
Yes, you may. It's possible, but hard to find one insurance or membership that fully covers all needs.
Get your HERO membership for local, in-country Haiti "911" services and medevac coordination.
Get a membership with HAA, Haitian helicopter ambulance
Get a high quality health insurance in USA that is contracted with a hospital in South Florida AND covers major medical cases, like catastrophic trauma.
Get a medevac coverage that will either pay upfront for a medevac flight, and/or reimburse you for a flight to Florida if they agree it was medically necessary.
Get a line of credit (singular or combined) for $25,000+ for emergency medevac contingency funds, and for any deductibles... and don't forget you'll need to pay the Haitian hospital before they'll physically allow you to leave the hospital. Depending on what they had to do to medically stabilize you for the flight, this could easily be thousands.
Get the "traveler's coverage" offered to you by your airline with you purchase your flight to Haiti, because why not? This can cover delays, lost bags, and unexpected hotel stays.
Some hospitals in Florida to check out
If you're unsure where to start with USA Health Insurance that can help you if you are in Haiti and need a medevac to the USA, please see these hospitals below. Check their list of insurance companies they are contracted with, and then independently verify with the insurer and hospital to make sure your coverage is sufficient for a "catastrophic medical case" originating abroad.
South Florida Hospitals most frequented by medevac clients:
Prepare to pay for a medevac jet
Sometimes people have a medevac flight coverage worked into their health insurance policy. This can be great coverage to have, however many times in our experience a medevac coverage worked into a health insurance can slow the process down considerably. Once you have been accepted in USA, your insurance will then begin "shopping" for the cheapest flight provider. This activates a sort of bidding war in some cases, while your loved one is losing time. Sometimes your medevac coverage through an insurance provider will only pay to fly you to "closest appropriate", meaning you may end up in the Dominican Republic instead of Miami. We have seen this part of the process take several days in some cases, and we do not recommend relying solely on your insurance provider in a time sensitive crisis. It's best to also have a back up plan.
The best kind of medevac coverage you can have is one that gets you to the USA the fastest. It is recommended that you have a plan which works well on both an upfront payment AND also (if necessary for time) on a reimbursement basis. Reimbursement means that you pay for the flight yourself to get to the Florida faster, you'd file a claim to recoup the funds (per the rules of the insurer). Not all insurance companies allow this, so make sure you find one that does. This method also requires you to have the liquid funds available to swipe for a $16-26k medevac during an emergency. Medevac companies will allow you to combine multiple cards. Another option is to pay for a Medevac Membership, which is different than an insurance. These can offer the fast payment required to get a medevac quickly, however they tend to refuse service Level 4 countries.
I can't afford this level of coverage. Should I still travel to Haiti?
This is a sensitive topic. We can't tell you what you should and should not do when it comes to visiting family, friends, or pursuing your goals and serving your mission. We can share our opinions, and maybe give you some things to think about.
How will sending an employee or missionary to Haiti totally uncovered potentially HURT your entire mission? How will your decision to travel uninsured affect others? Your parents? Your Children? Your church? The burden you will be putting onto others if you choose to allocate funds to other expenses before solidifying your own crisis contingency plans can be immense.
When the worst happens, the burden an uninsured person places on their family and supporters is not only financial, it is emotional and psychological. Family and friends will have to potentially choose between a critical need their own family has, or their life savings...and your life...when the reality is that you knowingly made the choice to travel without the coverages required to be self sustainable in the event of such crisis.
Is there a One Stop Shop solution?
We are asked very frequently who we would recommend to take care of all these confusing insurance needs for them.
Since we are a company located in Haiti, we make deliberate choices to conduct business locally whenever possible. This not only supports our local economy, but no one understands Haiti and all the unique challenges like those who live here!
For years, we have insured our staff, executives, fleet, contracts and more with INASSA - a Haitian insurance company who can offer the level of coverage needed to gain acceptance in a USA hospital and cover your medevac. Since INASSA is a global insurer and authorized reseller located in Haiti, you get the additional support of local professionals who can help you on a concierge basis. This priceless during any crisis.
We at HERO are happy with the Best Doctors and United coverages that INASSA provides, however INASSA can offer a variety of other options that may better suit your local - and Global - needs. Check out INASSA here