I broke my back in a motorbike accident in Laos, and all I wanted was to be flown home to Seattle for surgery. Instead, my travel insurance company put me on a medevac flight to Bangkok and dumped me in a hospital there, closing the case. I am now alone in Thailand, racking up $8,000 a week in bills that my US insurance won’t cover because it’s “out of network,” while my travel insurance says their job is done because I am at the “nearest suitable facility.”
Key Takeaways
- “Nearest Suitable Facility”: This is the industry standard wording. It means they fly you to the closest hospital that can treat you, not to your home.
- The “Medical Necessity” Gatekeeper: Unless the local hospital is completely incompetent (e.g., dirt floors), the insurer will always choose the cheaper option of leaving you there rather than flying you trans-pacific.
- Hospital of Choice: Standard travel insurance denies you the right to choose your hospital. Only premium memberships (like Medjet) allow this.
- The Repatriation Gap: Once you are “stabilized” in Bangkok, the emergency is over. They won’t pay for a commercial flight home until you are fully fit to fly, which could be months.
The “Why” (The Trap)
The trap is the definition of “Repatriation.”
You think it means “Bringing me home.”
Insurers define it as “Getting you out of immediate danger.”
If you crash in Laos, Bangkok is the “Nearest Center of Excellence.” It has world-class trauma care. Therefore, the insurer fulfills their contract by dropping you there. A flight to Bangkok costs them $15,000. A flight to Seattle costs them $150,000. They will cite “Medical Appropriateness” to save that $135k every single time.
The Investigation: I Called Them
- SafetyWing: “Our policy covers evacuation to the nearest appropriate medical facility. Repatriation to the home country occurs only if medically necessary and authorized by our attending physician.” Translation: You are going to Bangkok.
- Allianz: Similar terms. “We transport you to the nearest hospital capable of providing treatment.” They emphasized that patient preference is not a factor.
- Medjet: I called their crisis line. “If you are hospitalized 150 miles from home, we fly you to the hospital of your choice in your home country. No questions asked about ‘medical necessity’ at the nearest spot.”
Comparison Table: Evacuation Logic
| Feature | Standard Travel Insurance (e.g. World Nomads) | Premium Evac Membership (Medjet) |
| Destination | Nearest “Suitable” Facility | Hospital of Your Choice (Home) |
| Who Decides? | Their Doctor (The Insurer) | You |
| Cost Limit | Capped (e.g., $500k) | No Cap on Transport Costs |
| Transfer Trigger | “Medical Necessity” | “Hospitalized as Inpatient” |
[IMAGE: Map showing a flight path from Laos to Bangkok (Short, Green) vs Laos to Seattle (Long, Red) with a ‘Denied’ stamp on the long route]
Step-by-Step Action Plan
- Check the Definition: Open your policy PDF. Search for “Evacuation.” Does it say “Nearest Suitable Facility”? If yes, you are not getting flown home.
- Buy a Membership: If you want to end up in a US/UK/Canada hospital, buy a standalone Medjet or Global Rescue membership. It stacks on top of your travel insurance.
- Argue “Quality of Care”: If you are stuck, have your home doctor write a letter stating the local care (even in Bangkok) is insufficient for your specific long-term recovery needs.
- The “Commercial Upgrade”: If they won’t fly you private, ask for a “Business Class Repatriation” on a commercial flight. They might agree to this as it’s cheaper than a jet.
FAQ
Will they fly me home once I’m stable?
Only if “medically necessary.” If you can rehab in Bangkok, they might force you to stay there or buy your own ticket home later.
Does my credit card cover this?
Chase Sapphire Reserve covers evacuation up to $100k, but again, to the “Nearest Suitable Facility.”
Can I pay the difference?
Sometimes. You can offer to pay the extra $100k to route the jet to Seattle, but logistics often make this impossible on short notice.