I shattered my pelvis in Thailand. The Thai surgeon said, “You need a stretcher and a nurse to fly home.” The insurance company’s medical director in New York reviewed the file and said, “Pelvis is stable. He can fly Business Class seated.” I was in agony. Who makes the final call?
Key Takeaways
- The “Medical Director” Override: The insurance company’s Chief Medical Officer (CMO) has the final contractual authority to determine “Medical Necessity.” They can override the treating doctor’s recommendation.
- Cost Containment: Stretcher = $40,000. Business Class = $4,000. The CMO is incentivized to approve the cheaper option if it is “safe” (even if painful).
- The “Fit to Fly” Certificate: Airlines require a MEDIF form signed by the treating doctor. If the treating doctor refuses to sign it for a seated flight, the airline won’t board you, forcing the insurer’s hand.
- Medjet’s Advantage: Memberships like Medjet generally defer to the treating physician or the member’s preference more than insurance companies do.
The “Why” (The Trap)
The trap is “Adjudication.”
The policy says: “Evacuation… as determined by Us and Our Medical Advisors.”
You signed away the right to choose. The local doctor works for you. The insurance doctor works for the shareholder. If there is a disagreement, the one writing the check (insurance) wins, unless you can prove safety risk.
The Investigation: I Called Them
- AIG Travel Guard: “Our medical team consults with the local doctor. If there is a disagreement, we may hire an independent third party opinion, but ultimately our Medical Director decides what we pay for.”
- Global Rescue: “We deploy our own medical personnel to the bedside. If our medic says you need a stretcher, you get a stretcher. We don’t rely on a desk doctor in NY.”
- Airline Medical Desk: “We don’t care what the insurance says. If the form isn’t signed by the doctor at the hospital saying ‘Fit to Sit,’ you aren’t getting on the plane.”
Comparison Table: Who Decides?
| Scenario | Standard Travel Insurance | Membership (Medjet) | Airline Rules |
| Conflict | Insurer Wins | Member/Local Doc Wins | Safety Wins |
| Pain Level | “Manageable” accepted | Comfort prioritized | Safety prioritized |
| Authority | CMO (Remote) | Bedside Assessment | MEDIF Form |
[IMAGE: Split screen. Left: Doctor arguing on phone. Right: Patient in Business Class seat looking in pain vs Patient on Stretcher]
Step-by-Step Action Plan
- Get the Local Doctor on Your Side: Ask the treating doctor to write: “Attempting to fly seated poses a significant risk of Deep Vein Thrombosis (DVT) and is medically unsafe.” Use the word UNSAFE, not “Uncomfortable.”
- Refuse to Sign: If the insurer tries to force you, tell the local doctor NOT to sign the “Fit to Fly” for a seated ticket. Without that signature, the airline blocks you, and the insurer must upgrade the transport.
- Appeal to “Assistance”: Call the assistance line and demand a peer-to-peer call between your home doctor and the insurance doctor.
- Pay and Claim: In worst case, pay the upgrade yourself and sue/claim later (risky).
FAQ
Can I sue them for pain and suffering?
Hard. The contract gives them discretion. You’d have to prove gross negligence.
What if I just stay in the hospital?
If the insurer says “You are fit to fly” and you refuse, they stop paying the hospital bill from that day forward.
Does Business Class lay flat?
Yes, but you can’t be strapped in safely while lying flat during takeoff/landing/turbulence. A stretcher allows you to stay flat 100% of the time.