When a vacationer gets sick or injured overseas, there may not be anyone around who speaks English well enough to grasp what the complaint is or advise on getting help. This sort of emergency is one driving force behind the growth of organizations that give help by phone in many languages 24 hours a day.
The organizations, known as assistance companies, have multilingual employees who might translate to a health-care worker at the scene, give victim and companions directions to the nearest hospital or even call directly for help. They can arrange for evacuation if necessary.
Despite the risks of parasites and acute altitude sickness, heart disease is the leading cause of death for American travelers; heart disease and accidents account for almost three-quarters of such deaths. What most seriously ill travelers need, then, is not an exotic injection for tropical maladies, but whatever care they would require at home.
Bear in mind that assistance companies with telephone counseling networks do not necessarily sell their services straight to you unadorned; you may need to buy an insurance policy that includes them along with other coverage, or use a credit card that offers these services as an inducement.
Insurance companies that provide an assistance component do so to help keep claims for minor problems from growing into major claims after improper care. Many tour operators and steamship lines provide access to an assistance service.
The credit-card companies, in their heated competition for business in recent years, discovered assistance plans. One expert put the cost of medical assistance to a credit-card company at less than $1 a year per cardholder, so this enhancement, as it is called in the trade, can be provided to the cardholder without extra charge.
According to The Nilson Report, a monthly newsletter for officials of credit card companies, emergency medical assistance has become the most popular enhancement now offered, with 5 percent of the enrolled people using medical assistance at least once a year.
Brochures that mention the assistance companies` services use the term
”hot line,” but this is a misnomer; it is not a constantly connected line. The companies give their clients one or more toll-free numbers that can be dialed from the United States or from overseas. The calls go to a bureau or switchboard that is usually staffed 24 hours a day.
Usually a call is answered by someone who speaks English and at least one other language. This person can plug into a network of other interpreters for help in unraveling a medical problem or can get someone who speaks the right language to call back. Depending on its sophistication, the service has links to hospitals in many areas overseas or has lists of physicians and their numbers and information on transportation to places with medical expertise.
To see one system in action, I spent a day in Dallas at the center maintained by the American International Assistance Service, a subsidiary of the American International Group of insurance companies in New York. The assistance service, which usually calls itself Inter-Claim, does not sell its medical-advice system direct to the public, but contracts with credit card companies, employers, tour operators and insurance companies.
Only some of the 36 employees at the center are involved in the medical-advice project; the company also processes insurance claims and advises travelers who rent cars with certain credit cards and are having trouble persuading the clerk that they need not buy the collision damage waiver.
The president, Jerome M. Edwards, showed me a computer chart on what sorts of problems befall what sorts of travelers. No surprises there: heart trouble, particularly for older and overweight people, bulks large. But there is drama: A woman who broke her hip aboard a cruise liner was removed from a Caribbean port and flown home for emergency surgery.
Faced with the question of whether to move a sick client, the Inter-Claim counselor relies on the advice of physicians at the CareFlight Center at Methodist Hospitals in Dallas. For a per-case fee, paid by Inter-Claim, a physician talks to the medical person caring for the ill or injured traveler at the scene and decides on the next step.
The room at CareFlight looks like an ambulance dispatcher`s room. A physician was dealing with a patient in Hawaii for Inter-Claim while I was at CareFlight. His written decision would be sent to the Inter-Claim office by facsimile copier to eliminate any possibility of ambiguity.
Inter-Claim says it makes assistance services available to 10 million clients and their families through its varied channels, which include Citicorp Diners Club and some American Express services. The company is used by Carefree Travel Insurance, with Inter-Claim holding the decision power on whether emergency evacuation coverage kicks in. Depending on the value of the coverages, a Carefree policy costs $39 a person for a trip of one to eight days, up to $213 for a trip of 31 to 60 days. (Carefree, Box 310, 120 Mineola Blvd., Mineola, N.Y. 11501; 516-294-0220 or 800-645-2424.)
There are several other large assistance companies in the United States, and trying to untangle who works under what label and with what insurance company or credit card service is difficult. The prices that follow are not comparable because the policies differ in their coverage:
– Europ Assistance, which provides American Express cardholders` medical assistance services, is probably the best-known company, claiming 50 million clients worldwide. In the United States it sells-directly to the public, and through travel agents and some banks-travel policies known as Travel Assistance International. A policy with several areas of coverage costs $50 for an individual for 16 days and $75 for a family. (Suite 300, 1333 F St., N.W., Washington, D.C. 20004; 202-347-2025.)
Europ Assistance is also available under three policies, Health Care Global, Health Care Abroad and MedHelp Worldwide, all offered by Travel Insurance Programs Corp., 243 Church St. West, Vienna, Va. 22180;
703-255-9800, 800-237-6615.
– Access America (600 3d Ave., New York, N.Y. 10163; 800-851-2800), a medical insurance company that is a subsidiary of two Blue Cross-Blue Shield organizations, sells insurance and does its own assistance work. A policy for a two-week trip overseas by one person would cost $74, with an unlimited allowance for medical transportation approved by the assistance experts.
– International SOS Assistance does not sell insurance, only assistance, although it will advance money to its clients for care. It says it serves 20 million people, principally overseas personnel of its client companies. It also sells individual memberships starting at $15 for a trip of 1 to 7 days, up to $195 for a year. (Box 11568, Philadelphia, Pa. 19116; 215-244-1500 or 800-523-8930.)
– Global Assistance Network is now owned by Claude A. Giroux, who also owns International SOS. This organization does assistance work for holders of the Air Travel Card and for Tourcare insurance policies sold by Mutual of Omaha. It also sells directly to the public. Its Global Assistance full service package, with medical and evacuation insurance up to $25,000, with a deductible of $1,000, costs $80 a year for the first person in a family. (Box 18100, Philadelphia, Pa. 19116; 800-523-8930.)
– WorldCare Travel Assistance Association sells its services by memberships that cover medical expenses and other costs, and, for an added fee, trip cancellation. A basic membership for an individual for a one week trip would be $38. Its ScholarCare has similar rates, with time periods keyed to semesters as well as to academic trips. (Suite 7600, 2000 Pennsylvania Ave. N.W., Washington, D.C. 20006; 202-293-0335.)
