Adam Hickman
October 9, 2026
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5 min read
When a medical emergency strikes abroad, the instinct may often be to reach for the most expensive and reactive solution. A recent case shows how calm, informed decision-making led to a better result for the patient and the insurer.
Good medical assistance starts with understanding the medical situation:weighing the healthcare and logistical options, then deciding on next stepsbased on sound information and clinical knowledge.
When a new case comes in, with an insured person who has had a potentially serious or critical medical emergency, it is all too easy for assistance companies to plan for the worst outcome and most extreme and costly solution, such as an air ambulance transfer. Sometimes this is the right call, because local facilities can't meet the patient's needs. But often, treating the patient locally is both more medically appropriate and better value. It is more cost-efficient and can give the patient a better outcome than a knee-jerk response would.
The case
In a recent case, we were notified of a patient who had gone into cardiac arrest, been successfully resuscitated and was admitted to hospital. Cases like this always lead the medical team to think through a range of possible outcomes, both medical and logistical, including repatriation.
The team asked themselves: was this a simple coronary event, where treatment might be relatively straightforward, or was there a more complex underlying pathology that could need a longer, costlier and higher-risk path, such as coronary artery bypass graft surgery? Also, did the hospital have the capability to manage this kind of patient, and was it a trusted provider?
The outcome was that the hospital could manage the patient’s medical needs and could provide appropriate and immediate investigations to find the cause of the cardiac arrest. These showed a single-vessel lesion in one coronary artery, which was successfully stented, and a cardiac ultrasound was broadly normal, with no evidence of significant structural damage to the heart.
That decision was made on the merits of the case, because there was a real clinical benefit to the patient being treated where they were. It was not about choosing the cheaper option. Planning by reflex to evacuate this patient would have been neither medically appropriate nor financially justified.
The outcome
We supported the patient through their admission and after discharge, through a period of convalescence with their partner. After a period of observation, and a local outpatient appointment to reconfirm that they were clinically stable, the patient was able to travel home without a medical escort. That was the right outcome for the patient and the right cost outcome for the insurer.
Why this is an underwriting issue, not just a clinical one
An assistance company is responsible for helping underwriters understand the medical risks and the cost implications. That covers both immediate care needs and the options for repatriation, whether urgent or routine.
When an assistance company responds to a critical case calmly and with focus, and has a good grasp of the medical and practical situation, it can help the underwriter weigh a range of options for further management, backed by solid knowledge and an understanding of the risk.
But if an assistance company doesn't understand the situation well, or escalates by reflex without enough knowledge or a proper risk profile of the patient, it puts underwriters in a difficult position. They may end up making costly decisions that aren't necessary, or even medically appropriate.
This is what proactive case management means. It means actively managing the case as it develops, understanding the information even when it seems alarming or urgent, and weighing every option against risk, cost and need, so that each decision rests on clear evidence, even if that does mean considering a costly intervention, such as to evacuate them.
The question to ask
For underwriters and claims managers, the practical question to put to any medical assistance company is simple. When an expensive option is proposed, is it driven by clinical and logistical need, and is there sufficient information to justify and approve it?
The relationship between insurers, underwriters and assistance companies rests on trust. Medical assistance companies must bring rigour to understanding each case, so that insurers and underwriters can make well-informed decisions based on the best information available, whether those decisions are high-cost or not.
Clinical details in this case have been generalised and anonymised. Every repatriation decision is made on its own clinical facts, and no two cases are alike. This account is illustrative of an approach, not a clinical protocol.
