Hiring a Medical Escort – Insurance & Clinical Practice Concerns
Selecting A Medical Escort for Repatriation of Crew
Recently, SphereMD was asked to assist with medical repatriation services in an area where we had no trusted assets available. We immediately began searching for a medical service provider who met our standards, and our pursuit proved to be eye-opening.
Typically, we use our own staff for repatriation services. When SphereMD staff are unavailable, we rely on trusted, pre-vetted partners. In fact, most of our partners have been heavily vetted for large, ongoing government and oil contracts. With our staff and trusted partners, we are confident our patients are in good hands.
This time, we faced the rare case of having to find a new partner.
With a few phone calls to colleagues and a couple of internet searches, we easily found over a dozen options. Each service was willing to accept the assignment of transporting a stroke patient from the North American West Coast to Bangladesh.
Expected Services Proved Easy to Find
On the surface, the providers seemed equally viable. They all offered the services you would expect:
- Air travel coordination
- Ground and air travel for the patient
- Hospital discharge coordination
- Collection of repatriation
- Authorization documentation
- Receiving facility coordination
We were satisfied with the basic services offered, but what about medical direction and insurance?
We dug deeper.
The Surprising Challenge—Medical Direction and Insurance
Medical repatriation services are far more complex than simply transporting a person from one country to another. To align with our in-house standards, we needed our new provider to also guarantee medical direction and proof of insurance.
Medical directors play a critical role in medical repatriation services. A medical director can confirm when a patient’s medical condition is stable enough for travel, and can give orders for required care and emergency treatment. Any provider we partner with must have a qualified, in-house medical director.
At SphereMD, we require medical direction for all repatriation services provided by our staff and trusted partners. When we asked each company about their medical direction, we were surprised to find that it is not always required.
A few companies had in-house physicians who could approve and set orders for the repatriation staff. Other companies relied on repatriating nurses or EMTs. We found this concerning and removed all companies without medical directors from our list.
Our pool of candidates was thinning, and we still had more questions. Having explored the basic services and medical direction; we turned our attention to an important, but often overlooked, aspect of medical repatriation services and international travel—insurance.
Insurance is rarely fun, almost always complicated, and too important to ignore. Therefore, we asked each company to provide proof of insurance and show us their insurance certificate. Results varied, including:
- One provider’s insurance certificate showed a $1,000,000.00 policy attached to an EMT license. When we requested a copy of the corporate insurance, we were told corporate insurance was not required because the providing company did not own assets.
- Several companies only provided proof of basic insurance policies attached to nursing or EMT licenses.
- Many of the companies had no professional liability coverage (sometimes referred to as medical malpractice coverage). One company had a $1,000,000.00 general liability policy, but no professional liability.
- None of the companies could certify that their coverage extended beyond the United States. This is critical when operating internationally as a policy written in the US is often limited to the US, its territories and possessions, and Canada.
While we are not insurance experts, SphereMD believes we have a duty to understand the types of insurance and extent of coverage services providers carry before we partner with them to transport patients under our care. A $1,000,000 general policy is inadequate (in our opinion).
At SphereMD, we carry the following and recommend that you require your providers to offer similar levels of insurance:
- Professional (medical malpractice) liability that provides coverage for suits brought anywhere in the world. We look for limits of $2,000,000 per occurrence/$4,000,000 annual aggregate.
- Workers’ compensation coverage with endorsement for coverage outside of the United States. This sometimes can be endorsed on to the existing workers’ comp policy, but many times it is picked up through an international policy.
- General liability policy with limits of $1,000,000 per occurrence/$2,000,000 annual aggregate minimum that extends internationally.li>
- Automobile liability with liability limit of $1,000,000, again extending internationally.
- Excess liability (sometimes called umbrella) with a minimum limit of $1,000,000. This policy should provide excess liability for general liability, automobile liability, and workers’ compensation (employers’ liability) on a worldwide basis. Because professional liability is a separate “tower”, you will not typically find that this policy would extend above it.
Our goal is to protect everyone involved in repatriation. At SphereMD, we believe comprehensive coverage is a requirement and a responsibility.
Questions to Ask
When looking for a medical repatriation provider, ask about services, medical direction, and insurance. For example:
- Do you have an in-house physician or qualified medical director who can approve and set orders for the repatriation staff?
- Do you have insurance certificates to show proof of coverage for general liability, professional liability, auto liability, and workers’ compensation (employers liability)?
- Does your insurance coverage extend on a worldwide basis?
Consider asking your existing providers these questions, as well. Do their services include medical direction and adequate insurance? If not, what can be done to improve the situation?
Asking these types of questions can help with both reducing risk and avoiding financial fiascos.
After extending our search and conducting extensive research, we finally found a partner who met our standards. We confidently partnered with the company for our mission and will employ their services again in the future.
Fortunately, we can avoid such extensive emergency research in most cases. SphereMD focuses on staying ahead of emergencies by preparing well and actively filling geographical gaps by pre-vetting providers before an emergency occurs. We rely on our highly qualified staff and heavily pre-vetted repatriation providers in nearly all cases. On rare occasions, we search for new providers in critical times. When we do search, we seek the best.
We’re Here for You
If you would like to learn more about what we found during our search and our vetting experiences, please contact us. Regardless of whether you contract our medical services, we would be happy to help you find the best medical repatriation providers for your needs.