Can You Refuse a Repatriation Proposed by Your Insurer?

The question families ask

The assistance company's doctors propose to bring the patient home. The patient, or the family, hesitates: the hospital abroad seems good, the patient does not want to travel, or the proposed solution does not look suitable. Can you say no?

The patient remains free to decide

A patient who is conscious and able to decide is free to accept or refuse a medical transfer, as for any medical act. No insurer, assistance company or transport provider can force a patient onto an aircraft. If the patient cannot decide, the decision is taken with the person entitled to represent the patient, always on the advice of the treating physicians.

What the contract may say

Freedom to decide does not mean that the consequences are the same. Many assistance contracts provide that if the insured person refuses the transfer proposed on medical advice, the assistance company may consider that its obligations end, or that it will not cover the costs that follow. The wording differs from one contract to another, so read yours, or ask the assistance company to confirm in writing what a refusal means for the coverage.

Why an insurer proposes a repatriation

The proposal is generally based on the opinion of the assistance doctors, who talk to the treating physician abroad. Common reasons are:

• the care needed is not available locally, or not at the level required;
• the patient will have a long hospital stay or a long rehabilitation, and being close to the family is better for recovery;
• the condition allows a safe transfer now and may not later, for example because of a risk of complication;
• the hospital abroad is not able to continue the care, or the language or the means of communication make follow-up difficult.

Good reasons to hesitate

A hesitation is legitimate when it is based on a real concern. For example:

• the treating physician abroad thinks that the patient is not yet fit to travel;
• the means of transport proposed does not seem suitable for the patient's condition, for instance a commercial flight where a stretcher or intensive care would be needed;
• the destination hospital is not clear, or has not accepted the patient;
• the patient is recovering well and the family would prefer to wait.

How to handle a disagreement

1. Ask for the reasons. Ask the assistance doctor to explain in plain words why a repatriation is proposed and why now.
2. Have the doctors talk. Ask the assistance doctor and the treating physician to speak to each other. Most disagreements are settled at this stage.
3. Ask for the alternative. If you think another solution is better, such as a different date, a different means of transport or a different hospital, say so and ask whether it is possible and how the contract treats it.
4. Get the answer in writing. A refusal, or a request to wait, should be recorded with its date and the name of the person you spoke to.
5. Do not commit to expenses without advice. If you decide to organize something yourself, ask first what will be covered.

When a second opinion helps

If you are unsure whether the proposed transfer is right, a second medical opinion can help. This is where a specialized provider can assist: our coordinating physician can read the medical file, give an opinion on fitness to fly and on the most suitable means of transport, and explain it to the family. We do not replace the treating physicians or the insurer's doctors, and we never organize a flight that the medical teams consider unsafe.

In short

• The patient is free to refuse, but the contract may attach consequences to a refusal.
• Ask the reasons, and ask the doctors to talk to each other.
• Get any decision or refusal confirmed in writing.
• When in doubt, an independent medical opinion on the transfer can help.

To go further, read who decides on a medical repatriation and what to do when an insurer refuses or delays.

General information only — not personalized medical, legal or insurance advice. Your insurance contract and the treating physician's opinion prevail in your situation.