Who Decides on a Medical Repatriation: The Doctor, the Insurer or the Family?

A medical decision before anything else

When a relative is hospitalized abroad, the family often wonders who really decides whether the patient comes home, when and how. The short answer is that the decision is a medical one. It rests on the patient's condition, on the care available where the patient is, and on the patient's ability to travel safely. It is not decided by the family alone, nor by the insurer alone, nor by a simple wish to be closer to home.

The treating physician on site

The physician who treats the patient knows the condition best. He or she provides the diagnosis, the treatment given, the evolution of the condition and, when possible, an opinion on whether the patient can travel. Without this information, no repatriation can be organized. If the local doctor considers that the patient cannot be moved, the transfer waits.

The assistance company's doctors

When the patient is covered by an insurance or assistance contract, the assistance company's medical team studies the file with the treating physician. Together, they decide whether a repatriation is necessary and what its terms are: the destination, the means of transport and the type of accompaniment. In practice, the criteria are the medical necessity, the care available on the spot and the stability of the patient for the journey. Assistance companies generally cover only the decisions taken by themselves and by their doctors, which is why it is important to call them before organizing anything yourself.

The three levels of repatriation

The decision also concerns the means of transport, which depends on the patient's condition:

• Non-medicalized transport: for a patient in a stable condition who needs no medical supervision, by ambulance, train or scheduled flight.
• Medicalized transport: when a physician or a nurse accompanies the patient to monitor the condition and administer the necessary treatment, often on a scheduled flight.
• Air ambulance: for the most serious cases, or when the local medical infrastructure is insufficient, with a medical crew and equipment on board.

The role of the family and the patient

The family and the patient are not spectators. They give the information the doctors need, express their preferences, for example the receiving hospital close to home, and give their consent. The treating team and the assistance company take these wishes into account whenever the medical situation allows it. When the patient is conscious and able to decide, the patient's consent is essential.

Can a patient or a family refuse?

A patient remains free to decide about his or her own care. However, many assistance contracts state that if the insured person refuses the solution proposed on medical advice, the assistance company's obligations may end. It is therefore important to read the contract and to discuss any disagreement with the assistance doctor before refusing. If you think that the proposed solution is not the right one, say so and ask the assistance doctor to talk to the treating physician.

When there is no insurance

When no insurer is involved, the family organizes the repatriation, always on the advice of the treating physician. This is where a specialized provider can help: our coordinating physician assesses the file, advises on the patient's fitness to fly and on the most suitable means of transport, and we give a written quote before departure. The final decision always remains with the treating physicians: we never organize a flight that the medical teams consider unsafe.

In short

• The decision is medical and shared between the treating physician and the assistance company's doctors, when there is one.
• Call the assistance company first, before committing to expenses.
• The family and the patient give information, preferences and consent.
• In case of disagreement, ask the doctors to talk to each other, and read your contract.

To go further, read which documents to prepare for a medical repatriation and the difference between an air ambulance and a commercial flight with medical escort.

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