Assistance companies play a vital role getting travellers to safe and appropriate medical facilities, so most insurance plans include 24-hour emergency services, with a dedicated team experienced in the local language and customs. They can also help when an expat returns to the UK for medical treatment.

NHS holds the key

In the UK, if a doctor is needed urgently – such as for a heart attack – the patient must go to the nearest Accident and Emergency (A&E) department, as most private hospitals are not set up to provide emergency care.

“Most overseas patients’ entire hospital admission will be in the NHS, even if they have insurance,” explained Dr Finn Morgan, Group Medical Director, Healix. “Depending on their illness and cover, they may be able to organise a transfer to a private hospital, but many insurers might decline to cover this as not medically necessary. But if the patient has international private medical insurance (IPMI) cover, and their condition is stable, a private hospital transfer is possible.”

Usually, the patient’s insurer will look for local providers and recommend someone, pointed out Will Rowberry, Chief Commercial Officer at Cleveland Clinic London. Or the patient may ask their hotel for the details of a suitable healthcare provider.

“Often patients who have been treated in A&E become stabilised and ask to transfer to a provider such as the Cleveland Clinic. The patient chooses to activate private health insurance, once the emergency is over.”

Joined-up care

Some major UK private hospitals, especially in London, have a concierge service to manage patients visiting the country and needing unplanned assistance, including ICU care.

One example is the HCA UK Concierge Centre set up by Annabelle Neame, Assistant Vice President of New Markets and Innovation for HCA Healthcare UK. It’s for joined-up care across the One HCA UK network of hospitals, urgent care centres, outpatient clinics, GP practices and NHS partnerships in London and Manchester, with a planned hospital opening in Birmingham later this year. HCA UK has direct relationships with many international insurers and managed hundreds of NHS transfers to date.

Its HCA UK Concierge Centre will organise the transfer once the patient is stable, Neame said. It’s an area of medicine that’s growing. “We’re extremely busy doing what we’re doing. The more global people become, the more need there is,” she explained.

The process of moving an unwell patient carries its own challenges. “It is quite logistically difficult to transfer to another hospital, as it interrupts care and a new consultant will be required,” said Morgan.

Rowberry added: “There will be a consultant-led discussion around the appropriateness of moving them."

One option for overseas patients is to access either an NHS or private GP for primary care. They are eligible to see an NHS GP by registering as a temporary resident, or they may be staying at a hotel which can link them up with a private GP. Of course, individuals living and working in the UK are classed as residents regardless of nationality, so can use all NHS services in the normal way.

Initially, a patient is likely to call their insurer for help, and be guided towards calling 999, 111, or advised how to make an appointment with a private specialist – either NHS or private, depending on medical need and the level of service the insurer is providing.

Dr Lynn Gordon, Chief Medical Officer at Charles Taylor Assistance (CEGA), said: “Outside of the UK’s major centres, there are not that many private options, especially for urgent hospital admissions, and very few private A&E departments outside of London. “It would also depend on the traveller’s policy conditions as to whether they are entitled to private hospital care. This could potentially be covered by travel insurance for international patients.”

Question of eligibility

Close relationships have grown between major UK institutions and large international insurers. Neame said her hospitals have good overseas connections, while the large insurers know who they are. “We use the UK language translation service, LanguageLine, for medical reports and to aid communication during an overseas patient’s stay,” she explained.

Healix is also a big player in this area. Morgan said: “We have a big department specifically dedicated to organising private medical care in the UK. So, when we’re looking after foreigners and need to access private medical care, it’s easy to organise, as we already do it for UK residents.

Most overseas patients’ entire hospital admission will be in the NHS, even if they have insurance

“UK private hospitals are used to dealing with the big domestic payers such as Healix – they are much less familiar with overseas insurers,” he added, pointing out that Healix is also experienced in navigating medical patients through the NHS.

To a large extent, the location and extent of care depends on the nature of the policy. Some individuals with comprehensive cover may even have access to an air ambulance for return to their home country.

Rowberry agreed that this factor is key: “Patients usually know the level of cover they have on their insurance,” he said, but help can be offered by the hospital’s Global Patient Services (GPS) team.

Cover eligibility can be checked and, depending on the insurer, Cleveland Clinic may have a preexisting relationship, as they are part of a worldwide network, now providing a London-based setting for international patients visiting the UK. Cleveland Clinic London’s GPS team sets up the initial medical treatment, oversees the care, and liaises with specialists to follow-up in the patient’s home country. A number of these are known as ‘embassy patients’, with foreign embassies covering the treatment costs.

In terms of payment, insured patients pose few challenges to assistance providers. “This is not usually an issue for us if cover is in place,” Gordon confirmed. “On rare occasions, or if cover has not been approved yet, the client may have to pay and claim the money back.”

Morgan explained: “Every major NHS hospital has a department to charge overseas patients, and will have a conversation about payment as the patient is responsible, they are likely to then contact their insurer.”

He noted that patients are frequently in hospital and have accessed medical care before they speak to their insurer. “Then, they can pay for it in one of two ways: directly and claiming it back, or the insurer arranges with the hospital to pay directly – this is only possible if the insurance company has a network allowing them to do that” he said.

But when it comes to the NHS, there may be significant obstacles to recouping the cost of care from overseas patients, but “the NHS needs beds, so they won't delay discharge while waiting for payment”, Morgan said.

Case-by-case basis

In the cases of repatriated patients needing hospital treatment back in the UK, what are assistance providers offering?

Gordon makes the point that repatriated clients from the UK will only go into a private hospital if they already hold separate private health insurance, ‘but again, the NHS may still be the first port of call’.

Private health provision is unlikely to be covered once back on UK soil, as ‘repatriated patient cover usually ends when they are handed over to a UK NHS hospital’, Gordon said.

Usually, the insurer will look for local providers and recommend someone

Morgan believes that almost all medical repatriations of travellers abroad will be coming back to the NHS. “They very occasionally can be transferred to a private hospital, but usually only if the condition is straightforward and very stable, otherwise the private hospital will be cautious about taking them.”

Some groups of expats retain their NHS entitlement, depending on working status, or may still have a UK residential address and remain registered with the local GP.

Neame has extensive experience with medically repatriated patients returning to the UK. She said that it isn’t possible to book an ICU bed on the NHS, so patients may well look at the private sector, especially if they have international private medical insurance, or would be willing to self-pay. Expats working in countries where there may be limited secondary and tertiary care are often covered by insurance, e.g. Bupa, with a policy giving them a comprehensive international level of care.

“When seriously ill, clinicians and patients can decide which country they are transferred to, and depending on insurance cover or ability to self-pay, they may be transferred to intensive care elsewhere,” Neame said.

HCA UK is often asked by medical directors of insurance companies to bring patients home, although it can be the patient personally contacting them for help, if the hospital is well-known and has a good reputation. The Cleveland Clinic London has also seen instances of that patient-led decision.

The more global people become, the more need there is

Fitness to fly

As with transfer between the NHS and UK private providers, a repatriated client will only be sent home if they are in a suitable condition to fly and it is in their best interests.

Neame explained that ‘fitness to fly’ is an important consideration. “Patient safety comes first,” she stated. “The HCA UK Concierge Centre is Care Quality Commission (CQC) registered and will always ensure a patient is safe to move. We use a number of international rescue companies, commissioned for specific cases.

“Whenever possible, a patient is transferred on a domestic flight which can be adapted if necessary – for example, a seat removed to make space for a broken leg. The patient may need someone medical to fly with them. We will only use an air ambulance if the situation is critical, say a head injury."

A consultant-led multidisciplinary team examines the patient’s notes and decides the best method of travel to reach them. At HCA UK Concierge Centre, the Clinical Quality Guidance Council includes ‘Intensivists’ – medical practitioners specialising in the care of critically ill patients.

Overall, there is a comprehensive range of solutions offered by assistance providers, both for international patients visiting the UK and medically repatriated clients returning. The NHS works in tandem with private providers to stabilise the condition, offering quality care in either setting, based on patient need and the level of private cover held.