Insurance Considerations for Travelling Cancer Patients

Over the past 40 years, I’ve travelled to all seven continents and most of the US states. I didn’t feel much like travelling most of the time I was on cancer treatment, but now that I’m feeling fairly normal on Xalkori, I’ve begun to venture out again.

When I buy expensive tickets on common carriers (airlines, cruise ships, train), I buy travel insurance. Before I was diagnosed with lung cancer, I bought it primarily to cover non-refundable payments in case I had to cancel due to illness or family emergency, or to cover lost luggage and medical expenses abroad. Now that I’ve got metastatic cancer, and I’ve learned how much quality of cancer care varies, I’m more concerned with covering expenses if I have cancer-related problems while on a trip.

The CDC has a good page that summarizes the three types of insurance for travelers: travel insurance, travel health insurance, and medical evacuation insurance. Here’s what I’ve learned from the travels of myself and others.

Travel Insurance and Travel Health Insurance

These policies are usually purchased for a specific trip, and cover the following travel medical problems, along with baggage insurance and other things.

Trip cancellation provides reimbursement for non-refundable trip payments and deposits if I must cancel the trip before it starts. If the trip is expensive — say, a two-week cruise — and purchased many months in advance, I want my deposit and payments to be reimbursed if changes in my treatment plan (say, radiation for a new met) force me to cancel my trip.

Trip interruption provides reimbursement for non-refundable trip payments and out of pocket expenses if the trip is interrupted after it starts. If I have a health problem on the cruise, and the ship departs without me while I’m waiting on a doctor or hospital, I will get reimbursed for the extra airfare to catch up with the ship after treatment, and meal expenses I had to pay out of pocket while I’m off the ship.

Emergency medical and dental pays medical or dental expenses incurred on the trip. Cruise ship doctors are pricey, and expect payment at time of service. Medicare and Medicare supplements usually do not cover medical expenses incurred outside the USA.

Emergency medical transportation arranges and pays to medically transport me to an appropriate medical facility when I need care, and get me home after I’ve received care. More on this under Medical Evacuation Insurance.

Frommer’s has compiled a list of companies that offer travel insurance and travel health insurance. The US State Department has another list of companies that provide coverage for overseas travelers. AAA-hosted trip usually book me through Allianz, and I’ve booked through Allianz myself online.

Medical Evacuation (Medevac) Insurance

If I become severely injured or ill while away from home, I might need an air ambulance to transfer me to a major medical center, or even my home hospital. Such transfers are EXPENSIVE. A friend with cancer paid $20,000 to be flown by air ambulance from Seattle to Kentucky. If you’re overseas, the cost could be $100,000 or more if you’re in a remote area with little medical care available. Travel insurance policies often don’t provide sufficient coverage for this.

Medevac policies can be purchased separately or in combination with travel insurance. Some Medevac insurance providers have their own network of specially-equipped airplanes whose flights are not restricted to airline timetables and routes; other providers are simply brokers that make arrangements for evacuation with contractors. Most medical evacuation insurance companies offer policies that cover the insured on all trips during a set period, be it short- or long-term. Annual policies are typically around $200. Terms and availability vary from carrier to carrier.

Some carriers that offer Medevac insurance are listed below. I don’t have personal experience with any of them; this list is just offered as a starting point for readers.

Allianz
Global Rescue
IMG
MedjetAssist
TravelAssist Network
Travel Guard MedEvac Plan
WorldMed

Buyer Beware

Here are a few lessons learned from my own experience:

1. Read the insurance policy to be sure my specific travel situation is covered. Some policies will allow me to cancel within a short period after purchase if I discover my situation isn’t covered.
For my first trip to Denver for a clinical trial, I bought Alaska Airlines travel insurance through what was then AccessAmerica (now Allianz). The full policy was emailed to me after I bought it. Good thing I read it immediately: it didn’t cover travel for medical treatment! Fortunately I was able to cancel and get a full refund within 10 days, if I hadn’t already left on the trip. Without travel insurance, however, I would have to forfeit my cheap non-refundable ticket if the clinic changed my appointment day. I was able to reschedule a non-refundable flight for free once by playing the cancer card, but I wouldn’t want to rely on that approach.

2. Disclose pre-existing conditions (lung cancer!) and check for pre-existing conditions waivers that might disqualify me for coverage.
Because I have lung cancer, AAA travel agency told me I had to buy non-refundable travel insurance at the time I made my initial deposit on a cruise, months in advance of the trip. If I had waited to buy the insurance, any claims related to my lung cancer would not be covered. My healthy son was able to wait to buy his insurance until he made his final payment for the cruise.

3. Check for dollar limits, deductibles, and terms regarding medical evacuation.
Be sure the coverage limit is high enough to pay for evacuation from wherever I plan to travel. Ask what air carrier the insurance company would use for evacuation from the travel location—they may not have contractors in all countries. Check the policy to see who decides whether I’m sick enough to qualify for air ambulance, and whether I would be transferred to “the nearest appropriate hospital” or a hospital of my choosing.

The Places I’ve Been … June 2013 Edition

I’ve been neglecting this blog for over a month for two reasons:

1. I helped my Aspie son with a 70-page college geology term paper (serving as typist, scribe, interpreter, cheerleader, and organizational consultant), and

2. Hubby and I took a two-week road trip through six states (Washington, Idaho, Montana, Wyoming, Colorado, and Oregon), three national parks (Yellowstone in WY, Grand Tetons in WY, and Craters of the Moon in ID), two national monuments (Fossil Butte in WY and Hagerman Fossil Beds in ID), and my monthly clinical trial visit in Denver.

The summary: we had a great trip, I had another clean PET-CT scan, AND the kid earned a 3.7 out of 4.0! I intend to write some entries about traveling with lung cancer, geology, and the sites I was privileged to see … as soon as I recover from vacation.

In the meantime, here are some previews of coming attractions:

 photo f7cbde49-e97f-4d10-a6a6-e7a1f5e15081_zpsa2399d3c.jpgOld Faithful in Yellowstone National Park

 photo 0a22a5d7-b10e-4554-9321-87bbe10c2f25_zpsdc31567e.jpgGrand Tetons National Park

 photo 2013-06Roadtrip440_zps2281cd30.jpgCraters of the Moon National Park

Coming Out of the Storm

Early this week I traveled to Denver for my April trial check-in and scans. In addition to the bimonthly PET-CT scan, I was scheduled for my semi-annual brain MRI to see if my lung cancer had spread to the brain. I had been having more headaches and neurological issues over the preceeding month, and I left for Denver apprehensive about what the scans might find.

I had my scans Monday April 22 (read a summary of my scan day), but had to wait for my Tuesday appointment with the oncologist to learn the results of the scan. While I kept busy Monday evening visiting with my nephew and his wife, and helping my son via phone with his geology assignment, my scanxiety hovered quietly in the background. However, it made its presence known by waking me several times during the night, and ensuring my eyes flew open Tuesday at 4 AM Denver time (3 AM by my body clock). I gave up on the idea of sleep around 7 AM and rose early to find this awaiting me.

it snowed overnight in Denver

My rental car was under three inches of powder snow, and white stuff was still falling. Denver’s had a snowstorm every time I’ve visited it for the past four months. I checked the local weather on my iPad. Although Denver is well-prepared to handle snow, the roads weren’t cleared yet, and the freeways were gridlocked by accidents.

I skipped breakfast and headed into the belated winter chill. After brushing snow from the windows and doors, I started the car, turned the heat and defroster to max, and connected the GPS to its traffic cable. The suggested route avoided freeways, offering side streets for the 22-mile trek.

On the 90-minute crawl to the University of Colorado Cancer Center, my mind wandered to what ifs: What if they did find a brain tumor? Then the light would change, and the demands of the drive would yank me back to the present. At the next back-up, my thoughts wandered again: What if my cancer has spread elsewhere? What if I have to leave the trial? What if I have to go elsewhere for the next trial?

It was indeed a long drive.

I arrived at UCCC with just enough time to grab a quick breakfast at the cafe and hustle up to my appointment. I was on time, but other patients delayed by the snowy streets created a 45-minute wait for the oncologist. I was shuffling back and forth between the lab results on my UCCC iPhone app and previous months’ lab results on my iPad when the doctor walked in.

His big smile said it all. “I’m so glad to be able to give good news.”

Both my scans were clean. I was still dancing with NED (No Evidence of Disease).

By the time I left the clinic, the streets were bare and dry, and the sun blazed bright. The snow had simply evaporated, along with all my fears. I plugged my phone into the car’s stereo and sang along with the Eagles all the way to my nephew’s house.

Even when mind storms make the road look bleak, there’s eventually sunshine to be found.

On the flight home the next day, I looked out the window into the unusually clear skies over Washington and saw the bright side of snow.

Mount Rainier from the air

Yep, the scanxiety is cured.

The Hazards of Trial Travels

I've been flying between Seattle (Washington) and Denver (Colorado) once or twice a month since late October to participate in a Phase I lung cancer clinical trial. Flying frequently exposes lung cancer trial patients to all sorts of hazards. The most obvious, I suppose, are the airborne respiratory viruses which spread so easily in cramped TSA security lines and airline cabins. Another is the long walk from security to the gate, which can tax those of us with compromised lung function. And travel for a cancer trial is inherently stressful, with embedded concerns about time away from family and home, negotiating an unfamiliar city, and the possibility of side effects occurring when you're hundreds or thousands of miles away from your oncologist.

But these hazards pale in the face of the unknowable threat that looms over the entire flight and infuses dread in the hearts of all airline patrons, no matter how healthy.

I'm talking about seat partners.

Please don't misunderstand me. I've sat next to pleasant SPs during trial travel: college students going home for winter break who slept through everything, business people occupied with a project, even some articulate folks knowledgeable in a subject of interest to both of us (I'm actually sorry to part company with them). And once, my SP was a Harvey-style pooka with laryngitis, who I especially appreciated after a sleep-deprived week.

Other flights are more ... interesting.

There was the 9-year-old boy traveling alone, a creative and verbal lad, who explored scenarios that might cause a plane to crash.

SP: "What if two guys had a sword fight in the aisle and broke a window?"
Me: "That's why we can't carry pointy objects onto airplanes."
SP: "What if the pilot forgets where the airport is?"
Me: "The airplane has a GPS system that tells her where the airport is."
SP: "What if the GPS fails?"
Me: "She has a big book with maps of all the airports as backup."
SP: "What if she forgets how to read?"
Me: "So what do you want to drink?"

I received a free glass of wine from the cabin crew on that flight.

On another trip, a science geek occupied the middle seat next to my aisle seat. I would have loved to chat with him, but our window SP babbled nonstop about her hobbies, grandchildren, and assorted afflicted body parts. I empathized with him, silently.

The most memorable SP to date was a twenty-something conspiracy theorist who shared his wisdom while crossing three Western states (Western states are very wide). I learned so much from this young man. Big corporations are suppressing cheap clean energy (engines can run on water). Congress wants the US economy to fail. Our government is hiding the cure for cancer – never mind that cancer is not just one disease, the cure exists. Also, perpetual motion machines work. Being an engineer by training, I couldn’t resist the urge to correct that last misconception. I set about explaining entropy and physics. I managed to emit all of three sentences before I was corrected. I was surprised to learn we don’t really understand physics yet. But we will Someday, when we know The Truth. And there is only one Truth.

As I was told more than once on that flight, all we need is The Truth.

I'd settle for a good set of noise-cancelling headphones.