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Illness or injury on vacation in a foreign country can be financially ruinous at best and life-threatening at worst.

Personal experience 1: Last year, my mother fell and broke her arm a few weeks before a scheduled cruise. Her doctor didn’t want her to travel, and so we had to cancel the trip. We’d bought travel insurance, so we were only out a few hundred dollars.

Personal experience 2: On a ski trip abroad, one of my party had an awful fall on the mountain. He had to be airlifted to a hospital, stabilized, and treated for weeks. The travel insurance he had was minimal, and he ended up being held in a South American hospital until his $50,000 bill was paid. He then needed U.S. State Department involvement to get him home on an air ambulance at a cost of many more tens of thousands of dollars.

Travelers are by their nature risk-takers, after all, and buying insurance almost seems like cheating. So we play it fast and loose, and a canceled trip means we’re sitting sadly at home a few thousand dollars poorer. But few of us stop to think that a medical emergency in a foreign country can be financially ruinous at best and life-threatening at worst.

It’s not just the daring who need medical coverage when they travel. According to Kim Seay, RN and director of assistance for Allianz Global Assistance, the five most common ways people get injured on vacation are by falling, motor vehicle and pedestrian accidents, high-risk activities (trekking, scuba diving, rock climbing, etc.), attempted robbery or assault, and injuries associated with alcohol and drugs. (We suspect that last one often overlaps the other four with some frequency.) Still, according to the U.S. Travel Insurance Association, only 7.8 percent of U.S. travel policies are for medical and medical evacuation benefits. Travel medical insurance is not to be confused with the sort of standard trip-protection coverage that is often provided as a credit-card perk. 

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“Travelers from other countries—particularly those with socialized medicine, which typically do not have out-of-country benefits—automatically purchase travel insurance whenever they leave the country,” says Dan Durazo, director of communications at Allianz. “Americans are just starting to catch up to the rest of the world.” Most comprehensive travel insurance policies include coverage for medical and dental emergencies and emergency medical transportation, he notes, but check the coverage you’re getting. “Frequently, medical facilities outside the U.S. will ask that payment for services be made at the time of treatment; travel insurance can guarantee payments so that travelers do not have to pay out of their pocket for expensive treatment.”

If the unthinkable does happen, a traveler has only to call a hotline (or have it called by some medical professional who finds a policy on your person), or in the case of Allianz, use the company’s TravelSmart app preloaded with policy information. Once contacted, Seay’s team of nurses—a sort of travel triage help desk—kicks into gear. “Our medical team can translate if needed, and make sure our customer is receiving the best possible care,” says Seay. “If we determine a customer needs to be transported to another facility, we’ll arrange and pay for that transportation.” Some entire countries are labeled “Red Zones” by the assistance team, meaning that the standards of care are so low that evacuation to another country is almost always necessary. The company has thousands of prescreened medical providers around the world, and a U.S.-based medical team is always on rotation to meet travelers on-site for a full assessment and some home-country assurance, even if repatriation isn’t necessary. Beyond care and transportation, the company can provide nursing support, payment guarantees, travel for unattended dependents in the event of a medical evacuation, medical monitoring, prescription replacement, and even the transportation of family members to your foreign bedside.

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And if they’ve got to fly you home? Often some nursing care and a first-class ticket can get an injured traveler safely to a hometown hospital without too much discomfort, but in some instances, the only option is an air ambulance. Seay can rattle off the price of these flights, based on the hundreds she’s booked: “Being airlifted back to the U.S. from South America is roughly 40K-80K; the U.K., Germany and France, 45K-65K; Italy and Spain: 50K-75K; Russia: 75K-100K; the Middle East: 75K-110K; Asia: 80K-150K; and Australia: 90K-150K.”

The moral of the story: A clumsy fall on the marble of a hotel lobby can not only ruin your vacation, but it can also burn right through your lifetime travel budget. And that’s more pain than any traveler wants to suffer.

>>Next: Hurt on Vacation? Meet Your Lifesaver