Travel Daily Media interviews interviews Adam Mikulski, Founder and CEO of Medical Air Service, one of the world's leading air ambulance providers specialising in international medical evacuations. Having established the company in 2009, Mikulski has spent more than a decade overseeing complex medical repatriation missions across the globe, giving him first-hand insight into the realities of emergency medical transport, travel insurance, and cross-border patient care. In this interview with Travel Daily Media, he dispels common myths surrounding medical evacuation coverage, explains how insurers assess emergency transport decisions, highlights the challenges travellers with pre-existing medical conditions face, and shares practical advice on choosing the right travel insurance before embarking on a trip.

TDM: International medical transport can cost hundreds of thousands of dollars in some cases. Are travellers generally underestimating these costs, and what level of evacuation coverage should they realistically look for when purchasing insurance?

AM: Many travellers do not have travel insurance at all, which is something I strongly discourage. Those who do purchase insurance should read the policy terms carefully. For example, does the policy cover evacuations only when they are medically necessary, or also when they are considered medically reasonable? There may also be limitations related to pre-existing conditions, destination countries, the duration of the trip, or high-risk activities. Travellers should make sure that the circumstances of their trip are fully covered by their insurance policy.

 Travel Daily Media (TDM): Many travellers assume that medical evacuation is automatically covered under travel insurance. What are the most common misconceptions people have about medical air transportation coverage?

Adam Mikulski (AM):  Many insurance companies are not as quick to approve a medical evacuation as people tend to think. When tourists become sick or injured, they often assume that their insurance will cover an evacuation simply because they want to return home. In reality, insurers typically require a clear medical necessity. If you can receive appropriate treatment locally, they are unlikely to approve an evacuation just because you cannot communicate easily with the doctors at an Italian hospital.

TDM: Medical evacuation can involve anything from a commercial flight with a medical escort to a dedicated air ambulance. How do insurers determine which type of transport is medically necessary, and who makes that decision?

AM: This is usually a joint decision involving the treating physicians on site, the doctor overseeing the evacuation, and the insurance company's medical team. In most cases, the decision is straightforward, and there is little disagreement. However, things can quickly become complicated. The flight doctor assumes responsibility for the patient's well-being throughout the mission and will therefore decline the mission if they believe the proposed mode of transport is not safe enough. The insurance company, however, may refuse to pay for a more sophisticated means of transport. In such cases, the dispute can drag on and may even end up in court.

TDM: Pre-existing medical conditions are often cited as a reason for claim denials. What steps should travellers with existing health issues take before departure to ensure they remain eligible for evacuation coverage if an emergency occurs?

AM: When it comes to pre-existing conditions, the key question is whether the patient's deterioration could reasonably have been expected or whether it may have been triggered or worsened by travel. That is why it is important to consult your doctor before your trip to determine whether travelling is safe in your current condition. Ideally, your doctor can also provide a written statement confirming that your condition is stable at the time of travel. While this does not guarantee that an insurance claim will be approved, it can help support your claim if an emergency arises.

TDM: Adventure tourism and remote-destination travel continue to grow globally. How are insurers adapting to the increased risks associated with activities such as trekking, diving, mountaineering, or travel to isolated regions?

AM: High-risk activities are often excluded from standard travel insurance policies. However, many insurance companies offer optional coverage for these activities, although it is typically more expensive because of the increased risk involved.

TDM: From your experience handling medical evacuations worldwide, what are the most important questions travellers should ask their insurance provider before they travel to avoid unpleasant surprises during a medical emergency abroad?

AM: Apart from reading the fine print in their policy, travellers should also understand how a potential medical evacuation would be arranged. Only a few insurance companies have their own medical teams and aircraft to carry out evacuations. Some work with a dedicated partner company, while others allow clients to choose their own medical repatriation provider and either pay the bill directly or reimburse the client afterwards. Delayed reimbursement can be particularly problematic because most medical evacuation companies require payment in advance. Even if the costs are reimbursed later, this can place a significant financial burden on the patient and their family.