One of the worst medical experiences of my life occurred two years ago, and I wasn’t even the patient. Shaun, a visitor to Cambodia whom I’d recently met, was admitted to Calmette Hospital, a public hospital in Phnom Penh, with a near-fatal spinal injury. He’d been mugged by a motodop and left for dead, and he urgently needed high-quality medical care.

Shaun in Calmette Hospital, waiting to be airlifted to Bangkok.

Instead, he was shuffled around from clinic to clinic, and after it was confirmed that he had a potentially fatal injury, he lay in a bed at Calmette for 33 hours, untreated and surrounded by filth, while his friends and family tried to convince his travel insurance company to honor his policy and evacuate him to an international-standard hospital in Thailand.

Disasters like the one that befell Shaun are the strongest argument for why every visitor to Cambodia should make sure to have travel insurance, including substantial medical and evacuation coverage. But Shaun had such a policy, and not a cheap one. Unfortunately, his insurance company appeared to be ill-equipped to deal with a medical crisis in a least developed country, and the underwriter, whose approval was required to move Shaun to an international-standard hospital, totally fell down on the job, refusing to approve or deny the claim and leaving Shaun and his broken neck in medical limbo.

We all learned two important lessons from that horrible experience. One was to pay up front for medical evacuation if the medical situation is serious, rather than wait for the insurance company to approve a transfer if they aren’t willing to move quickly.

The other was that it’s vital to thoroughly vet a travel insurance company before buying a policy.

We were told that a spinal injury such as Shaun’s (C2, also known as the “hangman’s fracture”) could be fatal if he so much as turned his neck or ate anything. And although he was in a hospital, it wasn’t what most Westerners would recognize as hospital care. At Calmette you have to buy your own drinking water and your own bedpan and bribe the nurses to provide even basic care. Cockroaches crawled across the room, bloody gurneys were left stranded in empty hallways, and the hospital was full of both mosquitoes and patients with mosquito-borne illnesses.

As the hours passed, the travel insurance company kept stringing us along, telling us that the transfer request would be approved in another 30 minutes, another hour. Perhaps they thought that, since Shaun was already in a hospital, moving him wasn’t all that urgent. Despite having the police report, CT scans of Shaun’s injury, and a call from the British Embassy telling them how serious the situation was, the travel insurance company continued to stall for some 33 hours.

Patients waiting for care at a Cambodian hospital.

Had the travel insurance company told us it would take so long to get approval, his family would have put down a credit card and paid for the $20,000 airlift to Bangkok themselves. In the end, we finally asked if we could sign a waiver that we would cover any costs that the insurance company would not cover. During all the time that we waited, the insurance company never suggested that we signed a waiver; it was only once we asked that we found out he could be immediately transferred without forfeiting his insurance claim. Once the waiver was signed, he was quickly transferred to a high-end private hospital in town and was in Bangkok a few hours later.

We later learned that the one person at the insurance underwriting company who could approve claims this large had gotten onto an international flight without giving anyone else authorization to approve claims in her absence, and so the company’s hands were tied as they waited for the one woman who could give approval to turn her phone back on. To not have a backup decision-maker when people’s lives are hanging in the balance is outrageous.

In the end it took a total of three days to get Shaun air-lifted to Bangkok. According to British Embassy staff, the average length of time for an airlift in Cambodia is closer to 12 hours. When he arrived in Bangkok and was put into traction before undergoing spinal surgery, he was told that the poor care he received in Cambodia had exacerbated the seriousness of his condition and that he was lucky to be alive.

Sitting in a hospital and wondering if this man was going to die because of which travel insurance he had chosen was one of the most frightening experiences of my life. I live in Cambodia; I know what medical care is like here. What was so terrifying was realizing that a tourist could purchase an expensive travel insurance policy and be just as badly off as if he had no insurance at all.

Visitors to Cambodia underestimate how bad the public hospitals are here and also underestimate the cost of medical care. Many doctors in Cambodia have not been to medical school and are not licensed practitioners. For almost anything that’s very serious, it’s best to get to Bangkok or Singapore for care, but the airlift alone costs $20,000. Traveling without travel insurance is a risky proposition, but as Shaun’s experience showed us, so is traveling with a policy from an insurance company that doesn’t have any understanding of the local situation where you are going.

I spent much of those three horrible days waiting for word from Shaun’s insurance company with my friend Niall, another long-term expat in Cambodia and an old friend of Shaun’s. As hour after hour passed, Niall and I looked at each other several times and said, “This wouldn’t be happening if he had World Nomads.” World Nomads is the company that both of us use when we travel abroad, and although we’d never faced a situation as dire as Shaun’s, we knew from our own experiences that World Nomads is knowledgeable about local conditions and extremely responsive.

That was back when my only relationship with World Nomads was as a very satisfied customer. Since then — full disclosure — we’ve partnered with them and advertise their travel insurance on this site. The point of this post isn’t to promote a specific company, however, but to underscore the importance, first, of having travel insurance if you travel to Cambodia, and second, of doing your homework to make sure the insurance you buy will be there for you in an emergency.

In another post we’ll go into more detail about what you should look for when deciding on travel insurance. Whether you end up choosing World Nomads or another company, thoroughly researching your options is imperative.

You may also want to look at worldwide health insurance. Cigna Global, a well-known American insurance company, has several plans designed specifically for expats who are living and working abroad and we’ve heard great reviews from Cambodia expats who use them. Depending on the plan, they offer $1,000,000 coverage and up; the platinum plan has unlimited coverage. They have optional benefits that include worldwide outpatient cover, vision and dental, and medical evacuation (and trust us, you’ll want the latter). Check out their international plans and get a quote from Cigna Global online now.

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