Getting a call that someone you love is in hospital in another country is frightening in a very particular way. You may not know the hospital, the doctors may not speak English, the time difference means you’re hearing about it hours late, and you can’t just drive over. This guide is for family and friends back in the US in that situation, and for Americans abroad who want to make it easier on their families if it ever happens.

It describes, in general terms, what the US government can and can’t do and the practical questions that tend to come up. It isn’t medical or legal advice, and the details will depend on the country and the hospital.

Finding out what’s happening

The first difficulty is often simply getting information. Hospitals in many countries are cautious about what they tell callers, especially over the phone and especially to someone they can’t identify. If the patient is conscious, the quickest route is usually for them, or a spouse or friend at the bedside, to tell the hospital that you’re allowed to be kept informed.

If you can’t reach anyone, contact the US embassy or consulate that covers the area; you can find it at usembassy.gov. If you can’t get through in an emergency, the State Department’s Overseas Citizens Services can be reached at 888-407-4747 from the US and Canada, or +1 202-501-4444 from elsewhere, as listed on its Help Abroad page.

The State Department says that if a US citizen is seriously ill or injured abroad, it can help find local doctors and hospitals, contact family or friends with the patient’s permission, and explain options for sending money. When a relative isn’t responding, embassy staff can check for reports of an American being hospitalized, try to locate them and pass on a message.

Why the embassy may not tell you everything

Families are sometimes upset to find that the embassy knows more than it will say. This is usually the Privacy Act at work. The State Department explains on its missing U.S. citizens page that even when it reaches someone, it may not be able to share information without that person’s written consent. The State Department’s internal guidance for consular officers does allow some information to be shared with family without written consent, for example when the person is in an emergency and unable to sign, or in genuinely compelling circumstances affecting their health or safety. But a patient who is able to decide generally gets to decide who is told.

If you live abroad, this is a good reason to make sure your family already has the basic information they’d need, rather than relying on officials to pass it on.

Who pays for treatment

This is where many families get an unwelcome surprise. The State Department is clear that the US government does not pay medical bills abroad, and that in many places hospitals ask for payment or a deposit before treating someone. It also notes that Medicare does not cover medical costs outside the United States. Its health abroad page covers this.

For an American who lives in the country, treatment may well be covered by the local public health system or by a local or international insurer. The urgent job is to find out which. Look for an insurance card, an insurer’s app, or emails from the insurer, and call the insurer’s emergency line as early as possible. Many policies require you to notify them before or soon after treatment, and some insurers can deal directly with the hospital about payment.

Sending money in an emergency

If the patient needs money quickly and can’t get to their own, ordinary routes such as a bank transfer or a money transfer service are usually fastest. Where those don’t work, the State Department runs a service called OCS Trust, through which family or friends can send funds via the embassy or consulate. Its page on emergency financial assistance explains how, including the $30 fee it charges and the details for sending money by Western Union.

Be wary of anyone who contacts you out of the blue claiming that a relative abroad is in hospital and needs money urgently. The State Department’s advice on scams is to tell the person to contact the embassy, and to call Overseas Citizens Services yourself if you’re unsure whether a situation is real.

Bringing someone home for treatment

Sometimes families want to bring a patient back to the US. It’s worth knowing that this can be very expensive. The State Department says medical evacuation by air ambulance back to the US can cost from $20,000 to $200,000, depending on where the person is and their condition, and that most health insurance plans don’t pay for it. Some travel and international health policies do include evacuation or repatriation cover, so check before making plans, and talk to the treating doctors about whether moving the patient is safe and sensible.

For many long-term expats, of course, the country where they live is home, and staying put for treatment is the obvious choice.

When the patient can’t make decisions

If the person is unconscious or otherwise unable to decide for themselves, the question of who speaks for them is answered by local law, not US law. In some countries the spouse or next of kin is consulted automatically; in others, a formally appointed representative is needed. A healthcare power of attorney or advance directive made under US law may or may not be recognized.

That’s why it helps if the person has already made the relevant documents under the law of the country where they live, and told their family where they are. If you’re trying to help from the US, ask the hospital who it considers the decision-maker and what documents it would accept.

Practical things family can do from home

Even from thousands of miles away, there’s a lot you can usefully do. Keep a simple log of every call: the date, who you spoke to, what they said and what they need. Gather the patient’s details in one place: full name as on their passport, date of birth, insurer, regular doctor, medications and allergies if you know them. Find out who in the country can help on the ground, such as a partner, a friend, an employer or a neighbor with a key, and keep in touch with them.

If there are children or pets in the home, make sure someone is looking after them. If the person has a job, someone should let the employer know. And look after yourself; this kind of waiting is exhausting.

For Americans abroad: making this easier in advance

Most of the difficulties above become smaller if a few things are written down and shared before anything happens. Who should be called, and in what order, with full international numbers. Your health insurance, its 24-hour number and whether it covers evacuation. Your doctors, medications and allergies. Where your healthcare power of attorney or advance directive is kept, and who you’ve named. The details of your nearest US embassy or consulate, and whether you’re enrolled in the State Department’s STEP program with an up-to-date emergency contact.

We’ve written a longer guide to the emergency information every American expat family should write down. If you’d like a ready-made place to record it, Just in Case, Abroad: US Edition has pages for medical information and wishes, insurance, key people in both countries, and your embassy details, in a fillable PDF that stays on your own device.

A fillable “if something happens” binder for Americans abroad, $14, in US Letter and A4. Find out more.

Official sources