Prior approval is usually mandatory
Policies typically require the insurer or its assistance company to approve the repatriation before it is arranged. Booking a transport first and claiming afterwards is the most common reason a claim fails.
Medical necessity, not preference
Insurers fund the transport that is medically necessary, based on their own medical assessment of the treating doctor's reports. Wanting to go home sooner, or in a particular way, is generally not enough on its own. A documented clinical rationale is.
Common exclusions to check
Pre-existing conditions not declared, activities excluded by the policy, alcohol or drug involvement, travel against medical advice, and destinations under government travel warnings. Check the policy wording rather than assuming.
If cover is declined
Ask for the reason in writing and the clinical basis for it. You can request a review, provide further reports from the treating doctor, or escalate through the insurer's complaints process. In parallel, ask a transport provider for the lowest clinically appropriate option so you know the private cost.
What documentation helps
Current medical reports, the treating doctor's view on travel and its urgency, the receiving facility's acceptance, and a written transport quote with the clinical rationale for the option recommended.