As it does every spring, a temporary city of tents was erected at the foot of the world’s tallest peak, Mount Everest. Climbers and tourists from around the world - some paying upwards of $50,000 - made this once in a lifetime trip to Basecamp. A pilgrimage. For some, it’s a staging area to the highest point on the planet. For others, a bucket list destination.
Supporting these pilgrims are expedition leaders, guides, outfitters, sherpas, camera crews, cooks, and other staff who build, maintain and resupply the camp of roughly one-thousand people. This year, there was one extra tent. A temporary command post staffed by a Traveller Assist doctor and paramedic, equipped with medical packs, satellite communications, and a list.
On the 65th anniversary of the very first known ascent of Everest, 2018 is set to welcome over 1 million travellers by the end of this calendar year. During this peak season hotel occupancy has only been around 65%, while expedition companies are reporting record sales, and helicopter companies have logged a record amount of flying hours. Visitors to Nepal are heading to the mountains, and this is a major problem for travel insurance companies.
This spring season was particularly busy, in part because Nepal’s Department of Tourism continued to honour the climbing permits from the 2014 and 2015 aborted climbing seasons. While Everest is popular, climbers also target other mountains in the Himalayas, including: Mera, Makalu, Nuptse, Lhotse and Dhaulagiri - with a total of 649 permits for 22 different peaks being issued.
In August 2017, Traveller Assist - in a joint venture with an Australian based insurer - sent their Operations Manager to Kathmandu to assess the level of care being provided in hospitals, and to ascertain why the 2017 spring climbing season had been the most expensive on record for medical claims, particularly for helicopter rescues and evacuations.
"We learned a lot from the 2017 high-season [Oct-Nov]. It was the busiest year on record since the 2015 Nepal earthquake. This gave us the opportunity to try-and-test different methods to facilitate, and improve rescue and evacuation missions." said Forest Williams, Operations Manager
Last year, a record 940,000 visitors arrived in Nepal and within the last three-months of 2017, Traveller Assist provided medical assistance for over 250 travellers from the UK, Australia, New Zealand, Canada, and the United States - 37 of which involved a heli-evac. After further investigation, it was found that 30% of these helicopter evacuations were completely unnecessary.
A typical scenario that we have seen repeated again and again - a traveller on an expedition complains of a headache or other such ache. The expedition leader calls for a helicopter. Helicopter arrives and provides an evac, with an agreement to pay the expedition company a commission. The helicopter company then fly’s the patient to a hospital, where in turn they are promised a commission by the hospital. The patient - who remember only complained of a headache - is then admitted for observation, and given blood tests, x-rays, and in some cases, even an MRI and EKG.
A helicopter rescue and inpatient medical bill is then presented to the travel insurance company - who at the time had no choice to seek a medical opinion or direct care - in some cases totalling more than $20,000. It’s a racket that’s tantamount to fraud, and it’s happening on a large scale throughout Nepal.
This became our main focus. Spearheaded by our Head of Assistance, Danny Kaine - the first task was to create a chart of all helicopter companies registered in the country, and then ascertain which companies actually owned helicopters, and which ones just rented them. Stands to reason that the cost to charter a helicopter from the owners is less than renting it from a company who in-turn rented it from the owners.
The second task was to visit the senior management of every hospital in Nepal who we suspected of over treatment, and of paying helicopter companies a commission to receive patients. With a letter signed by four major insurance companies - who in-turn manage 27-brands and insure collectively over three million travellers worldwide - we were authorised to deny a claim on their behalf if we suspect(ed) fraud, and this was explained to hospital management in no uncertain terms.
With the intelligence we had gathered, and the support we received from our clients - I reached out to request a meeting with a representative at the Department of Tourism in Nepal - where I was authorised to disclose that a major underwriter was considering the option of no longer offering travel insurance in the region due to the sheer amount of fraudulent claims, which would have a major effect on the economy of Nepal.
Fast-forward to the end of the 2018 spring climbing season, and Traveller Assist has provided medical assistance for over 800 cases and stopped over 100 unnecessary helicopter evacuations from happening in Nepal - with the full support of the Department of Tourism, and Ministry of Law, Justice and Parliamentary Affairs - saving our clients over $500,000 in helicopter fees, and over $3 million in medical costs through our independent provider network.
Our doctors and nurses are highly trained with extensive experience operating at altitude - including our medical director who is a former British Army Gurkha, helicopter pilot and flight doctor, with two successful summits of Everest - and who assesses every single patient that requests a helicopter evacuation - with standards exceeding telemedicine governance and duty of care law.
Even a simple case in Nepal can quickly escalate into a complex case. For patients who do not warrant a helicopter rescue, our company provides alternative methods of evacuation to the nearest hospital/medical centre, and we continue to monitor each and every patient.
We have launched a regional operations centre based in Kathmandu, and hired local staff, including a doctor, nurse, and three paramedics - with ground agents in Pokhara, Lukla, and Basecamp - and we have established a trusted, independent provider network of helicopter rescue companies, hospitals and hotels with typical savings for our clients of 25%.
In an industry first in Nepal, we have created an agreement and established a line of communication with helicopter companies, whereby if they are called to evacuate a traveller who is insured by an insurer on our list of clients - they call our regional operations centre in Kathmandu - and our in-house doctor or nurse assesses whether the patient requires an evac, or not.
So far in 2018, we have successfully managed to capture 65% of helicopter evacuation cases insured by our clients, and 40% of medical assistance cases, before a service was provided - meaning that we got to assess the patient, and direct care before a single helicopter charge or medical bill was created. While these numbers will never reach 100% due to various factors, we do think we can get them closer to 80% based on this seasons results.
At present, we provide medical assistance for 32 travel insurance brands,13 expedition companies, and on behalf of several other assistance providers in Nepal, but with visitor numbers reaching 1 million by the end of this year, we estimate that we currently represent less than 10% of those travellers - meaning that unnecessary helicopter lifts and over treatment will continue to run rife in Nepal if other travel insurance companies continue to pay.
On June 25th, 2018 - the Ministry of Culture, Tourism & Civil Aviation in Nepal to announce official investigations (press release pictured below) into 500+ expedition, trekking and helicopter companies who are accused of corruption through unnecessary and fictitious helicopter rescues to defraud the travel insurance industry out of millions of dollars. Watch this space.
By: Jonathan Bancroft, Managing Director, Traveller Assist