• October 6, 2021
  • |Blog
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What began as a straightforward air ambulance medevac from Uganda to Kenya for a patient diagnosed with COVID-19 turned into an expensive and challenging lengthy stay at the receiving hospital in Nairobi. This created unforeseen exposure to financial risk for the insurer and AMREF Flying Doctors. This case also put a financial strain on the long-standing relationship between AMREF Flying Doctors and the caregivers at the receiving hospital in Nairobi.

This case provided unique challenges due to the initial poor prognosis of the patient, a long and turbulent hospital stay, a recovery to discharge and a repatriation air ambulance flight to reunite the patient with his family in the USA. AMREF Flying Doctors is proud to have been involved in all the stages, from initial medevac, treatment and repatriation home. The patient spent over four months at the hospital in Nairobi.

About AMREF Flying Doctors

While AMREF Flying Doctors (AFD) is Africa’s best-known air ambulance service provider, it is also an accredited medical assistance service provider representing a wide variety of International Insurance and Assistance partners from Europe, North America, Asia Pacific and Africa while affiliated with International Assistance Group (IAG). AFD provides a plethora of services on behalf of its partners within the Eastern Africa Region, which forms the network through which these assistance services are extended. The assistance services are majorly medical, logistical and technical solutions that have continued to be provided over a period spanning 65years. Additionally, solid relationships have been built with various service providers in this region, ensuring fairly smooth service delivery for the patients.

The Case

The initial request to AMREF Flying Doctors was to arrange for a commercial ticket for the patient and his wife from Entebbe, Uganda to Nairobi, Kenya. The patient had been diagnosed with Covid Pneumonia in early January 2021 and had home-based care for the first eight days. After failing to improve, he was admitted to a local facility in Kampala. Due to severely declined oxygen levels, he subsequently required intubation and ventilation 48 hours before transfer to Nairobi. AFD assisted with obtaining a pre-flight medical report to assist the patient’s insurer in obtaining an acceptance letter into the hospital in Nairobi. This is a mandatory requirement for medevac clearance from the government authorities. The medical report obtained was also crucial for the medical flight crew in their planning for the medevac.


Crucial Financial decisions


As an accredited service provider for assistance services, AFD conducted the medevac and requested a Guarantee of Payment (GOP) to cover medical expenses for one week at the hospital in Nairobi. The requirement to increase the cost coverage necessitated a lot of back-and-forth communication with the assistance partner, who in turn had to seek authorization for coverage from the primary insurer.


The patient was admitted into the Intensive Care Unit and given how critical he was; it was impossible to estimate the hospital length of stay. However, this is a very significant question asked by the assistance partner on a near-daily basis. His journey to recovery would be lengthy; he would require dialysis almost daily as he was in kidney failure and had already developed complications brought on by the COVID-19 disease. It was crucial for AFD to ensure that there was adequate cost coverage for the patient’s hospitalization.


AFD kept the assistance company updated on the interim medical costs, which continued to escalate by the day. The admitting hospital was a private facility and thus the very high costs for the region. The cost of medical care in private institutions is comparatively very high and unaffordable for the average person, especially if there is no medical cover by an insurer. However, the quality of care in these private hospitals in Kenya is higher than in public hospitals.


The patient’s wife and daughter, for whom AFD had booked for their hotel accommodation, were anxious to get back home after being in Nairobi for almost two weeks.  The family was very cognisant of the guarded prognosis of the patient. They at times felt compelled to have the patient repatriated back home even though he was unfit for flight.


The patient’s prolonged hospital stay resulted in an accrued hospital bill of over USD300,000.00. This amount was invoiced to the requesting assistance partner in intervals enabling AFD to pay the hospital in instalments and manage cash flow prudently.


Patients face challenges getting released from hospitals in the region without the medical bills being guaranteed. AMREF Flying Doctors ensured that there would be no hindrances related to the patient’s discharge. It was also noted that many health insurers were not covering COVID-19 related medical admissions at the time. The hospitals were keen to ensure that these patients had adequate medical cover to reduce their financial strain.


Medical repatriation

As the patient was not fit enough to fly commercially, discussions about repatriating the patient back home became a priority once he had shown signs of adequate recovery. A decision was made to repatriate through air ambulance.


AMREF Flying Doctors began to consult with other providers with whom a wing-to-wing transfer could be done. The patient had twice been considered unstable for repatriation until he took a good turn and began to show signs of stability and slow but gradual improvement. AFD took advantage of the window of opportunity and arranged for the patient’s repatriation back to the USA. The patient was flown from Nairobi in May 2021, on AFD’s air ambulance jet to Istanbul, Turkey, where the wing-to-wing transfer occurred. The patient was then transferred safely to his home country.

The rigorous planning and pre-flight COVID-19 testing for the patient and crew was necessary to ensure the successful repatriation of the patient. A few weeks after the repatriation flight, AFD was happy to receive communication from the client. He continues to recover and is grateful for the support and care that he received.



AMREF Flying Doctors is a trusted brand and reliably provides air medevac and medical assistance services on behalf of its partners. In this case, client relationship management was crucial and this helped enhance trust between AFD and the partners they interacted with.


Effective and timely communication between the care providers at the hospital, the assistance company as the client, and AMREF Flying Doctors as the assistance service provider, helped facilitate efficient and well thought out decision-making all in the best interest of the patient. The AFD team ensured that the insurance company was fully informed of the patient’s clinical condition and his level of readiness for repatriation, through follow-up of the patient’s medical reports as well as bedside visits by AFD doctors and nurses.


AMREF Flying Doctors prides itself in the delivery of high-quality services. They prioritize integrity and patient-centeredness as core values in providing assistance services. The COVID-19 pandemic has brought on hard times to many players in the medical assistance industry. AFD is grateful that they continue to provide a value add services to their partners despite these challenges and continue to strive to go the extra mile.







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