By John Frenaye

Travel columnist

updated 8:20 p.m. ET April 4, 2005

Did you hear about the resort guest who was sitting by the pool, minding his own business, when a palm tree toppled over and crushed him to death?

I’m not making it up. It happened a few weeks ago at hotel in the Caribbean. No one ever likes to imagine the unimaginable, but sadly enough, it happens all too often.

Americans have some of the best medical care in the world and it’s sorely missed when we’re traveling internationally. But when things go wrong abroad, there are some things you had better not leave home without, and the American Express card is not at the top of the list.

While most people don’t think twice about the necessity of other types of insurance, travel insurance somehow falls way off the radar screen. According to the Centers for Disease Control and Prevention in Atlanta, one out of every two travelers in a foreign country will experience some health problem. While most are minor ailments that can be treated with a trip to the pharmacy, there are times when it is not as simple.

Sometimes a domestic trip might not require insurance, but rarely is there an international one that does not. Here are some of the questions I am frequently asked:

I already have health insurance, why do I need travel insurance? Read your fine print. A lot of insurers will not cover you in a foreign country. Also, many foreign hospitals will not let you leave without payment arrangements in place. Be sure to check your policy very carefully.

In the event of a severe emergency, you may want to be airlifted to quality medical facility. Trust me, you do not want to be treated in a third-world hospital. While immediate care is critical, sometimes it just makes more sense to wait until you can get qualified care.

Travel insurance will cover you. Since medical treatment is an immediate need, most insurers will require documentation to support the claim. Be prepared and keep all invoices, notes, and receipts. Check with your travel insurance policy for their procedures—many require a toll free call to them prior to any treatment being initiated. It may be a hassle in the end; but the main point is that you received the proper medical attention.

Well, I’m healthy, is that all it covers? Not really. While you may be healthy, accidents do happen. Stupidity happens. Ask my cousin who had the urge to become an Acapulco cliff diver in Bermuda. The coral scrapes healed, but only after an unscheduled trip to a local emergency room, a first class flight back to Philadelphia, and 3 days in a hometown hospital. Don’t forget those you leave behind as well. Travel insurance policies will cover you if you need to return to take care of an ill or dying relative.