By Peggy O'Farrell
The Cincinnati Enquirer

Linda and Mickey Conner just wanted to have a nice dinner with friends to celebrate their last night in Mexico.

But a medical emergency put a scary end to a trip that was supposed to give the Union couple a break from the cold.

Mrs. Conner dislocated the hip she had had replaced several years ago when she reached to pick up her purse, and needed emergency surgery. The cost for the ambulance and hospitalization in Mexico came to nearly $10,000 - which she had to pay on the spot.

Travelers plan their vacation itineraries down to the last tube of sunscreen, but many fail to plan for the worst - illness or injury when they're far from home. That can be an expensive mistake, since many health insurance plans don't cover medical bills incurred outside the United States.

The Conners did it right: Before they headed to Cabo San Lucas last month, they made sure their health insurance covered them while they were out of the country and they took out evacuation insurance, which covered the cost of flying Mrs. Conner from the hospital in Mexico to St. Luke Hospital in Florence. They will submit their hospital bills to their insurance company for reimbursement.

Mrs. Conner, a former insurance agent, knows most travelers aren't aware they need to read the fine print to find out if they're covered while they're overseas.

"When you're looking at $10,000 to $20,000 in bills, you should be made aware of it," she says.

Recent headlines about cruise ship passengers being stricken by gastrointestinal woes have vacationers thinking about the possibility of being taken ill while they're taking a break. More savvy travelers are consulting travel medicine specialists before hitting the road.

Dr. Jeff Heck, a family practitioner and director of the University of Cincinnati's travel clinic, offers this advice: Plan for health care as carefully as you plan for everything else while traveling, which means plenty of advance preparation for vaccinations, insurance coverage and other concerns.

Dr. Heck's tips for planning a healthy vacation:

Worry wisely: Odds are, you're not going to be stricken by any exotic tropical diseases - though malaria and yellow fever are still threats in some parts of the world - but a broken leg or a heart attack can happen anywhere.

"If you look at the most severe types of things people get into in the last 30 years of international travel, it's the same thing people die from or get ill from in the U.S.: heart disease, stroke and a definite increase in auto accidents," Dr. Heck says.

Take your best shot: Smallpox might have been wiped out, but other diseases are very much active, even in popular tourist spots. If you're heading to Mexico or other tropical locales, it's a good idea to get a hepatitis A vaccination, administered in two doses over a six-month period.

Travelers to many countries will need to take anti-malarial medications to guard against the disease, which can kill quickly.

It's always a good idea to get a tetanus booster before traveling, and you might need to update standard vaccinations, such as measles or mumps, before heading abroad.

Do the research: The Centers for Disease Control and Prevention and the World Health Organization are excellent resources for travelers. Check out www.cdc.gov/travel/ or www.who.int/ith/ for health advisories issued around the globe, including what vaccinations are necessary and other practical information. But be realistic, Dr. Heck says. If you're heading to Thailand for a weeklong business trip, you won't need the same precautions as someone staying for six months or a year.

Get covered: The health insurance policy that works in the Tristate might not cover care overseas. Call your insurance company and ask.

Some companies provide special riders or additional policies for overseas travel, and some travel insurance policies cover health care costs.

Consider evacuation insurance, which will cover the cost of emergency air transport for you or a loved one in the event of an illness or accident. Odds are, your HMO won't pay for you to be flown from a hospital in Mexico to a cardiac care unit in Cincinnati.

The Conners bought their evacuation insurance through Medjet Assistance in Birmingham, Ala. A family policy costs $295 a year and covers two evacuations a year or the evacuation of the entire family once a year. Coverage varies from company to company, but, under Medjet Assistance's policies, members pay only the annual fee. There are no additional expenses for travel.

"We're talking about what could potentially be thousands and thousands of dollars if you're not covered," says Dr. Heck.

Swat: Even in Cincinnati, mosquitoes and other critters carry diseases. Prepare to guard yourself against insect bites with long sleeves, long pants, mosquito netting, etc. if you're heading someplace buggy.

Pack smart: Take your prescription medications with you, but leave them in the original bottles labeled with your name, especially if you're heading to a country where drug trafficking is a concern.