In recent months, we've seen cases of swine flu, tuberculosis, measles, mumps and other highly contagious diseases traced back to one infected person on an airplane. It's no secret that airplanes can be highly efficient places for illness and diseases to spread.

I've written quite a bit about the absence of common sense in many recent developments in travel, but perhaps few make so little sense as does the high cost of deciding not to travel when you are ill. While the airlines claim to be very serious about containing disease in flight, their policies are heavily tilted to make sure you will fly or pay for it, contagious or not.

If you are not feeling well, the airline policies aren't going to make you feel any better -- the "bad medicine" of surcharges, fare difference markups and change fees conspires to make it potentially very expensive to stay home. The following guide to your rights, recourse and medical options should help the next time you are not feeling well before a trip, and are faced with the decision to fly sick -- or pay dearly.

First and Foremost
One critical piece of advice up front: If it looks like you may not be able to travel, get a doctor's note -- it may not help in the end, but without it you are really stuck. If you do file an appeal or claim with the airline or your travel insurer, this piece of documentation may decide the outcome.

How to Avoid Catching a Cold on a Plane

Air Travel
Policies affecting sick or injured travelers vary considerably by airline. Southwest, for example, imposes no change fees or penalties for travel postponed for illness, applying a full credit for use within the next 12 months -- but it is just about alone in this regard. Among the big carriers, the most common stance is to charge a standard change fee (usually $75 to $150), plus any difference in fare.

This can get extremely expensive; say, for example, you bought a ticket with a 21-day advance purchase, but decide on the day of your flight that you are too sick to fly. Then the next morning you are feeling better and try to land a new seat to travel that day. Airfares for same-day travel usually cost a LOT more than 21-day advance purchases, and you will have to make up the difference, as well as the $150 change fee. In most cases, you are looking at extra costs in the hundreds or even thousands of dollars. If you are traveling as a family, multiply those costs by the number in your travel party. Owwww... For a family of four, deferring travel by just one day could cost a couple thousand dollars.

Poll: What Do You Do When You Get Sick While Traveling?

Most airlines will allow you to appeal the extra charges "on a case-by-case basis," but this usually means paying the change and fare difference up front, writing an appeal accompanied by a doctor's note to airline customer service, and hoping they think your situation merits a refund of the upcharges.

A few airlines have made policy exceptions for documented cases of specific illnesses; for example, AirTran will not charge a fee if you have a proven case of swine flu. For other illnesses (even for a different type of flu -- go figure), AirTran's $75 change fee will typically apply.

Of course, all of the above applies to nonrefundable fares; for refundable fares, you may cancel for any reason in most cases, but of course you have already paid a considerable premium for that right, as refundable fares cost much more.

On some occasions, an understanding and proactive customer service representative may waive fees on the spot when travelers contact the airline; this depends as much on the person who answers the phone as it does the specific circumstances. If you are really in trouble, airline personnel sometimes do have the authority to make exceptions. I wouldn't count on it if you are calling in with a cold, however.

Five Foods to Avoid Before You Fly

Hotel Stays
Policies at hotels vary tremendously from property to property. Even at a single place, policies may change depending on any number of variables, such as whether you're traveling over the holidays, whether you booked directly with the hotel, whether your credit card has been run, whether you bought your room on a site like Priceline where the refund process can be byzantine ... you get the picture. My suggestion would be to contact the company with which you made your booking, and go from there.

Hidden Hotel Fees to Watch Out For

Car Rentals
Most car rental reservations are not paid before you pick up your car, so you are on a bit more solid ground. However, as with hotels above, if you made your car reservation on an auction site or other booking engine that has already charged your credit card, it gets a lot tougher to get your money back. These policies vary both by booking engine and by car rental company; your best bet if you think you may not be able to travel is to contact them immediately.

Does Travel Insurance Cover You?
In most cases, the simple answer is yes -- this is the most commonly cited reason to purchase travel insurance, after all.

A representative at Access America, which has partnerships with many major airlines -- these are the folks you probably end up talking to when you choose to purchase insurance during the booking process on most major airline booking sites -- let me know that most common travel insurance policies do cover the cost of delays or cancellations due to illness. However, as we have noted elsewhere on the site, it is important to know what is and is not covered in your specific policy.

Access America's "Basic" plan covers the following:

• Complete Cessation of Services
  
• Death of Family Member
  
• Death of Insured
  
• Death of Traveling Companion
  
• Foreign and Domestic Terrorism
  
• Hijacking
  
• Home Uninhabitable
  
• Illness of Family Member
  
• Illness of Insured
  
• Illness of Traveling Companion
  
• Injury of Family Member
  
• Injury of Insured
  
• Injury of Traveling Companion
  
• Jury/Subpoena
  
• Quarantine
  

There is nothing at all equivocal about most of these; it is important, however, to understand the insurer's stance on pre-existing conditions (the bugbear of the insurance industry at all levels). In the simplest terms, pre-existing conditions are not covered, unless you purchase a policy that specifically covers your condition. This applies to longer-term conditions (a broken leg) as well as to more temporary conditions (a stomach bug); in short, they don't want you to buy travel insurance after you are already sick or injured.

A raft of "General Exclusions" may also apply; the Access America Basic plan lists the following:

In addition to any other exclusions that may apply to a particular benefit, no coverage is provided for any loss that results directly or indirectly from any of the following unless as specifically included: existing medical conditions; intentional self-harm, suicide or attempted suicide; pregnancy (unless unforeseen complications or problems), fertility treatments, childbirth or elective abortion; mental or nervous health disorders, (like anxiety, depression, neurosis or psychosis); use or abuse of alcohol or drugs, or related physical complications; war (declared or undeclared), acts of war, military duty, civil disorder or unrest; participation in or training for any professional or amateur sporting competition; participating in extreme, high risk sports; flying or learning to fly an aircraft as pilot or crew; nuclear reaction, radiation or radioactive contamination; natural disasters; epidemic or pandemic; air, water or other pollution or threat of pollutant release; unlawful acts; expected or reasonably foreseeable events or problems; financial default of a travel supplier; terrorist events; travel bulletins or alerts; and government prohibition or regulations.

Clearly these two lists contradict one another in places -- the "Covered" list includes terrorism, as does the "Exclusions" list -- so as noted above, you will want to read and understand the fine print when purchasing insurance. We recommend calling the insurer and asking directly about any questions you may have.

And again, when filing a claim based on illness, you will almost certainly need a doctor's note -- so get one!

Learn More About Travel Insurance

Fine, Those are the Policies ... But Doesn't Anyone Care That I Am Contagious?!?
Yep, you are. But the airlines aren't going to give you much slack for it -- that is simply a risk you take when purchasing nonrefundable fares. Of course, this is why it is unsurprising that swine flu and TB are being spread on airplanes -- faced with hundreds or thousands in penalties and upcharges, most folks just get on the darn plane.

So what can you do to reduce the risk to yourself and others when contagious -- and when should you absolutely skip the flight and throw yourself on the mercy of the appeals process?

I asked Dr. Alla Kirsch, Medical Director with Travel Clinics of America, several questions that may help guide you the next time you are in the position of deciding whether or not to travel when not feeling well, both for your own health and that of others.

Are the risks mainly for spreading illness to other passengers, or does the infected traveler also take on additional risk?
The risk of an ill person spreading the disease is not only to those traveling near him but populations at large. Recent outbreaks of TB, measles and mumps in United States and elsewhere have been started by one ill person traveling from another country. Also, recognize that risks may extend to unborn children, such as in the case of a pregnant woman contracting chicken pox on a plane. This would put her unborn child at risk for congenital abnormalities.

Is there anything specific to traveling that makes the situation more critical?
A person who has early appendicitis may have only vomiting and malaise. If he is on a long flight, pain may become severe and the appendix may even burst before he can be taken to surgery. Obviously traveling under such circumstances may be very dangerous. Intermittent chest pain may be an early warning sign of a heart attack and may become an emergency during a flight. Flying is already a risk to dehydration and someone with vomiting and diarrhea may be unable to keep up with fluid replacement and become severely dehydrated. Flying with a sinus or an ear infection can make one miserable from pain as well.

What do you recommend as the best precautions to take when traveling while contagious?
To protect others, do not touch anything that others could also be touching. Consider wearing a mask. Best advice: If you are contagious, do not travel.

Which common conditions present the most risk of transfer to other folks?
Viral respiratory illnesses, influenza and gastroenteritis are most common but measles, mumps, tuberculosis and others can also occur.

Do airplanes present a greater challenge in this case than do, say, trains or buses?
Supposedly not because the air is filtered. I as a practicing physician see many who become ill after a flight. This could be because of overcrowding and close seating.

At what point or under which circumstances do you recommend that someone cancel their travel?
I would advise to cancel the trip if someone is running a high fever (over 101), has vomiting or severe diarrhea, or is unsure of the diagnosis.

In the end, it is worthwhile to remember that sick people travel every day -- they also handle and exchange money in stores and banks, lick envelopes, cook for their families and in restaurants, open doors, etc. When it comes to travel, though, an ounce of prevention may be worth a week's pay in fees.


Go Anyway,
Ed Hewitt
TravelersEd@aol.com
Features Editor
The Independent Traveler