Medex is also pretty good, I've used them (fortunately not for evacs). International SOS has also been around for a long while.

When one is abroad, a lot depends on the local representatives (doctors) affiliated with these companies. And a lot might possibly depend on someone else knowing that you have evac/med insurance so that they can inform the local embassy or a local provider.

I once had to help another person abroad and somehow figured out that he had emergency med/evac insurance (he was near-comatose and I guess I found the ID card in his wallet). But it was quite difficult to get the local rep (a doctor) to respond because "Why should I? He's already in the hospital." I had to threaten this local physician with bad publicity and a report to the U.S. embassy and to his own company to force him off his duff and to come and attend to his patient/client. He was not happy with me in the slightest, nor I with him.

On the other hand I've met some of the medical and logistics personnel of these companies while abroad and they seem very professional and committed.

Serious medical issues can come up while abroad, I've seen it happen repeatedly. Especially in underdeveloped countries, this can be a very big deal. And your own embassy is more likely to lend a hand (even guaranteeing the bills) if they know you have reputable travel insurance. I've seen that happen too.

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