Health Insurance Exclusions
In health insurance, an exclusion is a medical procedure or treatment that the health insurance company does not cover. This may include specific medications, surgeries or therapies that are specifically omitted from your policy. Exclusions vary from plan to plan, meaning that even if your friend’s health insurance covered a service, yours may not.
It’s more difficult for insurance companies to exclude many medical procedures if the insurance is considered a “qualified health plan” and meets the ACA (Obamacare) rules and standards. Most anything “medically necessary” should be covered. Not all medications will be. You’ll need to look at the health insurance plans “formulary” which is a list of medications that they will cover.
What Are the Most Common Health Care Exclusions?
While exclusions vary considerably across plans, there are some that are consistent regardless of the health insurance provider. A health insurance agent can help you review your coverage to determine the exclusions that apply to you.
Hospital Stays
Hospital fees can be notoriously high. While you expect to pay for services such as diagnostic screenings, physical therapy, and skilled nursing services, you may not expect to see your bill ran up by non-medical nickel-and-dime charges. For example, if you use the television in your hospital room, you may have to pay for that luxury out of pocket, as most health insurance companies exclude coverage for it. The same goes for bandages, extra pillows and even use of the in-room telephone.
Pre-Existing Conditions
Thanks to the Affordable Care Act, health insurance companies can no longer deny coverage for pre-existing conditions. Also, very good news, there are no longer waiting periods for covered services and treatment related to the medical condition. Pre-existing conditions must be covered the first day your policy is effective without lifetime or yearly limits on coverages for the “essential 10 healthcare benefits”.
Elective Surgeries
Elective surgeries such as nose jobs and face lifts are usually not covered by health insurance. In some cases, if surgery is needed to fix an injury, health insurance coverage may apply. But “vanity” surgeries will, for the most part, not be covered. Hair loss after cancer treatments most likely will be covered. Breast augmentation after cancer would be covered. But just wanting hair transplants due to familial hair loss won’t be covered and getting breast implants to enhance your self-confidence will not be covered. Having gastric bypass will not be covered unless you meet the medical requirements to deem it medically necessary. So being medically necessary is one factor that plays the biggest role. Another would be to restore you back to pre-harm, pre-injury or pre-disease status.
Dental and Vision Services
Dental and vision services such as teeth cleanings, cavity fillings and eye exams are not covered under health insurance for adults. The ability to buy your own dental and vision plan is open to enrolling into year-round. You are not limited to certain times of the year to buy your own private dental and vision plan. If you work for an employer that offers these benefits, you’ll need to make sure you opt in during their “open enrollment” period at work.
How to Avoid Surprise Medical Bills
There are a few steps you can take to avoid high out-of-pocket medical costs.
- Look beyond the short list of exclusions in your policy handbook
- The exclusions can change, so make sure you have an up-to-date list
- Before setting up a payment plan for hospital services, get an itemized bill
- Research your state’s rules regarding services that can be excluded from your plan
- Call your health insurance company to find out if a new treatment or procedure is covered under your policy
Find Health Insurance Coverage with Nevada Insurance Enrollment
Understanding health insurance coverage can be challenging, but Nevada Insurance Enrollment is here to help. We have experienced health insurance agents who help you review and understand your coverage options to avoid high future medical costs.
Recent Posts
Various Tips to Protect and Maintain Your Car
According to Live Science, after being parked in the sun on a 95-degree day for an hour, the inside of a car hits an average of 116 degrees. The dashboard gets even hotter at 157 degrees, the surface of the steering wheel reaches an average of 127 degrees and the seats are a searing 123 degrees on average.
Why You Should Avoid a Lapse in Auto Insurance Coverage
n Nevada, auto insurance companies notify the Department of Motor Vehicles when you drop your auto insurance policy. If you have a lapse in your auto insurance coverage, even 1 day, it will be noted on your driving record. When this happens, you may be faced with a $250 dollar fine that will go up over time, and you can have your license suspended until you have auto insurance coverage again.
Hidden Pitfalls of Cheap Auto Insurance
Car accidents can be expensive, and your auto insurance policy is your best protection against financial devastation if the unexpected happens. While state-minimum coverage is definitely better than no coverage at all, a high percentage of scenarios shows it’s not enough for most drivers.
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Car In Storage? Don’t Cancel Your Auto Insurance!
If you have a car that you are just storing, or if you’re planning to leave your car here in the U.S. while you leave the country, or if you just don’t drive the car and don’t want to pay for auto insurance, here are some tips to consider before doing so.
Auto Insurance Scams – How To Avoid Being Victimized
If you feel like you are victim of an insurance scam accident, first thing to do is call 911. Take pictures of the other passengers and make note of who is in the car at the time of the accident. Take pictures of the damage and who was driving and note exactly what happened, along with getting all license plate numbers involved.
Auto Insurance and Your Custom Car Audio System
Many drivers would not even consider looking into insurance coverage on an after-market audio system. There are a few things to consider, however. Is it covered by your auto insurance?
Your Auto Insurance and the “Hit and Run”
If your car was hit by someone and they do the legal/right thing by admitting it and paying for it, all is well. The “at fault” driver’s insurance will cover it under their property damage portion of their insurance for your car to be fixed. In the case that someone hits your beautiful new car while you are in the store and drives away, what do you do?