Things that health insurance does not cover

8 services that are normally excluded in US health policies

Looking for the best health insurance is not an easy task. Oftentimes, consumers can’t decide on which services to cover or how much to pay. Some health insurance plans will help with paying a portion of them or the full amount of services. While many of them can pay up to 80% of the full amount, others leave the patient with all the expenditure.

Another scenario is when a patient goes to a consultation without knowing how much of the service will be covered. So, he asks the doctor and the company to find out the full amount. In some cases, the health insurance company does not clarify this question. Some come out with the typical “it depends” or “Will let you know after the consultation ends”. This is the only service that doesn’t “speak to you clearly” in terms of numbers, prices, and coverage.

Over time, health insurance companies have striven to improve their services and make them clearer. Below a list of the products and services that are generally not covered by private and public health insurance programs. There are discrepancies. Many customers are left holding the bag when some services that are supposedly covered are finally denied.

Abortion

While abortion is legal in The United States, it is also true that it is not paid by insurance in most cases. At times, it is covered by Medicaid but this will depend on the state. If a person has been a victim of incest or rape, some states approve the use of health insurance to practice abortion. Medicaid covers it, but there are other health insurance programs that do not.

How do you find this out? If you are covered by a private plan, call the company and ask about their policies. They will inform you if this service is covered or not.

Cosmetic Surgery

Undoubtedly, most health insurance plans do not cover cosmetic surgeries. They don’t cover, basically because these procedures are not life threatening, but there are exceptions.

If a woman, for instance, has had a mastectomy because of breast cancer, she can harness the coverage to pay for the surgery. Some health insurance plans, including Medicaid, cover breast reconstruction.

There’s another to resort to health insurance to get an aesthetic surgery. It is applicable when a person is due to undergo surgery because of a body malformation or after having an accident. In both cases, the patient requires cosmetic surgery to improve the situation. Contact the insurance company to know if you’re eligible.

HIV

HIV is covered by many plans, but some decline the assistance. If you are in this position, go for Medicaid, which includes outpatient care and emergencies. Other plans do cover HIV but exclude some services that appear in Medicaid.

Pregnancy

Although Medicaid agrees to cover pregnancy expenses, it is a reality that it is often excluded by other private plans. If you are married or live with your partner and expect a baby, make sure the policy covers pregnancy.

None of the plans available, however, include surrogate’s pregnancy. The cost generated by fertility treatments and pregnancy can add up to 200,000 dollars. It is too expensive.

Homeopathy

Homeopathy is another service that is not included in health policies. Homeopathy encompasses all related to alternative medications. If somebody wants to take this way, they’ll need to dig into their pocket. Neither the doctor visits nor homeopathic meds are covered by health policies.

Childbirth

Well, this depends. Childbirth is not covered in all cases, and when it is covered, some plans do not include all the services but a part of them. Also, the state’s eligibility has to do with this.

It is best to enroll in Medicaid to be sure childbirth services are partially paid at least. Some private companies exclude some products.

Ways to deal with childbirth expenses? The best alternatives will always be CHIP and Medicaid. With CHIP, which is an infant-focused program, a portion of infant care is covered, while pregnancy is fully included.

If you are above the 300% of the poverty level in your state, CHIP could be an option, otherwise, go for Medicaid, which targets low-income residents. Both options work.

Fertility treatments

Sadly, these treatments aren’t also included in health insurance. Some health policies, however, can assist in the payment of the fertility tests, but no more than that.

Another reason these treatments are not considered is because of their high price. Still, you can leverage the policy to pay for IUI and IVF. The exclusion of these services prioritizes infertility testing and treatment in women than infertility in male consumers.

The good news is that there are some private companies that help with the diagnosis and a little section of the overall treatment. Some of these programs are Aetna, Cigna, and TriCare, which will only cover IVF.

Off-label prescriptions

Some medications are used to treat other disorders that are not on the label of drugs. If you are prescribed a medicine that is not intended to treat your condition, expect the funds are denied by the insurance. One of five doctors uses a medication to treat conditions that are not signaled on the label, without considering this issue.

Health insurance companies do not cover these prescriptions on the grounds that these practices are just for investigational and experimental purposes. Most physicians do this for investigational purposes and obtain a high success rate.

While most off-label prescriptions of drugs are already documented, they are still not covered. Patients with cancer have to cope with this frequently, after having exhausted all the approved options.

New technologies

Even though medical technologies keep on advancing unceasingly, most health insurance programs refuse to cover them. Insurance companies claim new technologies can help but still need testing. When a condition is treated with these resources, there’s uncertainty everything will turn out well in the end.

Because new technologies are considered experimental, they are excluded from health policies. This will change as new technologies are irrevocably approved, and with that, more health benefits are confirmed.

As far as studies affirm, one of the first technologies to be admitted into health plans will be AI. The only advancements that will be covered will be those that are proven to give benefits to the majority of patients.

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