Health Insurance Articles

What Type Of Exclusions Exist On Health Insurance Plans?

2009-11-12

It is a common assumption that health insurance will cover all health care costs at least partially. However, many health insurance exclusions exist that if go unnoticed will present unexpected fees or needs unmet.

Pre-existing conditions are generally excluded from a new plan. A pre-existing condition does not necessarily mean a condition an individual had before acquiring the insurance, but rather a condition that had received medical attention before the first day of coverage on the new plan. For those conditions that are covered in the health care, the patient often experiences delay due to a prolonged waiting period. Fortunately, recent legislative changes have made it more possible to receive the health care in such situations. Another surprising exclusion from health care coverage is that of behavioral or learning treatment. For example, dyslexia and ADHD often are not covered under insurance because they require treatment for years, as opposed to a simple process of diagnosis, treatment and cure. This exclusion may be disregarded in the future due to recent awareness and developing procedures regarding similar disorders. Along these lines, many health insurance plans exclude any sort of mental treatment or treatment from a self inflicted harm. This includes denying certain care to those who have attempted suicide, suffer from drug abuse, or have a mental disorder such as anorexia or bipolar disorder.

Some exclusions are not quite as surprising. Cosmetic surgeries such as nose jobs, tummy tucks and face-lifts are not covered because they do not pose a threat to the patient if left untreated. However, if cosmetic procedures are done in response to a medical problem, the chance of it being covered by health care is more probable. Breast reduction to alleviate back problems and skin grafts for burn victims fall into this category. Alternative and complementary (used in conjunction with traditional) medicines, such as yoga, acupuncture and massage therapy, are also commonly excluded.

It is important to carefully inspect health insurance plans, and request detailed, itemized lists when being billed at a health care facility. This is especially important in regards to hospital stays. Using the phone, television, extra pillows and sometimes even extra bandages are excluded. Considering the high mark up the hospital will charge, these seemingly harmless "extras" will add up quickly. In addition to procedures, certain drugs and medications are excluded for various reasons. Most insurance policies will include a drug formulary, a list of drugs that are covered. It is safest to assume that anything not presented on that list is not covered.

The best step to avoid receiving health care excluded from your coverage is to be aware of the nuances of health insurance policy.