What Are Some Exclusions That My Provider May Have?

Having health insurance is great, but it can be a shock to find out that something you thought was insured for instance, a surgical procedure, medication or specialist visit – is in reality not covered. Unfortunately, some devices, procedures, drugs and specialists may be excluded under your heath plan. If your procedure is denied reimbursement by the insurance company, you will be the one responsible for paying the bill. Before you go to the doctor, it helps to familiarize yourself with your health insurance exclusions so you don’t get a nasty surprise later.

Common Health Policy Exclusions

What are some exclusions your health insurance provider may have on your policy? Some insurance companies do not cover certain devices, drugs or some kinds of specialists. For instance, if your physician recommends an MRI to diagnose a particular problem, your insurance company may cover the cost of an X-ray, but not an MRI, even though MRIs are more accurate and even though your doctor recommended the MRI. Or, your insurance company may not cover chiropractic care, or a drug treatment program.

Categories of Care Commonly Excluded

Certain categories of care are often excluded from health insurance policies. Cosmetic procedures, for example, are often not covered. In the case of some cosmetic procedures, there may be exceptions. For instance, some insurance providers will cover breast reconstructive surgery after a mastectomy. You should check with your insurance provider, however, before making any assumptions about whether your cosmetic procedure is covered.

Another category that often gets excluded from coverage is preventative medicine that will keep you from getting sick. Sports medicine, nutritionists, or elective surgeries such as stomach-stapling surgery (except in the case of life-threatening illness) may not be covered under your insurance plan. However, if you have a heart attack due to obesity, your health insurance company will pay for your coronary bypass.