Looking at common health insurance exclusions


Even after you’ve purchased new health insurance coverage, you may find later on that you’re not take care of for every single health issue that may arise. Although it’s a good idea to double-check your policy to see if you may be the exception, there are several common exclusions from your average health insurance plans which it’s good to keep in mind.

Cosmetic Surgery

One of the most common exclusions in any health care policy is cosmetic surgery. If the surgery is elective (optional) and is for purely cosmetic reasons, with no proven medical benefit, then the procedure will likely not be covered by your existing policy. There are exceptions in cases of medical necessity, however. For example, reconstructive surgery of the breast following a mastectomy is covered by health insurance, or a rhinoplasty (nose job) needed to repair respiratory issues may also be covered. In most cases, though, optional procedures are simply excluded.

Fertility Issues

You could be in for a disappointment if you cannot naturally conceive, and are hoping that the cost of expensive fertility treatment will be paid for by your insurance company. Although some procedures related to fertility, such as a vasectomy or tubal ligation, may be covered by insurance, elective procedures generally are not. Typical exclusions include hormone shots and in-vitro fertilizations. However, medical costs related to adopting a child may be covered.

Experimental Treatments

You will not be covered on your insurance for any treatment that has not been approved by the FDA. Examples of this include herbal supplements or unproven treatments such as energy healing. Some treatments which were previously considered alternative, such as acupuncture or chiropractic visits, have now started being covered at least partially by normal insurance policies. Some providers will also cover massage therapy or treatments under a naturopathic physician. However, this is another place where you will need to check your specific policy, because coverage varies widely among different providers.

As with any contract, be sure to read all the fine print before committing to a new health care plan. Remember, if your main provider does not offer the complete coverage you’re looking for, you may also be able to purchase supplemental health insurance coverage to fill in the gaps.

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