Despite the rising cost of health insurance, the protection it offers is important for everyone. First of all, everyone is vulnerable to injury and illness and medical care can be very costly. Also, for those with chronic or lifelong conditions, the follow-up care can really add up. Although the companies assert that the individuals have to pay part of their medical expenses, they are not charged with the totality. However, having health insurance does not mean that all the medical services are covered. It is important to read the contract carefully to avoid the additional costs.
Plastic Surgery
Medical insurance companies do not provide coverage for services rendered that are considered cosmetic in nature. For example, plastic surgery in order to improve a person’s appearance, such as breast enlargement or rhinoplasty, are not covered because there are no doctors to have these services. However, breast reconstructive surgery is typically covered for breast cancer patients. Also, surgery to repair a deviated septum may be covered if there is a medical reason for surgery such as chronic nasal congestion or respiratory problems.
Acupuncture
The insertion of needles into certain points of the body to relieve the symptoms of pain was founded by the Chinese. This practice continues to be used today for a variety of conditions. However, there is controversy in the world of Western medicine regarding the effectiveness of acupuncture. As such, most insurance plans do not cover acupuncture. Medicare and Medicaid also do not provide coverage for acupuncture.
In Vitro Fertilization
It is a method of reproduction for couples with infertility problems. The fertilization of an egg is performed outside the womb and inserted into a woman’s uterus. Because medical insurance companies are not required to provide coverage for IVF, they usually do not cover this expensive procedure, especially since it takes several attempts to succeed. Other less invasive procedures such as intrauterine insemination and intrathecal transfer of gametes may be covered in part, but the hormonal treatments that accompany these treatments are often excluded by pharmacy coverage. However, many states require insurance companies to cover the costs associated with diagnosing and treating any condition that results in infertility such as endometriosis.
Preexisting Conditions
Medical expenses incurred for a pre-existing illness are not typically covered by health insurance companies. A pre-existing condition is any condition that was asked for a consultation, a diagnosis was made or why treatment was obtained prior to insurance coverage. When you enroll in a new health plan, the lack of coverage for pre-existing conditions does not usually apply to people who were previously insured under another plan. However, if the coverage under the previous plan ended more than 63 days prior to enrollment in the new plan, the pre-existing condition clause is applicable.
Not Medically Necessary
Medical insurance companies do not cover any treatment or service they feel is not medically necessary. Therefore, even though a doctor may recommend that a patient should have a certain examination or x-ray performed, this recommendation must be approved by the insurer that the patient before the expenses will be covered. If the insurer does not believe that there is a medical basis for the recommended procedure, he/she can deny the payment.
