subject: Understanding Health Insurance Exclusions [print this page] One of the most common pitfalls of people when getting insured is failing to compare health insurance and ending up with health insurance that doesnt cover their actual health needs. This happens when the exclusions of health insurance policies are not carefully studied. Knowing the different exclusions health insurance providers impose helps in choosing the most appropriate health insurance plan.
Health Condition-related exclusions
Pre-existing conditions have always been controversial when it comes to insurance issues. Pre-existing conditions are those that one person is already being treated for before any health insurance plan has been availed. Though there are changes in policies regarding pre-existing conditions, some people still encounter delays in approval of their health insurance applications if they have pre-existing conditions.
Exclusions are also being imposed on hospital stay-related issues. Some health insurance providers do not include the use of phones or televisions in hospital rooms in their coverage. These are some miscellaneous services that often increase hospital expenses and their use must be planned carefully to avoid high expenses.
An exclusion that has always stirred reactions is that of behavioral or learning problems such as ADHD. The main reason why this is excluded is because it may require care that lasts for many years, if not for the entire life of the person. However, some changes have been imposed lately. While learning or behavioral problems are still generally excluded, some drugs for such problems may be covered.
Cosmetic surgeries, especially elective surgeries, are also excluded. Examples are nose jobs, breast alteration, tummy tucks and others. Such types of surgeries are not covered because they are not considered to be medically necessary. Some cosmetic surgeries are covered though especially those that are done for medical and not only for aesthetic purposes. For instance, skin grafting that is indicated for those who had severe burns is covered. Other covered cosmetic surgeries include nose job that is done to fix a deviated septum and reconstruction of the breast after a surgery to remove the breast or tumor in the breast.
Vision and dental services are usually not covered, too. Sometimes, coverage for these services may be given as a separate insurance plan. Even alternative and complementary medicines are not covered. Examples are yoga, massage, acupressure, acupuncture and the like.
If your intention is to get insurance for specific health services, always review the terms and conditions of the health insurance policies that you are interested to check if the services you need are covered. Finally, before you decide one what to choose, compare health insurance plans to make sure that your choice provides the best advantage.
by: Steve Waller
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