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Health Insurance Exclusions

When purchasing health insurance, one may expect to be covered for everything. Health insurance exclusions, however, controvert this understanding and you should read them.

Health Insurance Exclusions

There are few things as shocking to a person or detrimental to their wallet as to get a medical bill and then find out that the health insurance policy that you have been paying premiums on so faithfully does not cover this particular item. Each health insurance policy has a list of items that the policy will be pay for. These are called exclusions. They vary from policy to policy and it is the responsibility of the policy holder to know them.

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There are many common exclusions. Home care and private duty nursing is often excluded from health insurance policies much to the surprise of policy holders. Many policies have exclusion lists where they are all detailed very carefully, but others will include the exclusions in other sections of the policy. Home care is one of the items that is also mentioned in a section other than the exclusion list and is often overlooked.

Behavioral problems are another common health insurance exclusion. Behavioral problems are generally excluded because they are not only becoming one of the most common medical care expenses, especially of children, but also because they tend to require very long term treatment. Insurance companies fear that they would soon go broke if they were required to pay to treat these common and potentially expensive problems.

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Many policies do not pay for items that are considered common. These might include band aids and telephones in your hospital room. Most of these items are normally taken for granted and the policy holder is very surprised to find they are actually on the exclusion list. Dental care, hearing, and vision care are usually not covered in a health insurance policy. In most cases, they are covered under a separate program specifically designed for them. Do not assume that anything is covered. It is important to completely understand what your policy will pay for and what it excludes.

Cosmetic surgery is another item that is most likely a health insurance exclusion. Most policies are designed to discourage any type of treatment that is not absolutely necessary. Recently, many insurance companies have begun to realize that it is ultimately more profitable to encourage good health and many types of preventive medicine treatments have come off the exclusion list and are being encouraged. Even routine checkups used to be excluded, but are now being accepted on the principle that prevention of illness, or catching something early will ultimately result in reduced costs. Health insurance exclusions change constantly and State laws sometimes restrict what can and can not be excluded. Again, it is the individual’s responsibility to keep up with them.

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