Health insurance doesn’t cover everything–a bitter pill to swallow considering how expensive it is. While we can’t control which services are covered (or how much to pay for them), we can understand what insurance companies will cover.
Check-ups, surgeries, and lab work are generally acceptable, and you don’t have to worry about paying for them as long as you meet your deductible. However, certain procedures are not covered. These mostly fall in the “elective” category such as weight-loss surgeries. Unless you’re a special case, your odds of them being covered are slim to none.
Here we have a standard list of what most insurance companies deem acceptable, and also some cases you could receive assistance with. With the second group, you will most likely have to present your case as something out of the ordinary.
What Most Insurance Covers
Depending on the type of plan you have, insurance usually covers:
- Preventative services such as
- annual physical exams
- routine blood work
- cancer screenings
- blood glucose tests
- blood pressure monitoring
- blood cholesterol monitoring
- Electrocardiogram and X-rays
- Emergency services
- Maternity and newborn care
The main differences in coverage stem from your specific company and which plan level you’re paying for.
What You Could Be Responsible For
Surprisingly, there are quite a few things that insurance plans don’t fully cover.
For example, if you were doing something illegal and got injured, such as twisting your ankle while pulling a burglary, odds are you’re out of luck.
Besides getting hurt while doing something illegal, there are some other things you would think are covered (or at least should be) that are not. These out-of-pocket services are:
- Travel vaccines-Typically insurance companies will only cover vaccines for routine care within the U.S. If you are traveling to other countries, then vaccines for tropical diseases are not covered. It is not “medically necessary” according to health insurance companies. Travel at your own risk!
- Acupuncture– Even though studies approve of acupuncture’s benefits, health insurance will not cover it. It does not fit into most Western ideas of medicine and is thus not as quick to get accepted. A visit can cost anywhere from $100 or more out of pocket.
- IVF– Unfortunately, if you are having issues getting pregnant, then many states’ health insurance plans do not cover in vitro fertilization (IVF). The procedure can cost you anywhere from $10,000- $20,000. Only 15 states have laws that require IVF to be included in health insurance.
- Cosmetic surgery– Health insurance will not generally cover elective surgery. Like most cases, if it is not “medically necessary,” and approved by your doctor, then it will not be covered. For example, if you have large breasts, a breast reduction is not covered unless your doctor provides the necessary proof that it is causing other issues. In most plastic surgery cases, vanity is something you have to pay for out of pocket.
- Dental & Vision– Most plans do not include dental or hearing. In fact, most of the time, you will have to buy a separate plan. LASIK(laser eye surgery to correct nearsightedness, farsightedness, and astigmatism) is not covered. It is seen to be cosmetic, or elective.
- Weight-Loss Surgery– Some weight-loss procedures are not covered within your plan. There is no guarantee unless your doctor deems it medically necessary. There is no federal requirement that private plans cover this type of surgery.
- Hearing Aids– Hearing Aid coverage has been an ongoing issue in America for a long time. Insurance plans will cover hearing exams, but will not cover hearing aids. Why? Because it is viewed to be elective. Only 4 states require coverage of hearing aids.
- Out of Network Doctors– Don’t get hurt in a state that your insurance does not cover or you will be paying a hefty medical bill. If your medical visit, whether doctor or hospital, is out of network, then you will have to pay for it out-of-pocket. Make sure the doctor you are seeing participated with your plan.
When you are searching for a health insurance plan, make sure that you get the coverage that matches your needs. Do not just assume that your health insurance will cover most procedures. Do some research when looking into plans. Otherwise, you will be left with a large bill.
If you are overwhelmed and do not know where to start, we can help. EZ.Insure can search all the health insurance plans within your area, and compare them for you. If you are looking for a specific procedure to be covered, then our agents will search within all the plans available to see if it is covered. What’s even better is that it is all done at no cost. To get started, enter your zip code in the bar above, or to speak with an agent, call 888-350-1890 or email firstname.lastname@example.org.