The Limitations of Health Insurance

Health insurance is an important protection to have, but many people do not realize that an insurance policy is not a magical paper that will pay all of their bills. Even the most comprehensive medical insurance plan has restrictions and limitations on its coverage. Insurance companies may be very choosy about providing coverage for procedures above and beyond the routine. Reading the fine print in a health insurance plan before signing up can prevent applicants from making big financial mistakes.

Pre-Existing Conditions

Insurability is calculated according to risk factors. Therefore, applicants with pre-existing medical conditions can either be deemed completely uninsurable by the insurer or they may have to pay higher premiums for coverage. In the case of a health insurance coverage lapse of more than 63 days an applicant with a pre-existing medical condition might have to wait as long as a year for new coverage. A short term individual policy could prove to be beneficial at times like these to ensure uninterrupted health coverage.

Cosmetic Surgeries

As a general rule purely cosmetic surgeries are not covered by health insurance. This means that face lifts, liposuction, rhinoplasty and other vanity surgeries must be paid for out-of-pocket. However, there are some cases in which cosmetic surgery can be covered. For example, reconstructive plastic surgery following an accident or injury may be covered. Other cosmetic surgeries which are medically necessary to correct problems such as birth defects like a cleft palate or to repair a deviated septum can be covered as well, at the recommendation of a doctor.

Alternative Treatments and Medications

Non-traditional treatments and procedures used in lieu of conventional medicines are not typically included in a health insurance plan, nor are complementary medicines which are combined with the conventional treatments. Some of these treatments not covered by insurance include yoga, massages, acupuncture and sometimes even chiropractic treatment. This is due to the fact that such treatments are considered by health insurance companies to be experimental, non-traditional or both.

Private Home Care

Private in-home medical and nursing care costs are some of the most expensive health expenses not covered by insurance. There are nearly one and a half million patients using in-home health care and the average rehabilitating patient requires at least two months for their recovery. Without a good health insurance plan that can at least help offset the high treatment costs, private in-home medical care can be devastating to the finances and cause the patients and their loved ones to go into bankruptcy.

Mental Health Treatments

Mental health coverage is an evolving area for health insurers. Some plans cover in- and out-patient treatments for substance abuse, eating disorders, and various mental illnesses requiring intensive therapy. However, a referral from the applicant’s regular doctor is required in order to gain access to these services. It may also be a good idea to check your employer’s health program for mental health and substance abuse coverage, such as spending caps and number of treatments covered.

Health insurance is not a cure-all or an unlimited fund for each and every medical issue. Insurers are companies which operate for profit and by established rules and guidelines for coverage. Although supplemental policies can be written for all of these examples the customer should always determine their needs prior to contracting for health insurance coverage.