What Can Be Covered by Health Insurance?

Health insurance is defined as any program that assists with the payment for medical expenses. There are a number of medical services that are commonly covered by health insurance companies.

Medically Necessary Procedures

A “catch-all” for determining if something is covered by insurance is to determine if the procedure or service is medically necessary. A medically necessary procedure is classified as a medical service that is required to maintain an overall quality of life and wellness. This means that elective procedures, alternative medicine, and cosmetic surgeries are generally not covered by any insurance providers.

Doctor Visits

Routine visits to general practitioners are almost always covered by health care providers. These visits include the yearly physical exams that are required by school systems and some businesses. Pediatric care physicians are also covered under visits to general practitioners. Visits to dentists and optimists, however, are generally not covered without an additional rider on the policy.

Prescription Drugs

The cost of prescription medications can be alarmingly high, especially those prescriptions necessary to combat certain diseases. Luckily, most health care plans come with coverage for medications. These discounts usually work on either a copay or a deductible system. It’s important to note that some plans cover only generic prescriptions and may not have coverage for brand names.

Diagnostic Tests

Health insurance policies generally cover a range of common diagnostic tests. Diagnostic tests are used to diagnose diseases, track the recovery from a disease, or ensure that a patient is disease-free. These procedures include, but aren’t limited to, blood tests, physical exams, and exercise stress tests. Take note that some highly specialized diagnostic tests may not be covered by insurance providers.

Hospitals and Extended Care

Various health insurance companies provide coverage for hospital stays. Unfortunately, this coverage may not extend to emergency room services or ambulance services. Extended care facilities, such as nursing homes, rehabilitation centers, and various therapy institutions. Board and care facilities are generally not covered by health insurance as they do not provide medical services.

Diabetes Treatment

Americans with diabetes often require several medical services on a regular basis. This includes medication and equipment such as insulin and glucose monitors or test strips. The good news is that insurance providers typically completely cover diabetes treatment and its associated costs.

Preventative Services

Preventative services are now covered thanks to the Affordable Care Act instated by Obama in September, 2010. These services include but aren’t limited to alcohol abuse screening, blood pressure screening, cholesterol screening, HIV screening, and STI counseling. Immunizations for adults and children are also covered by the new insurance plans.

Mental Health

Mental health care for conditions such as depression, schizophrenia, or anxiety are generally covered under health insurance plans. However, providers such as therapists and psychiatrists can be severely limited based on which company a patient has coverage with. Patients will only receive benefits if they visit a therapist within their insurance coverage network.

If you have questions about what your insurance policy covers, call your provider’s 1-800 number for more information.