What Can’t Be Covered by Health Insurance?

Health insurance is a critical part of everyone’s finances. Unfortunately, there are some situations that coverage providers refuse to insure.

Cosmetic Surgery

Health insurance companies strictly operate on a basis that covered procedures are required in order to maintain health and well being. Cosmetic surgery is often not “needed” by the patient and as a result is not covered under most health insurance plans. If cosmetic surgery is covered it is usually for re-constructive surgery after an injury, or to rectify a birth defect.


Around 250,000 Americans are currently experiencing chronic kidney damage or kidney failure. The number of patients is expected to double within the next 5 years. This blood cleansing process takes place for six hours three to six times a week and is critical for the survival of patients. Surprisingly, most health insurance companies, around 73%,  do not cover dialysis treatments. Transplants are also largely uncovered, with 75% of insurance providers refusing coverage.

Pregnancy and Maternity Care

Insurance providers see pregnancy as a planned event that is under the control of the insured persons. As such, many policies do not cover the necessary maternity care (blood tests, ultrasounds, prenatal care) without an insurance rider.  A staggering one-third of Americans pay completely out of pocket for maternity care. Additionally, 30% of American insurance companies do not provide coverage for gynecology services. Another 73% do not provide coverage for infertility treatments.


Only 26% of insurance providers offer coverage for sterilization procedures such as vasectomies or tubal ligation. This procedure may fall under “preventative tests” which are also uncovered by insurance companies. It is also suggested that the non coverage of sterilization methods stems from political or religious views.

Ambulance Services

Ambulance rides are expensive, with some counties even charging fines for situations that require an ambulance. 36% of U.S. insurance providers do not cover ambulance services. This is largely because of the number of ambulance rides called in situations where patients, or families and friends of the patient, had the ability to reach the emergency room using a personal vehicle.

Vision Care

Insurance providers often have riders for discounts on glasses, contacts, and eye exams. However, most visits to the optometrist are paid completely out of pocket. For patients who only replace glasses every few years, the premiums for eye care insurance may be an unnecessary expense.

Alternative Treatments 

Otherwise considered as non-traditional, alternative treatments are not usually covered by a health insurance policy as it is seen to be used in place of conventional medicine or complementary (used alongside other treatments). This might include such treatments like yoga, acupuncture and massage etc.

If you have an important procedure or service that isn’t covered, you can always appeal to the coverage provider. Some states also have policies that pay additional funds if you file your appeal with their state-run programs and win.