5 Common Services That Are Declined By Health Insurers

by Leon on March 14, 2013

understanding your health insurance and what it coversConsidering how much you shell out for health insurance, you’d expect your provider to cover any services that fall under the mantle of medical care. And yet, there are all kinds of common procedures that your health insurance will decline when billed. Some of them will not come as much of a shock, but others may leave you scratching your head and wondering if the people who created the policies have any common sense. Here are just a few you’ll want to watch out for.

Annual physical. Coverage for preventive care seems like a no brainer, but you’d be surprised how many insurance companies deny payment for annual physicals. This basic checkup gives patients the opportunity to see how they’re doing and learn what they need to change in order to achieve better health. From an insurance standpoint, this means a reduced likelihood of expensive medical bills down the road for easily preventable health issues. Unfortunately, the insurance companies seem to view the annual physical as an unnecessary expense, and many do not include it in their policies.

Elective procedures. Any time you opt to undergo a procedure that the insurance company deems as unnecessary to preserving your ongoing health, you’re bound to see the claim denied. This generally includes any kind of cosmetic procedure, whether you want laser hair removal, a tummy tuck, a brow lift, or a gender reassignment surgery, just for example. Interestingly, there are some cases in which cosmetic treatments will be covered. Say you have excess skin on your eyelids that makes it hard for you to see. Your insurance company may cover the cosmetic procedure required to remove it. So long as there is a medical reason for having a procedure that would normally be deemed “elective” you might be able to obtain the coverage you seek. Otherwise you’re out of luck.

Generic pharmaceuticals. You might think that insurance providers would prefer for their customers to opt for generics, which are virtually the same as their name brand competitors with one major difference: a much lower price. But you would be wrong. Most insurers are far less likely to cover generics. In addition, they often won’t cover “off label” use of drugs, such as anxiety medications that are prescribed to treat digestive disorders.

Fertility treatments. If you’re having issues with fertility your insurer will likely pay for the vast majority of diagnostic services to determine the cause. What they won’t generally do is pay to fix those fertility problems.

Holistic medicine. This will not come as a surprise to most people. Western medicine has long written off its eastern counterpart, despite the fact that holistic and homeopathic treatments have been in use for thousands of years. But when you buy homeowners insurance in Florida, it won’t cover your residence in California. And when you purchase health insurance in the west, it won’t cover traditionally eastern medicine. In truth, attitudes do seem to be changing; some open-minded insurers now cover services like massage therapy and even acupuncture. But without any kind of standardized licensing for holistic treatment specialists, we’re unlikely to see widespread coverage any time soon.

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