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7 Things That Are Not Covered by Health Insurance in the US

If you are considering buying a healthcare insurance plan or have already bought one but are still determining what services it covers and what it doesn’t cover, then you need to read this blog. Medical insurance plans are more challenging to understand than they may sound. That’s why it’s important to know what healthcare services they cover. There may be services that your healthcare insurance plan might need to cover. Today, we will discuss the seven things not covered by health insurance in the US. So let’s start:

7 Things That Health Insurance does not cover in the US

1- Uncovered Prescription Medication:

The most common thing that people with healthcare insurance are unaware of is that sometimes their healthcare providers may prescribe medication for specific medical conditions that might not be included on the medicine’s label.
Such prescribed medications are termed off-label medication, and in the US, most health insurance companies don’t offer coverage for off-label medication. So if your doctor is prescribing you off-label medication, confirm with your insurer whether they are covered in your insurance plan.
If the medications are not covered under your health insurance plan, then be ready because you will pay for them from your wallet.

2- Cosmetic Treatments:

In the US, healthcare insurance plans generally don’t cover any of the services that are not medically necessary. Since cosmetic procedures or even diagnoses are usually not medically necessary, most medical insurance providers also do not cover them.
If you already have an insurance plan and plan to undergo cosmetic surgery to enhance your beauty, then your insurance coverage doesn’t include the cost.
However, there is an exception to it. Some medical insurance companies offer coverage for cosmetic surgeries if they believe it’s medically necessary for an insured person. For instance, if a person has a burned face and needs plastic surgery, her insurance plan might cover the skin burn treatment.

3- Private Nursing Services:

If you opt for private nursing services, you must know that your healthcare insurance doesn’t have coverage for that. Most healthcare insurance plans don’t cover personal nursing services since they are usually for long-term care of patients and are often very expensive.
Moreover, medical insurance plans are designed for medical treatments within the healthcare facility. Since private nursing is out of the scope of a healthcare facility, it’s usually considered not medically necessary by most insurance companies.
In addition, private nursing services include non-medical services, such as providing in-home assistance to patients and assessing their emotional and physical needs.

4- Adult Dental Services:

In the US, dental treatment and diagnosis are considered under the domain of cosmetic procedures; that’s why they are also not covered by most healthcare insurance plans.
However, suppose an adult dental treatment is considered life-threatening or medically necessary. In that case, the insurer can view it as an expectation and may include the treatment in the insurance coverage. However, you must talk to your insurance company before a dental procedure.
Generally, if you want your dental treatment covered by insurance, you need to get a separate dental insurance plan for it.

5- Infertility Treatments:

The coverage of infertility treatment by insurance companies is a very subjective matter in the US. Some states in the US believe that infertility treatment is medically necessary and, therefore, should be covered under health insurance. While in some other US states, diagnosis and treatment of infertility are not considered a medical necessity.
The lack of insurance coverage for infertility treatment is often discussed in the US. However, it’s still not included in insurance plans by many healthcare insurers because infertility treatments are generally quite expensive.
Infertility diagnoses and treatments have billable codes in the US. So you can talk to your insurer about whether you are eligible for infertility treatment or diagnosis under your health insurance coverage.

6- Weight Loss Treatments:

If you have gained a lot of weight and are now considering going for a weight loss treatment since you have healthcare insurance that will cover its expenses, then you might be wrong!
Neither weight loss treatments nor weight loss programs are covered by most health insurance companies in the US, as they don’t consider them a medical necessity. However, some health insurance plans cover nutritional counseling, including weight loss plans and treatment.
Nevertheless, it would help if you asked your insurer whether your health insurance plan covers weight loss programs, surgeries, or any other treatment related to weight loss.

7- Travel Vaccinations:

Though vaccinations are essential from a medical point of view, many insurance companies in the US think that travel vaccinations are optional and, in many cases, are also non-essential. That’s why your medical insurance plan might also not offer coverage for travel vaccinations.
Travel vaccinations generally include vaccinations for COVID-19, Hepatitis, Cholera, Polio, Chickenpox, and other diseases. So if you are planning to travel and need to get vaccinated, remember that you will need to pay for all the vaccinations.

Final Words:

There might also be a few other things that your health insurance might not cover plans other than the seven things we have discussed above. Therefore, it’s essential to contact your insurance provider and ask them before going for any medical diagnosis or procedure. Not only will it keep you safe from unexpected charges, but it will also give you peace of mind.

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