Health insurance has a broad scope that can be difficult to navigate; clients usually have no power over what services are covered. If you wonder whether your insurance company will cover old medical bills, the answer is no. It is unlikely that any insurer will cover costs incurred before your policy with them became effective.
Retroactive healthcare is an uncommon phenomenon; the most you can expect from any insurance provider to offer coverage as far back as your application date.
Even this is a longshot because every insurance policy has an effective date- a date when your insurance policy comes into effect. It is unlikely your insurer will offer you coverage outside of this date.
Health Care Services Insurance Does Not Cover
Insurance plans differ from company to company in the sense that what one person covers another person may not offer coverage. However, there are some services that insurance companies usually do not offer coverage for:
New Technology In Drugs Or Services
The medical industry is tasked with proving the benefit of a drug or service to a consumer, especially when it is at a high cost.
Benefit in this context is measured in terms of morbidity or mortality. In other words, if they can prove beyond reasonable doubt that such technology will save your life or improve your life, then your insurance provider will cover it.
Proving such points take time, and insurers are more likely to wait for such technologies to gain ground in the medical industry before providing coverage for them.
Prescription drugs are approved for treating specific disorders or achieving a known objective. For example, painkillers ease pain in the body, antacids calm indigestion and heartburn; contraceptives prevent pregnancies.
There are occasions where doctors may recommend a drug to treat something it is not typically known for. These are referred to as off-label prescriptions. Unfortunately, many insurance companies refuse to cover these off-label prescriptions.
Any procedure carried out for cosmetic purposes like plastic surgery and some dermatological procedures is usually not covered by insurance providers.
It goes in line with their principle of only covering medically required procedures. Screenings and testing for chronic diseases or surgeries required to save your life are necessary. However, you can live without a slimmer nose or fuller lips.
One good thing about these procedures is there is a high level of transparency. For example, you could place a call to virtually any provider, and they can instantly quote a price for you.
Fertility Treatments And Sterilization Reversal
You’d be surprised how many procedures typically aren’t covered by health insurance; this includes fertility treatments. However, health insurance providers must pay for all testing used in arriving at an infertility diagnosis.
A total of 19 states in the US mandate insurers to over coverage for fertility treatments. Unfortunately, many loopholes allow employers to decline such coverage.
If your coverage is a fully insured plan, state insurance laws apply to you. Self-insured plans reserve the right to decline coverage based on state laws.
1. Other Services Not Covered by Insurance
3. Travel Insurance
4. Private Nursing
5. Weight Loss Programs or Surgeries
6. Acupuncture and Other Alternative Therapies
Steps To Take When Your Service Is Not Covered By Insurance
Research On Alternative Solutions
You can’t force your insurance provider to offer coverage for a service just because you need it. However, you can ask questions and research for alternative solutions.
For example, are there other treatments or procedures covered that could benefit you? If these covered treatments are just effective, you should go for them instead. This way, you can spend less on out-of-pocket payments.
Save Up Or Suggest A Payment Plan
If your treatment is routine but not covered by insurance, this could cost a lot of money in the long run. However, you can appeal to your healthcare provider to arrange a payment plan over a period to cover these costs.
They may offer you a discount to ease the financial burden on you. We advise talking with the manager or whoever is in charge rather than a staff. Avoid phone conversations, rather aim for in-person conversations, and don’t take no for an answer.
Enroll In An Assistance Program
Many medical assistance programs are willing to pay the bills of needy or low-income individuals. All you have to do is research a few and inquire about your eligibility status for these programs.
Appeal To The Insurer
If all else fails, you can appeal to your insurer to reconsider your case. They may review their processes and decide to cover your bills.
Try Using Services Like Better.
Better is a service created to make navigating through the health insurance’s complicated system easier. Their objective is to make sure you get paid any money your insurer owes you; this includes past medical bills. The application is aids in filing out-of-network claims for reimbursement by your health insurer.
Health insurance is complicated like a maze; it becomes tricky figuring out what services your insurer will cover and what you have to deal with without pocket.
Our advice is to consider your health needs when selecting an insurance provider. This way, you can ensure that any policy you purchase covers every treatment necessary for you to live a healthy life.
You can also try some of the steps we recommended above when your insurer doesn’t cover a service you need.
What Does Health Insurance Not Cover
Health Care Services not Covered by Health Insurance
Options if Insurance Does not Cover a Routine Procedure