Excluded Services (Medical Exclusions)

When you are searching for the right health care policy, an important list to look for is the excluded services. When you are aware of the benefit exclusion of a policy, it will help you stay informed. Keep in mind what services you know you'll need, and which services you want to ensure you have covered. Then check to see if they fall into the health care's benefit exclusion list or their medical limitations list. When comparing price and care, medical exclusions often become the deal breaker. Take care to know what these terms mean and choose your healthcare plans wisely.

What Are Excluded Services

Medical exclusions are the services or benefits that are not covered by a particular health care policy. Excluded services can be as simple as a specific drug they will not cover or as complicated as a surgery they will not assist you in paying for. Each policy will have different benefit exclusions, so you need to check carefully and be sure all your medical needs are covered by your health insurance policy.

Where To Find Benefit Exclusions

You will find all of your medical benefit exclusions in the pages of your health insurance policy. You may also find a list of medical limitations on the same page, or in a subsequent list. Take care to look over these excluded services carefully as you compare health insurance policies. You may want to make a list of your own health care needs first, and use that list to compare with.

Exclusions Vs. Limitations

Benefit exclusion is not the only thing you need to be careful of. When looking at health insurance, also see what medical limitations they have. The difference between medical exclusions and medical limitations is simple, a benefit exclusion means that under no circumstances will the benefits in the exclusion list be covered. Limitations are services that have certain criteria listed in the health insurance policy. If those criteria are met, then the service will be covered by the healthcare policy, if the criteria are not met, then the service will not be covered.

Why Health Insurance Plans Have Medical Exclusions

There are many reasons why a health insurance policy chooses not to cover certain benefits. For a medical exclusion like acupuncture, it is not seen as a medical necessity. Infertility treatments and cosmetic surgeries are also good examples of excluded services. Cosmetic surgeries are usually just to make superficial changes to the body that don't affect a person's health. A health insurance company isn't going to pay for a nose job if it is just to make the nose look different.

Some cases of cosmetic or plastic surgeries may fall into medical limitations, however. If a child is born with cleft lip, or if a person was in an accident that caused disfigurement, cosmetic surgeries may be covered for the purposes of correcting something that had gone wrong and directly affects the livelihood of the person involved. Check the limitations list of your policy to see if this is the case.

Top 10 Medical Exclusions

There are some pretty common excluded services in most health insurance plans. Check this benefit exclusion list out and see if your needs fall into any of them.

  1. Long-term Care
  2. Cosmetic Surgery
  3. Adult Dental Services
  4. Weight Loss Programs
  5. Acupuncture
  6. Routine Foot Care
  7. Infertility Treatment
  8. Private Nursing
  9. Adult Eye Exam
  10. Weight Loss Surgery

Go through each policy carefully. Make sure you can compare the benefit exclusion list with another policy. Even if you don't have a need for any of the above services, look ahead into the future. You may find that you or a family member may need these services down the road. You don't want to be caught by surprise in the future.

What To Do If Your Plan Excludes A Service You Need?

Most health insurance plans come with excluded services or medical limitations. If you discover that a service you need is not covered by your health insurance plan, you can buy supplemental insurance policies to cover those holes. Supplemental insurance plans will cover things your primary insurance sometimes doesn't. This makes it a lot easier for you to get the health care you need, and be compensated through a policy.

Find A Health Insurance Plan With Fewer Exclusions With First Quote Health

Looking for a health insurance plan that covers all of your individual needs? First Quote Health can help you find the coverage you need at a price you can afford. Enter your zip code here to explore affordable health insurance options in your area, or browse our health insurance company section to find a plan that fits your needs from a carrier you can trust.