Limitations of Medical Insurance

06-Aug-2007

Before you commit to a health insurance plan, make sure you know exactly what you are signing up for. There are quite a few catches and limitations that you may not be aware of concerning your health insurance plan.  Fee-for-service plans generally do not cover routine checkups and physicals. However, most managed care plans do. Be sure to check that part of your policy before you make an appointment so you don't end up with more fees than you can handle.

Another limitation is that most health insurance plans do not cover cosmetic surgery. Many plans will cover surgery for reconstructive purposes that are caused by an accident or a birth defect, but they will not cover elective cosmetic surgeries like liposuction, nose jobs, or face lifts. Those will be out of pocket expenses. However, your plan may cover your cosmetic surgery if your doctor declares that it is for medical reasons.

A pre-existing condition is another case when there may be a grey area in your health insurance policy. Many insurance plans make you wait from six months to a year before they will cover any treatment of a pre-existing condition such as allergies or diabetes. You may want to consider getting a personal health insurance policy if you are leaving one job and moving to another because there might be a time when you're not covered at your new job.

Many health insurance policies still do not cover non-traditional treatments like massage, alternative birthing, or acupuncture. While health insurance plans with this type of coverage are more common now days than they used to be, many still don't provide these types of options.

Mental health treatment and drug rehabilitation are not generally covered by insurance policies. However, you may be able to get coverage if your doctor refers you to a mental health professional or to a substance abuse programme. If substance abuse occurs with mental illness, some insurance providers will be more likely to provide coverage.

The Association of British Insurers has compiled a list of treatments that will not be covered by the majority of health insurance providers. The conditions and treatments are not covered include infertility, cosmetic surgery, self-afflicted injuries, drug abuse, kidney dialysis, preventative treatment, gender reassignment, HIV/AIDS, organ transplant, mobility aids, experimental treatment, war risks, and injuries incurred while doing dangerous hobbies.

When making a claim for an accident or injury that occurred due to the misuse of drugs or alcohol, it can be difficult getting coverage for them. Check with your provider to see what their definition of the word misuse is. Different providers define the word differently.

These are just some of the most common limitations of health insurance policies. Be sure to carefully read even the fine print of any policy you're considering before you commit to anything. It's important to be well informed about what type of coverage you will be receiving so you'll know what type of treatment you're entitled to in the case that you should need to use it.

Once you've done your private medical insurance research and you feel prepared to commit to a policy, allow SimplyFinance to assist you in finding the best medical insurance policy for you. 

Simply fill out this short PMI questionnaire, and we will connect with you an experienced health insurance adviser who can introduce you to the best medical insurance provider for you based on your answers on the questionnaire.