Assessment of your options in new health insurance marketplace coverage can be a tricky thing. These offers are governed by specific exclusions, depending on the insurance provider’s prerogative and patient’s purchased coverage.
If you don’t clarify these terms from the get-go, confusion may arise come the day of reimbursement. To provide you with an overview, here are five commonly excluded medical services.
There’s always been a separation between dental and medical care given the nature of the relatively minor risks posed by the former and its care’s deferability. For this reason alone, insurance providers have never considered it a priority.
Eyeglasses and contact lenses
Medicare, for instance, only covers corrective glasses once they the doctor requires them after a cataract surgery done via lasers or traditional surgical technology. This means that walk-in patients diagnosed with compromised vision normally pay for corrective lenses out of their pocket.
Weight loss surgery
A gastric bypass surgery costs around $23,000. Insurance coverages usually exclude this medical option for reasons akin to that of dental care. If patients would request for this coverage, insurance providers charge a higher premium.
About 1/3 of the country’s adult population subscribe to alternative medicine practices such as acupuncture. Although legitimate studies have long vouched for the efficacy of these treatments, insurance providers have yet to catch up.
Private nursing eligibility may depend on a patient’s insurance coverage value. For government-subsidized coverage like Medicare, though, the limitations are clear. For example, it will only shoulder 100 days of private nursing care after a patient stayed at least three days in the hospital for a necessary procedure.
Moreover, the patient should be at a Medicare-recognized nursing home facility.
Knowing these specific exclusions allows medical service providers the upper hand. This prevents difficulties come the time of reimbursement.