What Is An Exclusion In Health Insurance?

LAS VEGAS - April 18, 2024 - PRLog -- In health insurance, an exclusion is a medical procedure or treatment that the health insurance company does not cover. This may include specific medications, surgeries or therapies that are specifically omitted from your policy. Exclusions vary from plan to plan, meaning that even if your friend's health insurance covered a service, yours may not. It's more difficult for insurance companies to exclude many medical procedures if the insurance is considered a "qualified health plan" and meets the ACA (Obamacare) rules and standards. Most anything "medically necessary" should be covered. Not all medications will be, you'll need to look at the health insurance plans "formulary" which is a list of medications that they will cover.

What Are the Most Common Health Care Exclusions?
While exclusions vary considerably across plans, there are some that are consistent regardless of the health insurance provider. A health insurance agent can help you review your coverage to determine the exclusions that apply to you.

Hospital Stays
Hospital fees can be notoriously high. While you expect to pay for services such as diagnostic screenings, physical therapy, and skilled nursing services, you may not expect to see your bill ran up by non-medical nickel-and-dime charges. For example, if you use the television in your hospital room, you may have to pay for that luxury out of pocket, as most health insurance companies exclude coverage for it. The same goes for bandages, extra pillows and even use of the in-room telephone.

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