Benefit Secrets: What Your Insurance Doesn’t Actually Cover

Written by  //  2016/01/06  //  Insurance  //  Comments Off on Benefit Secrets: What Your Insurance Doesn’t Actually Cover

According to HealthPAC Online, health care expenditures cost Americans $2.6 trillion dollars in 2010 alone, with an average of $8402 dollars per person. With costs so high, you’d think your insurance would cover any injury or disease you suffer, but that’s not always the case. There are several coverage exclusions common to most health insurance companies you need to know about first.

Illegal Act Exclusion

Any injury you incur while doing something illegal is likely not covered, and this rule is applied in ways you may find baffling. For example, someone who accidentally lights themselves on fire with a crack pipe will not have their burn unit charges covered. Someone shot while robbing a house would not be covered. While this may seem reasonable, coverage is also denied in cases where people were not aware they were breaking the law. If you’re burning leaves illegally and are burned, you could be denied coverage. The same also applies if you are struck by a vehicle while jaywalking. Use common sense and a little forethought before doing anything dangerous.

Prior-Authorized Tests and Screenings

While you may know you need a pre-authorization from your insurance company for MRIs, PET scans or CT scans, you may be surprised to learn that prior authorization doesn’t mean your insurance company has agreed to pay for it. If the company decides the test wasn’t medically necessary, you could be stuck paying the bill for it.

Nursing Home Care

Long-term care is not covered by health insurance, no matter why you need it. If you need to stay in a care facility for a few weeks to recover from surgery, or need to be in one permanently, long-term care insurance is a better choice. If you’ve been disabled, you most likely need a disability law firm like to help you navigate this because health insurance will not cover nursing homes at all.

Vaccinations for Travel

This one is especially strange. Health insurance does cover routine vaccinations, but what they consider to be routine is up to the individual company to decide. If you’ll be traveling to the Amazon and want a yellow fever vaccine, you will likely need to pay out of pocket. Vaccines for polio are also unusually not covered, as the disease is considered eradicated in the US.

Knowing the specifics of your health insurance is important. If you want to avoid getting stuck with huge medical bills, being aware of what isn’t covered is essential. Read your policy carefully to determine the rules and exclusions of your policy.

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