What Exactly Does Health Insurance Cover?

When you have a medical emergency, you often go to the emergency room (ER), or to an urgent care clinic. As expected, they charge you for the services and treatment, with insurance covering a large portion of the bill. However, there are various medical procedures that your policy does not cover. And if you go into the operation blindly, you could wind up with a major shock later.

Medication
If you have surgery or a routine operation, chances are you will receive prescribed medication. Some of those meds are covered, while others are not. Your doctor or pharmacist should be able to answer any questions. Keep in mind, however, that over the counter medications like aspirin do not fall under insurance coverage.

Cosmetic Surgery
While policies cover many surgical procedures, one thing that it does not is cosmetic or plastic surgeries, such as a face lift, nose job, or liposuction. That is because these operations often improve one's appearance, but do not necessarily improve his or her health. The coverage simply depends on the company with which you are insured. However, if you feel that it could improve your way of life, write a letter to the insurance company to get them to reconsider.

Experimental Treatments
Depending on your diagnosis and recommended treatment, you may qualify for a clinical trial. However, insurance does not handle every single trial, at least if they define it as "experimental". Depending on the method of treatment, the product manufacturer might handle the product itself. However, you may have to pay for outside expenses like doctor's appointments or additional testing. The insurance company may allow clinical trials if you can prove the benefits of undergoing treatment.

Before you schedule any appointments, ask your insurer what is or is not covered. Your company can easily provide you with that kind of information, either on its website, or over the phone. If you find yourself having to pay completely out of pocket, call your doctor's office or hospital to work out a more reasonable solution. There are alternate treatments and lower payments that may suit your budget. A medical bill negotiation can help you reduce your bill tremendously, especially if you are already on a fixed income.

Maternity
Different policies cover different aspects of a woman's pregnancy, including when a woman goes into labor. However, some may exclude a woman if she does not have maternity coverage before contraception. Since that is virtually impossible to predict, if you are considering having children, you may want to look into coverage well in advance.