Medical Insurance Limitations

Before you commit to a health insurance plan, be sure to know exactly what you're signing up for. Your health insurance provider will give you a promotional package with only basic plan information included in it. It is important to read the fine print of the actual plan before you decide to go for it. 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. Most 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.
Your plan may also cover your cosmetic surgery if your doctor assures them 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. Health insurance plans with this type of coverage are more common now days than they used to be, but many plans 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 program. 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.

These conditions and treatments are not covered: 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, you will have a hard time getting coverage for those injuries.
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'll be receiving so you'll know what type of treatment you're entitled to in the case that you should need to use it.
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