Many of us assume that having health insurance will cover us in any and all medical emergencies. Unfortunately, that’s not always the case.
Despite the Affordable Care Act’s (ACA) efforts to expand coverage requirements and create a more user-friendly healthcare market, many insurance plans still leave large coverage gaps in a number of significant treatment areas.
By the time many of us figure out that our plan doesn’t cover a service or medication, it’s already too late. So make sure you’re in the know: here are some common medical services that are usually excluded from health insurance plans:
1. Adult Dental Services
Although dental issues can lead to some potentially serious health problems, they’re rarely covered by your typical health plan — the vast majority of insurers, about 81% according to BenefitsPro, exclude these services from their coverage policies.
So when costly procedures like fillings and root canals become a necessity, you better have a separate dental plan — or you’ll get stuck paying out-of-pocket.
Common services covered by dental insurance include:
- Emergency dental services
- Dental exams
- Preventative dental services
- Basic restorative dental services
- Advanced restorative dental services
- Periodontal services
- Oral surgeries
2. Weight Loss Programs
Despite the fact that millions of Americans suffer from obesity, 93% of the nation’s insurance plans don’t cover weight loss programs.
Obesity greatly increases the risk of heart disease and diabetes, along with a wide variety of other potentially life-threatening health issues.
And while the ACA requires insurance companies to provide coverage for obesity screening and counseling, the vast majority of plans still don’t provide financial assistance for third-party care without the existence of more serious health problems that result from obesity.
Unless the patient is suffering acutely, third-party services — including behavior modification programs supervised by a health practitioner, meal replacement plans, and pharmacotherapy — may not be covered.
3. Mental Health Services
Mental health is an integral part of both our emotional and physical well-being, but many people are still unclear about the obligations of providers when it comes to coverage in this field.
For reference, mental health services that may not be covered by your plan include:
- Psychiatry consultations
- Psychology consultations
- Child psychiatric services
- Alcohol and drug abuse counseling
- Marital and family therapy
In 2008, lawmakers passed the mental health parity law (explained here by the ACA), requiring that coverage for mental health issues remain comparable to coverage for medical or surgical treatments.
In other words, if an insurance company charges a $20 copay for a visit to a general practitioner, they can’t turn around and charge $40 for a session with a psychologist.
But the law doesn’t actually require an insurance company to provide mental health coverage. It only guarantees that if they do, coverage costs will remain consistent across your entire plan.
The lesson? While you never want to wait to seek out mental health treatment, consider SingleCare’s offered discounts on these services if you’ve got a gap in coverage.
4) Private Nursing
Private nurses provide an indispensable service for patients — typically the elderly — that require some level of day-to-day care in their homes. These roles are often wide-ranging, including everything from administering medication to hygienic duties like nail trimming and bowel supervision.
Despite the fact that many senior citizens depend on these services to maintain their quality of life, 92% of insurance providers exclude private nursing from their coverage policies. This can make it particularly difficult for elderly individuals with a fixed income to afford the care they need.
5. Infertility Treatment
Millions of Americans suffer from physical and psychological issues related to infertility, but only about 6% of all insurance plans cover treatment.
The average treatment cycle for infertility totals nearly $12,400, and most providers are unwilling to foot the bill, explaining that they don’t consider treatment of this condition a medical necessity. This has unfortunately made it very difficult for those diagnosed with infertility to receive any sort of help.
Again, it’s important to note that the following services and drugs may not be covered by health insurers:
- Fertility treatment clinic consultations
- Clomiphene and Metformin to address problems with ovulation
- Hormone injections
- Tubal surgery
- Laparoscopic surgery
- In vitro fertilization
- Intracytoplasmic sperm injection
Fill in the Gaps
Most insurance providers still leave large, often hidden gaps in their coverage, forcing many insured Americans to pay for necessary medical services out-of-pocket. Luckily, SingleCare is there to pick up where your insurance provider leaves off.
SingleCare offers its members an extensive database of healthcare specialists, therapists, and prescription medication plans, enabling you to get the care you need without breaking the bank. You’ll know exactly how much you pay up front, so you won’t get any nasty, surprise bills down the road.
And that means you can stop sweating the coverage gaps, and start filling them with pay-as-you-go services through SingleCare’s dedicated platform.
(Main image credit: www.audio-luci-store.it/flickr)