Does Your Medical Insurance Cover These Procedures?

A health or medical insurance is a safeguard. It is taken as a cover to reduce medical expenses in the case of injuries, disease, disability, death and dismemberment. To get insured, an individual pays the insurer a periodical payment in the form of premium.


Some countries like Switzerland, Japan and the Netherlands have strict health insurance policies and insist upon medical insurance for all its citizens, making it a part of the national policy.


What Does Medical Insurance Cover?


What medical procedures and services the insurance covers depends on the type of policy taken. It generally covers annual physical examinations, cancer screenings, blood tests, scans and routine and recommended immunizations.

The insurance policies should be carefully analysed and it should be checked whether they cover all your medical and travel expenses that are expected to occur on your trip.

Apart from preventive services, an insurance mainly aims to cover the costs of medication, emergency visits to the hospital in case of accidents, injuries and ailments of unforeseeable nature, etc. Some plans with more extensive coverage are known to cover the costs of dental, vision and psychological care.


Procedures That Are Generally Not Covered By Insurance


Most of the elective procedures are not covered by insurance policies, worldwide. Elective procedures are scheduled in advance and do not involve medical emergencies. This is because while emergency surgeries are a matter of life and death, elective procedures like cosmetic surgeries are not essential for one’s survival and health.


Some procedures like organ transplants are also excluded, despite being important, because they are elective in nature. Ongoing treatment for a chronic disease is excluded from coverage in most plans.


Insurance plans also generally make it clear that the cost of injuries related to substance abuse and adventure sports, self-inflicted injuries and treatment for STDs will not be borne by the company. Semi-elective procedures like removal of an old retinal detachment and hemorrhoid surgery are only sometimes covered, depending upon the type of plan chosen.


The following procedures are excluded from coverage in most medical insurance policies in the USA:


  1. Fertility And Sterility

There has been an ongoing argument to cover infertility in basic medical insurance plans since the WHO considers it a disease. But most profit- driven insurance companies do not consider in vitro fertilization and infertility as a necessity or an emergency. This is despite the fact that there has been a steady increase in the demand to conceive with alternative measures.


Only around 5% of the insurance companies in the USA provide coverage for such services. An individual would have to splash out nearly USD 12,000 per IVF cycle. However, it takes multiple cycles to be successful and therefore makes it inaccessible to many people due to the high cost involved. This results in an outflow of fertility tourism to countries like Hungary and India where the costs are lesser than 50% of the costs in US.  


  1. Cosmetic Surgeries

Almost 98% of the insurance companies in the USA do not cover cosmetic procedures like breast augmentation, rhinoplasty, liposuction, eyelid surgery, laser hair removal, etc. unless it is functional in improving the individual’s health. For example, the cost of double eyelid surgery could be covered by individual’s insurer if there is a situation of vision impairment because of excess skin blocking the peripheral vision. 

Botox procedures and breast reduction could also be covered by insurance companies if there is sufficient reason to believe that the individual’s quality of life would suffer. Due to lack of insurance coverage and high costs, people fly to countries like Thailand and Mexico where such surgeries work out to be cheaper by over 60%.


  1. Eye Surgeries

Eye surgeries of complex nature are excluded from being covered in insurance plans. This is because they can almost always be corrected with some simple treatment.  LASIK is generally not included as it is considered a cosmetic procedure and elective. Problems like nearsightedness (myopia) and farsightedness (hypermetropia) can be dealt with by wearing corrective eyeglasses.


Cataract surgeries with a basic Intraocular Lens (IOL) can be covered by insurance, as opposed to surgeries involving a presbyopia-correcting IOL. This costs much more as it would rid the individual of any eyewear! Children’s eyeglasses are also not covered by more than 80% of the insurance companies in the USA.


  1. Dental Procedures

Majority of the insurance policies do not cover the cost of any dental procedures. Medicare USA does not pay for routine cleanings, fillings, dentures or implants. But, it may fund for an oral check-up or the extraction of teeth as a part of preparation for a medical procedure to protect the general health of the person.

Dental insurance always comes with a 'benefit period' which is typically an year or so. Before opting for a dental procedure, check if you are still in the coverage period.

81% of the insurance companies in the USA exclude dental services from their policies. This has caused several adults to forgo or put off dental care due to the high cost involved.


Costa Rica, Thailand and Hungary have become increasingly popular for their expertise in the field of dentistry. People can therefore take medical travel insurance and go as dental tourists to such countries where the procedures are very affordable at only 30% costs in US.


  1. Weight Loss Surgery

Despite the fact that nearly one-third of the Americans are overweight, only 10% of the companies cover weight loss services in their plans. Availing insurance benefits for such procedures is very difficult and rare, as they are not standardized.


Due to increasing awareness of the ill-effects of obesity such as increased blood pressure, heart disease and high cholesterol, insurers are beginning to cover bariatric surgery in their insurance policies. Evidence has also proved that treatments for morbid obesity is far more profitable than funding for its outcomes.


  1. Alternative Medicine Treatment

Acupuncture has become increasingly popular in treating conditions like chronic back pain, flu and asthma. Doctors have only now begun recognizing it and recommending it to their patients. But insurance companies are slow to catch up with the trend and warm up to the idea.

92% of the insurance companies in the USA do not provide coverage for alternative medicine treatments. But some insurers have come up with the idea of discounts for their customers from practitioners to boost this form of tourism.


Other procedures that are generally not covered by medical insurance are hearing aid, prenatal and postnatal care, and foot care which includes treatments relating to the preventive and corrective aspects of ankles and feet.


Policies vary from situation to situation and insurers are looking for ways to increase their profits. However, it is debatable if the insurance companies are doing a good job at keeping up with the pace of demands of the people! But no one is complaining as we already have the option of medical tourism at our disposal.

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