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What are The Things Covered under Medical Insurance

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 What are The Things Covered under Medical Insurance
What are The Things Covered under Medical Insurance

What are The Things Covered under Medical Insurance

There are so many cosmetic, experimental or investigative procedures' expenses that are yet to provide coverage by most medical insurance policies officially. However, chances are your health plan might cover these procedures, if you need it. But for that you would have to provide medical data and justifications to get coverage for these services.

Health insurance providers usually overlook cosmetic or investigative procedures like rhinoplasty as these are uncommon medical practices or new/experimental procedures, yet to be validated by results. These procedures are labeled as "elective" procedures by insurance providers and physicians as they are rarely medically necessary. To be considered medically necessary, the procedure(s) must be generally accepted by the medical community, have proven results, and be relatively less expensive than alternative treatments. Health insurance providers shy away from offering coverage for expensive, unrecognized, or new medical treatments.

Though, majority of cosmetic procedures are categorized as vanity surgeries. But there are large number of investigative, elective procedures like hip replacement and angioplasty that has nothing to do with vanity. In a hip replacement may improve quality of life, but it is not a procedure performed to save a person's life. Similarly, in angioplasty procedure, a balloon is used to open a blocked coronary artery and improve blood flow to the heart. It dubbed as an elective procedure because, although it will likely prevent a future heart attack, but it's far from a life-saving procedure.

Though, at times, doctors do find cases where elective procedures are medical necessity. To get these types of procedures covered, HealthSymphony, a comprehensive health insurance website, offers some suggestions on steps you can take get the services you want. You must provide the insurance company with sufficient medical data about the procedure to justify its coverage. This requires research. You would need to find at least two articles from respected medical journals that provide the results of studies performed regarding the procedure. You also need to obtain a statement of medical necessity from the physician who is requesting the treatment. If your doctor truly believes that the procedure is necessary to improve your health and quality of life, the chance of receiving coverage from your health insurance provider greatly increases. All of the information you gather will be presented for consideration in front of the medical board and medical director of the health plan.

Chances are always high that despite providing all the information needed by provider and following the rules, you might not get cover for these experimental and cosmetic services. In such scenario, contact your insurer and state your case. Start by writing an appeal letter, include statements regarding the necessity of the procedure from your physician or surgeon. You will also want to provide all relevant test results and x-rays to help prove your case.

Due to unfamiliarity and lack of validated test results, many medical procedures fall under "elective procedures" category. Hence, are kept away from coverage by most health insurance policies. But, if you can provide sufficient evidence and appropriate test results, your health insurance provider might consider supplying coverage.

What are The Things Covered under Medical Insurance


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