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What to Do When Your Health Insurance Won’t Cover Your Medical Care


It is becoming increasingly expensive to get a health insurance coverage nowadays. However, health insurance is a long term investment that would save you money in the long run.

If you have looked at the various health insurance plans, you would have noticed that there is no health insurance plan that will cover every kind of medical treatment you will need during your lifetime.

Regardless of how good your health insurance is, you may someday need to be treated for a health condition that is not covered your health insurance policy. Elective treatments like cosmetic surgery and liposuction are typically not covered health insurance plans but there are other health conditions and medical procedures that may not be covered.

If you ever need to undergo a treatment or procedure that your insurance policy does not cover but the treatment or procedure is not specifically mentioned in the “excluded treatments” section, inquire with your insurance company. Request a written explanation that states their reasons for not covering the treatment or procedure that you need to have. Show this letter to your doctor. Most of the time, a treatment or procedure simply needs to be re-stated and then presented to the insurance company, have it approved and get your treatment or procedure covered.

However, you could land in a situation where the treatment or procedure cannot be re-phrased, or the treatment has already been given to you and now the company denies you the coverage. The fact is, you do not have much options left. You might need to spend your own money for the treatment or procedure.

If your health insurance company denies your claim for, you can make an appeal. Insurance companies have procedures for appealing a claim so you would need to follow the procedure of your insurance company. Insurance companies would generally reject an appeal based on technicality rather than use their resources to investigate the claim. Thus, if you decide to go with this route, make sure you follow all the steps. Check with your policy handbook as the process to appeal would be in there. It is also good if you seek advice from your doctor before filing an appeal.

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