Which Treatment is Generally Not Covered Under Health Insurance Policies?

Treatments Typically Excluded from Health Insurance Coverage

Health insurance policies offer significant financial protection for the cost of health care, yet certain treatments and procedures are excluded from their coverage. Such exclusions tend to vary across providers and health insurance policies. However, there are several common treatments excluded under most health insurance plans.

Treatments Which Are Not Covered Under Health Insurance Plans

1.Cosmetic and Aesthetic Procedures

All cosmetic surgeries and aesthetic procedures that are not medically necessary are typically not covered. Such treatments that are conducted for appearance purposes, not to address any medical conditions, are as follows:

●Rhinoplasty (nose job)
●Liposuction
●Botox or other dermal fillers
●Facelifts and other anti-aging treatments

However, accident reconstruction surgeries and surgical treatments that correct congenital deformities can be covered when deemed a medical necessity.

2.Alternative Therapies

Most health insurance policies do not cover alternative and complementary therapies. These are normally outside conventional medicine and do not have strong clinical evidence for their efficacy in case of serious medical conditions. Such exclusions commonly include:

●Homeopathic treatment
●Chiropractic treatments
●Ayurvedic therapy
●Acupuncture

Some insurance companies may cover limited services involving alternative therapy. However, it is not part of the core benefits.

3.Pre-existing Conditions

Health insurance policies normally have a waiting period for pre-existing conditions (PECs). During this time period, the insurance company will not pay for medical expenses due to your health conditions before purchasing the policy. These generally include chronic diseases like hypertension, diabetes, and cancer. 

The waiting period usually tends to differ across insurers and policies, ranging between 1-4 years in most cases. 

4.Outpatient Care

Health insurance typically covers in-patient hospitalization costs but usually excludes outpatient treatment, which doesn't require the patient to stay in the hospital. Outpatient care typically consists of:

●Doctor consultations
●Diagnostic tests that may be conducted within a clinic, such as blood tests or X-rays
●Prescription drugs
●Minor procedures, such as suturing outside the hospital

Certain add-ons within some health insurance policies may cover additional outpatient care. However, it is usually not included under the regular coverage.

Also read:-

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→ Why 18% GST on Health Insurance

→ Why do Health Insurance premiums increase Every Year

→ Why Do We Need Health Insurance

→ Why Health Insurance Claims Gets Rejected