When you go to the doctor, there are a few things that you expect to happen. You expect to be examined, diagnosed if necessary, and then prescribed medication or treatment. However, many procedures are typically not covered by health insurance – even if they are medically necessary. This can leave people feeling frustrated and confused about their options.
Before getting any procedure done, it is essential to check with your health insurance company to see if they will cover it. If not, you may be able to negotiate a payment plan with the doctor or facility where you will be getting the procedure done. But here are a few standard procedures that are not typically covered by health to help you get started.
1. Cosmetic surgery
This kind of procedure covers various elective surgeries done for aesthetic reasons. This can include things like breast augmentation, liposuction, and nose jobs. While some health insurance companies will cover corrective cosmetic surgeries – like those needed due to an injury – they generally do not cover elective procedures.
Cosmetic dental procedures are also not typically covered. This can include teeth whitening, veneers, and other procedures solely for aesthetic purposes. Depending on your insurer, your policy may not cover even a teeth replacement procedure or dental implants. You might need to purchase a separate dental insurance policy to cover these procedures.
2. Weight loss surgery
Weight loss surgery, also called bariatric surgery, is a procedure that helps people who are obese lose weight. It involves reducing the size of the stomach and sometimes rerouting the intestines. This surgery is typically not covered by health insurance companies because it is considered elective.
There are a few exceptions, however. If you have a body mass index (BMI) of 40 or higher or a BMI of 35 or higher and are experiencing obesity-related health problems – like sleep apnea, type 2 diabetes, or heart disease – your insurance company may cover the surgery.
3. Fertility treatments
Fertility treatments, like in vitro fertilization (IVF), can be very expensive- often costing tens of thousands of dollars. And while some health insurance companies offer coverage for fertility treatments, it is not required by law. Many people are left to pay for these treatments out of pocket.
A few states – California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, and New York – have laws mandating that insurance companies offer coverage for fertility treatments. And some employers provide fertility treatment coverage as part of their employee health insurance benefits. But for the most part, people have to pay for these treatments on their own.
4. Gender reassignment surgery
Many health insurance companies do not cover gender reassignment surgery or other procedures related to transgender care. This can be a very costly procedure, costing upwards of $20,000. Depending on your health insurance company, you may be able to get coverage for some of the related care – like hormone therapy – but not the surgery itself.
Because this is such an expensive procedure, many people seeking gender reassignment surgery have to pay for it out of pocket. A few organizations offer financial assistance for this surgery, but it can still be challenging to afford.
5. Addiction treatment
There is a lot of stigma surrounding addiction and mental health, which can make it difficult for people to get the treatment they need. Many health insurance companies do not cover addiction treatment, or they only offer limited coverage. This can make it very difficult for people to afford the necessary care.
If you or someone you know is struggling with addiction, a few organizations offer financial assistance for treatment. Some states also have programs that can help cover the cost of treatment. But for the most part, people have to pay for this care on their own.
You may also get coverage through a few private insurance companies. But it is important to remember that health insurance companies do not typically cover addiction treatment.
6. Eye surgery
There are a few different types of eye surgery, many of which are not covered by health insurance. This can include vision correction surgery, cataract surgery, and glaucoma surgery.
Some insurance companies will cover eye surgery if it is considered medically necessary – like if you have an eye injury or are facing blindness. But it is essential to check with your insurance company to see what is covered.
There are a lot of different procedures that are not typically covered by health insurance. This can include cosmetic surgeries, bariatric surgery, fertility treatments, gender reassignment surgery, addiction treatment, and eye surgery.
While some of these procedures may be covered by your insurance company, you must check with them to see what is covered. Many of these procedures can be very expensive, so you must understand the costs before undergoing surgery.