The purpose of having health insurance is to reduce the costs you owe out of pocket to cover medical treatments.
Unfortunately, there are some healthcare procedures not covered by health insurance. There are five common medical procedures not covered by insurance to feature. When shopping for insurance, take the time to see what each plan covers so you can find one that meets your needs.
1. Cosmetic Procedures
Over 98% of health insurance plans refuse to cover cosmetic surgery costs. The exception to this rule is if the surgery is a medical necessity to repair injuries, such as after car wrecks or other traumas.
However, if you’re looking into surgery to change an aspect of your physical appearance for vanity’s sake, your insurance will make you foot the bill.
Cosmetic procedures that you cannot claim for your health insurance are:
- Facelifts ($7,467)
- Nose jobs ($4,000 or more)
- Breast implants ($5,000-$15,000)
- Eyelid surgery ($3,282)
- Lipoplasty (Liposuction) ($3,548)
- Botox injections ($10-$15 a shot)
Plastic surgery can be expensive, so it’s not something most people will spend money on if they’re on a budget.
2. Dental Procedures
As weird as it seems, most health insurance plans do not cover dental services for adults.
Proper mouth care is a crucial part of your overall health. Yet 81% of health insurances exclude dental procedures from their policies. Your insurance may cover emergency medical issues, but it will not cover cosmetic treatments.
Dental indemnity insurance provides crucial financial protection for individuals undergoing various dental procedures, offering peace of mind and security in case of unexpected complications or challenges.
Situations where your health insurance may cover dental costs often require a medical condition to be present, such as a trauma. Toothaches may not fall under your insurance coverage unless it’s an abscess, which means infected.
Elective dental procedures that your health insurance won’t cover:
- Teeth or gum augmentation
- Braces
- Veneers
- Dentures
If you need crowns to stabilize your teeth, you may be covered. But if you just want to improve your smile with a set of porcelain veneers, you’ll have to pay out of pocket.
The cost of veneers can range from $300 to $1,000 for an individual veneer. The actual cost will depend on the material, the number, your location, and prep work. However, this amount does not include x-rays, follow-up appointments, or the initial visit.
3. Weight Loss
Another medical condition that insurances rarely cover pertains to weight loss. In the US, ⅓ of the entire adult population is obese.
Only 10% of current health plans cover medical procedures that help with obesity, including weight loss management programs, nutritional counselling, or surgery (bariatric).
Bariatric, or lap-band surgery, can cost around $14,500, whereas a gastric bypass averages around $23,000. Then there are the follow-up visits, which also cost money.
Left untreated, obesity can cause significant health complications, including:
- Type 2 diabetes
- Hypertension (high blood pressure)
- Dyslipidemia (high triglyceride levels, low HDL, and increased HDL cholesterol)
- Coronary heart disease
- Gallbladder disease
- Osteoarthritis
- Stroke
- Heart attack
The majority of Americans can’t afford to pay the astronomical costs of weight loss surgery. They may turn to weight loss programs thinking these may be more affordable. But most of these can become costly after paying the monthly fees and purchasing the program’s meals.
If your medical insurance doesn’t cover weight loss programs, there are a few options for getting the money for the procedure.
The most common is a secured medical loan. You may also qualify for a payment plan through the office, take out a loan on your 401(k), or get a CareCredit credit card that’s exclusively for medical expenses.
4. Infertility Treatments
Over 94% of health insurance refuses to pay for infertility treatments, leaving many people without suitable options for having a baby.
In the US alone, 10% of females struggle with pregnancy. That’s over 6.1 million people who have to come up with the costs of fertility treatments out of pocket.
A single round of fertility treatment starts at $12,400. Most couples will need more than one round of in vitro fertilization, jacking the costs up. Some people can spend hundreds of thousands of dollars attempting to get pregnant.
However, insurance companies have to pay the costs for any testing necessary to confirm infertility diagnosis.
5. Acupuncture
Acupuncture is an alternative type of medicine frequently prescribed to treat chronic pain, including arthritis and other chronic conditions like osteoporosis or Lupus.
However, despite the many advantages of using acupuncture for pain relief, most insurance companies (92%) refuse to pay for treatment.
This medical procedure ranges between $100 and $1,000 per session, and it’s better to have repeat visits to get the best results.
Is Your Procedure Not Covered?
Health insurance is a necessity to keep you and your family protected. But there are some medical procedures not covered by insurance. Dental insurance is useful to have along with health insurance to cover dental procedures. You can also get secure medical loans, medical credit cards, or borrow from your 401k to pay for treatments not covered by your insurance.
