How Do We Find Out What Is Covered or Not Covered by Health Insurance?

Insurance is regulated on a state-by-state basis, and each insurance company define the particulars of a health insurance plan differently. This means that procedures you are eligible for in one location may not be covered in another. The only way to be certain of what your policy covers is to know how the policy is worded, or to speak to an insurance representative who can explain it to you.

Preventive Procedures

• Preventive procedures are not covered by most health insurance plans. Health insurance will only cover surgery that is medically necessary for your well-being, such as an appendectomy. Insurance policies do not look at the long-time medical condition of the policyholder. They look at that person's current needs and how they can be met with the least expense.

Elective and Cosmetic Surgery

• Cosmetic and other elective surgeries are not covered by health insurance. This limitation includes plastic surgery and any dental surgery that is not considered medically necessary. Your doctor may consider an operation in your best interests that is not considered medically necessary in your health coverage, according to the Family Doctor website. It is the insurance company, not the doctor or state law, that decides what treatments, medications and services are covered.

Necessary Treatment

• Health insurance is focused on treatments that are medically necessary. That includes procedures that you require in order to lead a normal life or to prevent death or serious health complications. Your policy will define what treatments are covered, and list any exceptions that seem to be necessary but are not covered. Gaps in your coverage can be filled with rider policies, but your health insurance premiums will increase in line with the riders you add.

Possible Exclusions

• In an article published by the University of California, Martin Johnson points out that cancer is not usually covered by standard health insurance. Preexisting conditions are not usually covered either, including pregnancy and diabetes. Where a preexisting condition is covered, you may be faced with purchasing your own medications or other items necessary to complete treatment.

Insurance Riders and Supplemental Plans

• The solution to a situation where your basic health insurance does not cover the treatments you require is to purchase supplemental insurance riders or plans. Cancer insurance is one type of supplemental plan, and prescription assistance is another. Both offer the policyholder benefits that are not covered by his regular insurance.