Navigating health insurance coverage is a monumental task. Consumers generally have no say
in which services are rendered, which services are covered, and how much they will ultimately
be responsible for paying. Finding that you have to pay a big medical bill you thought your
health insurance was going to pay can be a nasty surprise. Here are some surprising things your
healthcare won’t cover:
• Breaking the law
Your health insurance might not pay for healthcare costs you racked up doing
something illegal. Known as an illegal act exclusion, if your health insurance policy has
one, it means you won’t be covered for healthcare costs caused by your participation in
an illegal act.
• Travel vaccinations
Getting shots before your exotic foreign vacation? Your health insurance might not pay
for your travel vaccinations. While all non-grandfathered health insurance plans cover
vaccines routinely recommended for preventative care in the U.S., vaccines for tropical
diseases that aren’t a problem where you live are probably not covered by your health
insurance plan.
• Incorrect Hospital Admission Status: Observation Status vs. Inpatient Status
Your admission status is very important to your wallet. If your insurance company or
Medicare determines that you should have been in observation status when you were
actually admitted to inpatient status, the insurance company can refuse to pay the
hospital bill.
• Nursing Home Care
Neither Medicare nor private health insurance companies pay for long-term care. You’ll
have to pay for your nursing home, assisted living facility, or custodial home health care
yourself if you don’t have long-term care insurance or qualify for Medicaid coverage
Understanding and working within the guidelines of health insurance is complex. It’s important
to know what your health insurance covers and what it doesn’t. If you have questions about
your plan, contact us at 714-888-2828. This way, you can make sure all your bases are covered!
