Individuals who are insured with a particular medical insurance provider seem to forget that the health insurance provider is a business like any other thriving business in their local community. It is obviously true that all providers offer a unique service to the public, but it still remains a business just the same.
There are times when an individual will fill out a health insurance claim form and automatically expect to receive reimbursement as provided for through the terms of their individual health policy. This is not always the way the medical health care issues are executed.
It is very important for individuals to make the time to read their particular medical plan and the attached addendums to gain a full understanding of what they are covered for and what they are not covered. This will help to clear up any future misunderstanding between the health insurance provider and the insured. A few of the causes for non-reimbursement regarding insurance claims are.
1. Intentional suicide during the first two years of purchasing an individual medical policy
2. Death through the act of war because most insurance providers exclude any military action
3. Deliberate attempt to cause personal bodily harm
4. All cosmetic surgeries
5. All treatment procedures for substance abuse because this is considered a deliberate act
6. Pregnancy and all preventive testing
7. Dental care unless you have an additional, separate medical insurance policy for dental care
8. Vision, hearing, and elective surgeries
9. Alternative methods of health treatment such as holistic medicine
The health coverage as a rule must take in more healthy insured as opposed to taking in those individuals who are generally ill or have long-term pre-existing health care issues that require medical care treatment on a regular basis. Currently there are three main issues for an individual to receive necessary medical care treatment.
1. The conditional health care related issues must meet with rigid criteria
2. The medical insurance issues must not have been a fabrication by the insured
3. The medical plan issues must not have been a direct cause created by the individual insured
The majority of exceptions to the rule on behalf of the medical health care community and the health insurance providers are very stringent for reimbursement factors to take place. The majority of times the responsibility rests with the individual insured.