Health insurance is one of the major components of any financial planning one does for health-related emergencies. However, it does not cover everything. There may be some not-payable expenses under your health insurance policy, and the realisation of the same may come as quite an unwelcome surprise. In this blog, we present some common non-payable
What Are Non-Payable Expenses
Non-payable expenses also known as Exclusions can be considered medical costs that are not covered under the health insurance policy.
They can vary widely across different insurers and plans but can be divided into some general categories:
- Pre-Existing Conditions: Most pre-existing conditions will not be covered, particularly at the beginning of the policy. The policyholder should be sure about how the policy works.
- Cosmetic Procedures: Any treatment or surgery considered to be performed only for cosmetic purposes, and not because it is medically necessary, is generally never covered, except conductive to plastic surgery.
- Non-Medical Expenses: Most expenses related to admission fees, service charges, or administrative costs paid during hospitalisation are usually not reimbursed by the insurance.
- Alternative Treatments: Some policies do not cover alternative treatments such as Ayurveda, homeopathy, or chiropractic care without a mention, explicitly, under the policy.
- Specific Surgeries and Treatments: Infertility treatment, weight reduction surgeries, and dental treatments are usually not covered unless specified.
Also Read: How To Find Your Best Age To Get Health Insurance
Common Non-payable Expenses on Health Insurance
Knowing what generally is not covered can go a long way toward helping you prepare to underwrite any out-of-pocket costs. Here are some of the most common non-payable expenses:
- Room Rent and Boarding: In many insurance policies, the amount of per day room rent is limited, and anything above this will be your liability.
- Diagnostic Costs: Although most of the tests will be covered, some of the diagnostic procedures done may not necessarily be covered, especially if they are not directly connected to the treatment you are in the hospital for.
- Consumables: Medicines like gloves, syringes, and other disposable items used in the course of treatment may not be reimbursed by your insurance.
- Personal Comfort Items: Television, telephone, food for the visitors you bring during the hospitalisation—these are items that you will most probably not get a reimbursement for.
- Post-Hospitalisation Expenses: The follow-up visit, the medicines, and the physiotherapy that should come after the discharge can sometimes be outside the scope of the coverage.
How to Control Non-Payable Expenses
- Understand Your Policy: Firstly, one should have a sufficient understanding of one’s health insurance policy. Much focus should be placed on the section on exclusions to know really what is not covered.
- Buy Comprehensive Coverage: While purchasing a health insurance policy, buy the one with minimum exclusions and maximum coverage limits, though it may mean paying a higher premium.
- Supplementary Insurance: One can look at taking a supplemental policy that will cover gaps in one’s basic health insurance. It could be in the form of riders for certain conditions or more coverage for treatments left untouched.
- Emergency Fund: The emergency fund would serve to meet those unforeseen medical expenses that your insurance would not cover. It provides peace of mind and financial security during a crisis.
- Negotiate with the Provider: Sometimes hospitals and clinics offer patient discounts or payment plans where the insurance does not always apply. There is no harm in asking the doctor or his assistant about every possible way to pay for the treatment.
Conclusion
Health insurance provides great financial security, but to manage your health costs well, you need to know about non-payable expenses. Knowing what will not be covered, and how to manage such expenses upfront,
FAQs
What are non-payable expenses in health insurance?
‘Non-payable expenses’ is a term popularly known as exclusions about those specific expenses in connection with the medical costs that your policy will not pay. Such exclusion may fall under pre-existing conditions, cosmetic treatments, non-medical costs, alternative treatments, and some surgeries and procedures.
Why doesn’t my health insurance cover some of my medical expenses?
All insurance companies have these exclusions to manage the risk. They should ensure they offer policies that have affordable premiums. To manage their financial position against some treatments and procedures that are non-essential and high-risk, insurers always exclude them to ensure they are competitive in giving rates to policyholders.
How do I know which health insurance expenses are excluded by the policy?
You have to go through the health insurance policy document thoroughly, especially the exclusions section. If you are confused and have any questions in mind, get in touch with your insurance provider to explain what is and what is not covered in your policy.
Are pre-existing conditions always a part of the exclusion section?
Well, not always. Although the majority of health insurance policies exclude a pre-existing condition for a particular period, usually referred to as the waiting period, some provide coverage for such conditions after the waiting period expires. You, therefore, need to ascertain those terms on your policy.
Do all health insurance plans exclude the same expenses?
No, the exclusions can vary drastically between insurance providers and policies. Not all policies will offer the same exclusion, so you have to compare policies and understand what exclusions are exactly in each policy before forming some conclusion.
How do I take care of non-payable expenses under the policy?
You could purchase either a supplemental insurance policy or buy riders to fill in gapping areas in your major health insurance. These supplementary policies could be useful in cases where the expenses are not considered by a basic health insurance plan.
What could be the non-payable expenses incurred in my treatment?
Common examples of non-payable treatment expenses are room rent above a particular limit, specific diagnostic charges, consumables like gloves, syringes, etc., personal comfort items in the hospital room like TV, phone, etc., and post-hospitalisation treatment expenses like follow-up visits and physiotherapy.
Can I appeal if the claim is denied for a non-payable expense?
Yes, you can appeal, though a successful appeal is conditional upon the nature of the policy and the reason why the claim was denied. Kindly check your policy terms and conditions, or if required, contact customer care of the insurance company for the appeals procedure.
Is health insurance covered for alternative treatments like Ayurvedic or chiropractic treatment?
Some alternative treatments might be covered based on an insurer to an insurer. Some health insurance plans may provide limited coverage to offer alternative treatments, as may be stated in your policy. I shall be writing to the policy provider in that regard.