What’s not covered by health insurance

Most of us spend so much time looking at what our Illinois health insurance covers that we forget all about the fact that some things may not be covered at all. It is critically important to know what is not covered so that there are no surprises when you arrive at a doctor’s appointment, or worse, need to schedule surgery only to find that your plan will not cover it.  Look specifically for treatments and conditions that are not covered. Some kinds of medical professionals are not covered, either, so be sure that you are well-informed before getting treatment of any kind.


If you break the law

If you hurt yourself while breaking the law, do not expect to be covered. It may seem brazen to break the law then file a claim, but it happens. Few people know that this is an exclusion that applies to many policies.



The meaning of prior authorization

You may think that prior authorization is approval, but it is not. If it were, it would be called “prior approval.”  Most plans contain verbiage along the lines that benefits are subject to your eligibility and to medical necessity. An insurance company may look differently at these than you or your doctor does.  You could have a procedure the insurer does not think is necessary and their review may cause a refusal to reimburse. That would be regardless of its prior pre-authorization. Be careful: you don’t want to end up with a big bill that you have to pay in its entirety.


Long term care

Nursing home care is usually not covered under either Illinois health insurance from https://illinois-insurance.website/illinois-health-insurance/ or by Medicare. If you are placed in a nursing home for rehabilitation after a surgery, stroke or bone break, that stay may be covered. But if you are unable to care for yourself any longer and require custodial care, chances are that stay will not be covered.  Whether you are or aren’t covered depends on why you need the nursing home. If you there to regain skills , then the stay may be covered for a limited amount of time.  But very few plans cover custodial care


Travel clinics

Don’t expect your visit to a travel clinic to be covered. Those who travel to exotic lands are aware that travel shots are paid for by the traveler. A tetanus shot because you cut your finger opening a can is going to be covered by your Illinois health insurance company, in all probability. But a shot to prevent disease you might get while on travels is not going to be covered.