What To Do if Treatment is Not Covered by Insurance?


In the United States, medical treatment is usually paid for through an insurance plan. Those who seek treatment will usually need to have an insurance plan in place which will provide cover for specific procedures. But it often does not cover everything. Insurance plans are frequently provided by employers as an additional benefit of their salary package.

What About Those Who Don’t Have Insurance?

Not everyone in America has healthcare insurance despite the introduction of the Affordable Care Act (ACA), which sought to make it easier for more people to access healthcare. Unfortunately for some people, the cost of insurance remains too high and many simply cannot afford to pay for it.

While both Medicare and Medicaid, types of public health insurance are available to some of the lowest paid individuals, those not eligible because their income is above the threshold level, may still be unable to access insurance because the premiums are too high. So, what can they do?

Free Community Health Clinics

In some states there is what is known as ‘charity care’, where medical treatment is provided at reduced rates or free of charge. There are also not-for-profit health centers where staff may offer certain treatments for free. Sometimes treatments will be charged on a sliding scale that takes a person’s ability to pay into account. The types of treatment provided by these non-profit organizations include preventative care, vaccinations, prenatal care, family planning services, and dental care.

Is Emergency Care Free?

In the U.S., treatment cannot be denied to those who do not have adequate insurance. But that does not mean that treatment is offered free of charge. Anyone accessing treatment via an emergency room will be billed, and this can be expensive. If you need urgent treatment and do not have insurance, you might find it cheaper to visit an urgent care center or a walk-in clinic, as their fees tend to be lower than those of emergency rooms

Are Some Treatments Not Covered by Insurance?

If you have insurance then you might be mistaken in thinking that it covers everything, but this is not always the case. It is important to know what your insurance plan covers before going ahead with any treatment in a hospital or other medical facility. According to Find-A-Code.com, if medical billing codes that are not covered are included in claims sent to an insurance company for reimbursement, they are likely to be denied.

When an insurance company denies a claim, they will include the reasons for their refusal to pay for specific services. It may be that the treatment provided was for a pre-existing condition that was not included in a healthcare plan purchased before the introduction of the ACA. This is known as a grandfathered health plan.

Insurance companies rarely provide cover for treatments that are not deemed as medically necessary. This might include cosmetic surgery, for example. Furthermore, many insurance companies will not provide cover for fertility treatments.

How to Pay for Medical Treatment Without Insurance

If you cannot afford healthcare insurance and are ineligible for either Medicare or Medicaid, you may be wondering how you can make a payment for medical treatment. The best way to solve this situation is with your medical provider. Sometimes, payment plans are provided, or you might even get a reduced bill from the medical provider.

It is never a good idea to simply ignore your medical bills as not paying could have consequences for your credit score, particularly if the medical provider sends the bill to a collection service. If you are sued for payment, a ruling to garnish your wages could apply.

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