It’s one of the best-kept secrets in the health insurance industry.
Many so-called elective procedures — like infertility treatments, weight loss surgery, acupuncture and chiropractic visits — could be covered under your health insurance plans.
And if you want to take advantage of these benefits, you still have time to enroll or change your health care plan, but the window closes on January 31, 2015.
“Insurance companies don’t want to advertise many of these benefits because they are expensive procedures,” says Ginalisa Monterroso – CEO of Medicaid Advisory Group in New York. “Many of these popular benefits are hidden in the ‘Summary of Benefits’ page, which is buried inside of your health care booklet.”
Monterroso has more than 25 years of experience helping patients and families navigate the complicated health care system. She says many consumers are on the wrong plan, and as a result, are paying for out-of-pocket visits that could be covered under a different plan.
For example, many people with back pain typically go to a chiropractor and pay-out-of pocket for their visits, but under some plans, these visits could be covered or partially covered by health insurance.
So how do you determine what is covered under your healthcare plan?
“Health care plans vary by where you live and the plan you choose. There is no one size fits all,” says Monterroso. “The specifics of your individual plan will dictate what is covered. Benefits also change depending on whether you get your health insurance coverage through your employer or under the Affordable Care Act.”
Other hidden benefits that could be covered under the Affordable Care Act or private-insurer plans include:
Weight Loss Procedures
Expensive weight loss procedures, known as bariatric or gastric bypass surgery, can cost upwards of $20,000, but 23 states, including New York and New Jersey cover it under the Affordable Care Act. Some states, like New Jersey, even cover partial nutritional programs to help overweight people, but all 50 states are required to pay for nutrition and obesity screenings.
Many consumers may not realize that alternative medicine is also covered under some health insurance plans.
Under the Affordable Care Act, the law prohibits insurers from discriminating against licensed health-care providers, including those who practice alternative medicine, which can include visits to the chiropractor or acupuncturist.
Some insurance companies may cover only partial treatments, like acupuncture and chiropractic care, but not cover others, such as aromatherapy and therapeutic touch massage.
There are 15 states that mandate some coverage for infertility treatments, but some states only cover infertility treatment on group plans, not individual policies, according to the National Infertility Association.
Birth Control Methods
The Affordable Care Act requires all FDA-approved contraceptive methods prescribed by a woman’s doctor to be covered, including barrier methods (diaphragms, sponges), hormonal methods (birth-control pills, vaginal rings), implanted devices (IUDs), emergency contraception, sterilization procedures, and patient education and counseling.
Affordable Care Act plans are not required to cover male contraceptive services and products, such as condoms and vasectomies. However, many plans do cover vasectomies.
Monterroso says consumers should call their insurance companies and ask specific questions in regards to their treatments, like:
• Am I covered for this treatment?
• Do I need a referral or prescription from my general practitioner?
• Will I have to meet a deductible or pay a copay?
• Am I limited to a certain number of visits?
• What are some local providers in my policy network?
“Take the time to read the Summary of Benefits page because we are in the open enrollment period right now,” said Monterroso. “After February 1st, it will be too late to make any changes.”