Excluded Services

What are excluded services?

Excluded services are health care services that a health insurer (payor) or health plan does not pay for.

In instances of excluded services, a health insurance plan will not pay benefits toward medical or hospital costs for these services, and those who choose to continue with these services are responsible for paying the costs out-of-pocket.

Some common excluded services include:

While most health insurance policies have common exclusions, service coverage may vary for each plan.

Pre-existing conditions and the services needed to treat them used to be excluded services. However, the Affordable Care Act (2014) now ensures that pre-existing conditions are not excluded from individual major medical policies.

Why is it important to know about excluded services?

It is crucial for patients using health insurance to be aware of excluded services of their plan to avoid surprise medical bills. Additionally, any costs paid for an excluded service do not count toward the plan’s out-of-pocket maximum, meaning the individual is still responsible for the full cost of any excluded services.