Medical Services That Are Not Included in a Managed Care Contract
Managed care plans are designed to provide individuals with comprehensive health care coverage at an affordable cost. These plans work by contracting with health care providers to offer medical services at discounted rates, which results in lower costs for patients. However, not all medical services are covered under a managed care contract. In this article, we’ll discuss some of the medical services that may not be included in a managed care plan.
Cosmetic Procedures
Most managed care plans do not cover cosmetic procedures such as facelifts, liposuction or breast augmentation. These procedures are generally considered elective and not medically necessary. However, some plans may cover reconstructive procedures that are necessary as a result of an accident or illness.
Alternative Medicine
Managed care plans may not cover alternative medicine therapies such as acupuncture, chiropractic care, or massage therapy. While many individuals find these therapies beneficial, they are often not considered conventional medical treatments and are not covered under many managed care plans.
Experimental Treatments
Treatments that are considered experimental or investigational may not be covered under a managed care plan. These treatments are often still in the testing phase and their effectiveness may not be fully understood. Managed care plans generally only cover treatments that have been proven effective through clinical trials.
Out-of-Network Services
Managed care plans typically have a network of providers that offer medical services at discounted rates. If a patient seeks care outside of this network, they may be responsible for a larger portion of the cost. Some managed care plans may not cover out-of-network services at all.
Dental and Vision Care
Managed care plans may not cover dental procedures such as braces, implants or cosmetic dentistry. Similarly, vision care such as LASIK surgery or eyeglasses may not be covered. Patients may need to purchase separate dental or vision coverage or pay for these services out of pocket.
In conclusion, while managed care plans provide comprehensive health care coverage, there are some medical services that may not be covered. It is important for patients to understand what is and is not included in their plan to avoid unexpected expenses. Patients should also consider purchasing supplemental coverage or paying for services out of pocket if necessary.