provider network participation

Understanding Coverage Limitations and Plan Exclusions in Health Insurance

Health insurance is designed to provide financial protection for patients, but not all medical procedures, providers, or locations are covered under every plan. Coverage limitations or plan exclusions occur when a patient’s insurance plan does not include a specific service, provider, or facility, leaving patients responsible for some or all of the costs. Understanding these exclusions is crucial for both healthcare providers and patients to avoid unexpected bills and ensure informed decision-making. Challenge A common challenge in healthcare administration arises