Insurance provisions and exclusions determine what's covered and what's not covered under the typical health insurance policy. Exclusions vary by plan and provider. Understanding what medical bills your insurer covers is challenging. Many providers have different definitions for terms like emergency care and what constitutes an emergency. Under some medical plans, the day of the week you check in at the hospital affects benefit eligibility. The typical health insurance plan covers preventative care as well as life-saving emergency medical treatment. However, most standard health insurance plans come with a long list of exclusions. Before you need to use your policy or undergo a major medical procedure, it's important to know what medical bills are covered.

At the hospital, you might pay for items and medical services that are excluded by your health insurance coverage. In many cases, claims are denied if the policyholder receives non-emergency care in the emergency room. Some insurers won't cover the cost of treating a broken arm or broken leg in the emergency room because it is not considered a life-threatening injury. Other common exclusions at the hospital affect benefits for comfort items, including TV service, outside phone calls, cough syrup, extra pillows and bandages.

Medical bills related to injuries caused by the policyholder's own negligence or reckless behavior are always excluded. Health insurance providers have broad exclusions that prevent policyholder from recovering benefits for injuries caused by participating in extreme sports and dangerous behavior, such as alcoholism, suicide attempts or driving while intoxicated. Other providers specifically state they will not deny claims for alcoholism treatment.

Elective procedures, alternative medical treatments, cosmetic surgery and clinical trials are not covered by typical health insurance plans. Most health insurance providers won't cover wellness procedures and alternative medical treatments, including acupuncture, yoga, chiropractic treatments or therapeutic massage. Other elective procedures that are generally excluded include fertility procedures, hormone therapy, surgical sterilization, prenatal care and well-baby treatment.

Before committing to any medical procedure, call your insurer and verify that the treatment you are undergoing is covered by your insurance policy. Most insurers have pre-existing condition exemptions that allow policyholders to obtain coverage but the provider won't pay for ongoing treatment for hypertension and other chronic conditions until a six to 12-month waiting period is satisfied. Policy exclusions and benefits have a lot of gray area where it's difficult to tell what is and isn't covered. To receive additional benefits that cover in-home care, nursing home costs, smoking cessation programs, alcohol rehab, weight management, look for insurance supplements, such as long-term care insurance, extended health benefits and wellness insurance. Health insurance supplements can cover everything from nutritional supplements to psychological treatment.