What does exclusion mean in medical terms?
Asked by: Maximilian Veum MD | Last update: March 18, 2025Score: 4.5/5 (31 votes)
What is a medical exclusion?
Things that are excluded are not covered by the plan, and excluded costs don't count towards the plan's total out-of-pocket maximum. In the past, individual health insurance policies frequently contained exclusions for pre-existing medical conditions.
What is clinical exclusion?
Diagnosis of exclusion refers to a medical diagnosis that is made by ruling out other possible conditions through various tests and examinations. It is often used when there is no clear or definitive diagnosis available and the medical professional must eliminate other potential causes before arriving at a conclusion.
What does plan exclusion mean in health insurance?
Health care services that your health insurance or plan doesn't pay for or cover.
What does exclusion apply mean?
The department store that advertises a big sale often states at the bottom of the ad that "some exclusions apply," meaning the discounts don't apply to all items.
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What is exclusion in medical terms?
exclusion. noun. ex·clu·sion iks-ˈklü-zhən. : surgical separation of part of an organ from the rest without excision.
What are 3 reasons for exclusion?
People can be excluded because of who they are, where they live, sociocultural reasons, lack of resources – and frequently a combination of these factors, as shown in Figure 1.2. The overlapping circles in the diagram indicate how there may be more than one reason for exclusion of any individual or group.
What is an example of an exclusion in insurance?
Policy exclusions create a balance between coverage for fortuitous losses (losses you couldn't have reasonably prepared for) and the need to remain solvent in order to pay those claims. For example, a homeowners insurance policy doesn't include flood insurance.
What is an exclusion list in healthcare?
Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, ...
What does exclusion mean?
the act of not allowing someone or something to take part in an activity or to enter a place: exclusion from Many people are surprised at her exclusion from the list of Oscar nominees.
What is a medical diagnosis of exclusion?
A diagnosis of exclusion or by exclusion (per exclusionem) is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing.
What is a medication exclusion?
Formulary exclusions are drugs that a PBM chooses not to be included in coverage. Usually, a PBM will contract with multiple insurance providers to manage their prescription benefits. A provider can choose not to follow their PBM's formulary exclusion list if they wish to cover a drug.
What is the exclusion statute in healthcare?
Exclusion Statute [42 U.S.C.
If you are excluded by OIG from participation in the Federal health care programs, then Medicare, Medicaid, and other Federal health care programs, such as TRICARE and the Veterans Health Administration, will not pay for items or services that you furnish, order, or prescribe.
What does "excluded" mean on insurance?
Excluded drivers are not covered by an auto insurance policy, even if they have permission to use the vehicle. If an excluded driver causes an accident, the accident is treated as if the driver had no insurance at all.
What counts as exclusion?
Examples of Social Exclusion: Leaving someone out on purpose when you know they will be hurt by your actions. Telling other students not to be friends with someone. Embarrassing someone in public when someone tries to approach the group.
What does Cannot exclude mean in medical terms?
The alternative diagnosis “cannot be excluded” because of poor visualization related to technique or artifact, the imaging study performed is not sufficient to enable the radiologist to make the diagnosis, imaging appearances of the alternative diagnosis can be identical to the more likely diagnosis [1]
What are exclusions in medical terminology?
1. Shutting off or removing from the main part. 2. In medical insurance programs, a list of specific hazards, perils, or conditions for which the policy will not provide benefits or coverage payments.
What does exclusion mean in medical insurance?
In a nutshell, an exclusion is a condition or instance that is not covered by your insurance plan. Just as each plan has a list of items that the insurance company will cover, they also have a list of items they will not.
What is an exclusion requirement?
2 A requirement in an emergency protection order or an interim care order that a person who is suspected of having abused a child is excluded from the child's home. A power of arrest may be attached to the order. From: exclusion requirement in A Dictionary of Law »
Why are exclusions important in insurance?
Exclusions in policy documents describe the circumstances under which a claim won't be paid. Additionally there may be limitations to coverage due to exceptions that apply under certain conditions or time periods. Taking the time to check for exclusions can be invaluable in avoiding surprises.
What does "limited exclusions" mean?
An exclusion is when you agree not to be covered at all for certain treatments. For example you may have hospital cover but it excludes joint replacements. A restriction is when you agree to receive very limited benefits for certain treatments.
What is an exclusion form for insurance?
When a policyholder — or an insurance company — takes formal steps to remove a household driver from an auto insurance policy, that's a driver exclusion.
What can exclusion do to a person?
These negative outcomes, including internalizing symptoms such as depression and externalizing symptoms such as aggression, can result from a range of types of social exclusion and rejection, including both interpersonal and intergroup exclusion (Killen et al., 2013).
What are the most common exclusion criteria?
Common exclusion criteria include characteristics of eligible individuals that make them highly likely to be lost to follow-up, miss scheduled appointments to collect data, provide inaccurate data, have comorbidities that could bias the results of the study, or increase their risk for adverse events (most relevant in ...
Why is exclusion a problem?
For example, lower immune function, reduced sleep quality, reduced ability to calm oneself in times of distress, reduced self esteem, feelings of anxiety, depression and aggression have all been observed in children who have been excluded from a peer group (DeWall, Deckman, Pond & Bonser, 2011).