What Do You Mean It's Not Covered: How the Policy Defines "Hospital Services"

Hospital services do not include professional services of a radiologist, pathologist, anesthesiologist, nurse, physician or surgeon. Benefits are payable in a hospital or in a mental hospital (which is licensed by the State) for the treatment of a mental, emotional or nervous disorder, alcoholism or drug dependency. We will pay the benefits which we would otherwise pay for the expense incurred in the treatment of a covered sickness. We will not pay for more than 30 days of active treatment in any one policy year. Confinement in a hospital or a mental hospital, means: (1) an insured person is confined to a hospital room for 24 hours or more, and (2) a daily charge is made. In order for a hospital confinement to be covered: (1) it must be for an injury or sickness (2) it must begin while this coverage is in force for the person confined (3) it must be at the direction of and under the supervision of a physician or surgeon.

Hospital inpatient benefits apply to charges made by a hospital as an entity (for room, board, overhead expenses, supplies, etc.). For this reason these benefits do not apply to any separate charges made by a radiologist, pathologist, anesthesiologist, nurse, physician or surgeon for professional services. (As you will see, separate optional coverages are available for services provided by doctors, nurses, and surgeons.) Inpatient benefits are provided when an insured is confined for the treatment of mental, emotional or nervous disorders, alcoholism, and drug dependency. But benefits for these conditions are limited to 30 days of treatment in any one policy year. "Confinement" means that an insured is confined in a hospital or mental hospital for 24 hours or more and a daily charge is made. In order for a period of confinement to be covered, it must occur because of injury or sickness, begin while coverage is in force for the insured person, and be at the direction of a physician or surgeon.