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About PatientInsure Exclusions
Exclusions
No coverage shall be provided under the policy and no payment shall be made for any loss resulting in whole or in part from, or contributed to, by, or as a natural and probable consequence of any of the following excluded risks:
- The Patient being under the influence of drugs unless taken under the advice of and as specified by a Physician;
- The Patient being under the influence of intoxicants while operating any vehicle or means of transportation or conveyance;
- Experimental or Investigative treatment or procedures;
- Suicide or any attempt at suicide or intentionally self-inflicted injury or any attempt at self-inflicted injury or autoeroticism;
- Sickness or disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from any of these except as provided for herein;
- Infections of any kind, except as provided for herein;
- Treatment of mental disorders;
- Medical expenses that are a result of a Patient’s dissatisfaction with the cosmetic results of a surgical procedure or additional surgery to improve the appearance of the affected area;
- Treatment that is normally managed on an outpatient basis by a surgeon such as, but not limited to, minor infections, tissue sloughing, and hematoma;
- Procedures, services, or supplies that are not Medically Necessary; or
- Expenses that exceed the Usual and Customary expense for the same medical issue.
The policy does not cover any of a Cosmetic Surgeon’s liability, including but not limited to liability:
- Arising out of bodily injury, sickness, death or disease sustained by any person, arising out of any act, error, or omission in providing or failing to provide professional services. This includes anyone for whose acts, errors, or omissions a Plastic Surgeon is responsible;
- Assumed by a Plastic Surgeon under any contract with any contract with any other party other than the arrangement between a plastic surgeon and the insured;
- That is due to any association or affiliation in any business or professional organization;
- Arising from dishonest, fraudulent, criminal, or malicious acts, whether intentional or negligent;
- Due to a violation of any anti-trust, price-fixing, or restraint of trade law, whether based upon statue, common law, or administrative directive;
- Arising from sexual intimacy, sexual molestation, sexual harassment, sexual exploitation, or sexual assault of any kind;
- Under any unemployment, workers’ compensation, disability benefits, or similar law;
- Pursuant to any order of court, judge, arbitrator or arbitration panel, administrator, governmental agency, or licensing body;
- Arising from the use of any non-FDA approved medication, device; or
- Peer review, quality assurance, or utilization review done on behalf of any managed care insurance organization.