The answer to this question is not straightforward. It depends on several factors, such as the type of health insurance policy you have, the medical necessity of the swimming pool, and the criteria for receiving coverage.
In general, health insurance policies do not cover the cost of installing and maintaining a swimming pool for recreational purposes. However, there are some situations where a swimming pool could be considered medically necessary and eligible for coverage.
In this article, we will explain how health insurance coverage works for swimming pools, what are the alternative ways to cover the cost of a swimming pool, and what are the arguments for insurance coverage of swimming pools.
Understanding Health Insurance Coverage for Swimming Pools
In general, health insurance plans will pay for most standard medical care costs, as determined by the insurance company. However, some policies include restrictions and provisions that others don’t. Some plans may include restrictions on how often you may see a doctor or how many prescriptions you can fill, while others might not pay for elective procedures like cosmetic surgery or experimental therapies at all.
Pre-authorization specifications are an essential part of comprehending health insurance policies. Before an insurance company will pay for a medical operation or treatment, it must first be approved. If pre-authorization isn’t obtained, coverage may be denied, and the patient will be responsible for all costs.
Swimming pools are often excluded from coverage under health insurance plans. While swimming pools may be fun, they also pose a risk to guests and can result in costly medical bills and insurance claims. Therefore, the expense of setting up and maintaining a swimming pool for recreational reasons is often not covered by health insurance.
However, there are certain cases when health insurance could pay for a swimming pool. Some examples of these terms are:
If a patient needs access to a swimming pool as part of their therapy, their insurance company could foot the bill. Aquatic therapy exercises, which can only be done in a pool, may be helpful for people with particular physical limitations or injuries. The benefits of aquatic treatment extend beyond the reduction of pain to enhanced mobility, strength, balance, and coordination. However, water therapy isn’t appropriate for every medical issue or treatment option. The patient must show that aquatic treatment is not offered or easily accessible in other institutions, and have a doctor’s prescription and recommendation for it.
Criteria for Receiving Coverage
Even if a swimming pool is medically necessary, it does not guarantee that it will be covered by health insurance. The individual must also meet the criteria for receiving coverage, which may vary depending on the type of policy and provider. Some of the common criteria include:
- The swimming pool must be installed by a licensed contractor and comply with local codes and regulations.
- The swimming pool must be used exclusively for medical purposes and not shared with others.
- The swimming pool must be the least costly and most effective alternative to other forms of treatment.
- The swimming pool must have a reasonable expected lifespan and require minimal maintenance.
- The individual must provide documentation and evidence to support the medical necessity and effectiveness of the swimming pool.
Limitations and Exclusions
Even if a swimming pool meets the criteria for receiving coverage, it may still be subject to limitations and exclusions by the health insurance provider. Some of the common limitations and exclusions include:
- The health insurance provider may only cover a portion of the cost of installing and maintaining the swimming pool, leaving the individual responsible for the rest.
- The health insurance provider may impose a cap or limit on the amount or duration of coverage for the swimming pool.
- The health insurance provider may exclude certain features or accessories of the swimming pool from coverage, such as heaters, filters, pumps, or slides.
- The health insurance provider may require periodic reviews or audits to verify the continued medical necessity and use of the swimming pool.
Alternative Ways to Cover the Cost of a Swimming Pool
If a swimming pool is not covered by health insurance or is only partially covered, there are other ways to cover the cost of installing and maintaining it. Some of these ways include:
One of the simplest ways to cover the cost of a swimming pool is to use personal savings. This means that the individual has enough money saved up to pay for the swimming pool out of pocket. However, this option may not be feasible or desirable for many people, as it can deplete their savings and affect their financial security.
Home Equity Loan
A swimming pool may be expensive, but a home equity loan might help offset those expenses. This implies taking out a loan against the homeowner’s equity (the value of their property less their mortgage debt) to fund the pool’s construction. Compared to other loan options, this one may have more favorable interest rates and tax treatment. There are possible downsides to this strategy, though, including taking on more debt, lessening their equity, and losing their property to foreclosure.
A third way to cover the cost of a swimming pool is to use crowdfunding. This means that the individual raises money from other people, such as friends, family, or strangers, to pay for the swimming pool. This option can be done through online platforms, such as GoFundMe or Kickstarter, that allow people to create and share their fundraising campaigns. This option can offer a way to reach a large audience and receive donations from people who support the individual’s cause. However, this option also has some challenges, such as setting a realistic goal, creating a compelling story, and managing the logistics and legalities of the campaign.
Arguments for Insurance Coverage of Swimming Pools
While health insurance coverage for swimming pools is not common or easy to obtain, there are some arguments that can be made in favor of it. Some of these arguments include:
Doctor Recommendation for Therapeutic Benefits
One of the strongest arguments for insurance coverage of swimming pools is that it is recommended by a doctor for therapeutic benefits. A doctor’s prescription and recommendation can demonstrate that a swimming pool is medically necessary and effective for the individual’s health condition or treatment plan. A doctor can also provide documentation and evidence to support the medical necessity and effectiveness of the swimming pool, such as medical records, test results, or research studies.
Water Therapy for Injuries or Medical Conditions
Another argument for insurance coverage of swimming pools is that it provides water therapy for injuries or medical conditions. Water therapy can offer many advantages over other forms of therapy, such as:
- Reducing stress and pain by providing buoyancy and hydrostatic pressure.
- Improving mobility and range of motion by reducing gravity and resistance.
- Enhancing strength and endurance by providing resistance and turbulence.
- Promoting relaxation and well-being by stimulating sensory receptors and releasing endorphins.
Water therapy can be beneficial for various injuries or medical conditions, such as:
- Back pain
- Cerebral palsy
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
Potential Long-term Cost Savings
A third argument for insurance coverage of swimming pools is that it can provide potential long-term cost savings. By providing water therapy for injuries or medical conditions, a swimming pool can help improve the individual’s health outcomes and quality of life. This can lead to reduced medical expenses and increased productivity in the long run. For example, a study found that aquatic therapy reduced pain, disability, and medication use in patients with chronic low back pain. Another study found that aquatic therapy improved balance, gait, and mobility in patients with Parkinson’s disease. These improvements can translate into lower healthcare costs and higher economic benefits for the individual and society.
Tips for Appealing a Claim Denial
If a swimming pool is denied coverage by health insurance, there are some tips that can help the individual appeal the claim denial. Some of these tips include:
Work With Your Doctor
One of the most important tips for appealing a claim denial is to work with your doctor. Your doctor can help you understand the reasons for the denial, provide documentation and evidence to support your appeal and write a letter of medical necessity to explain why you need a swimming pool. Your doctor can also help you find alternative treatments or facilities that may be covered by your insurance.
Highlight Medical Necessity
Another tip for appealing a claim denial is to highlight the medical necessity of the swimming pool. You should emphasize how a swimming pool is essential for your health condition or treatment plan, how it provides therapeutic benefits that are not available or accessible elsewhere, and how it meets the criteria for receiving coverage. You should also provide supporting documents and evidence to back up your claims, such as:
- A prescription and recommendation from your doctor
- Medical records and test results
- Research studies and literature reviews
- Letters from other healthcare professionals or experts
- Testimonials from other patients or users
Provide Supporting Documents
A third tip for appealing a claim denial is to provide supporting documents to prove the cost and value of the swimming pool. You should provide receipts, invoices, estimates, or contracts that show how much you paid or will pay for installing and maintaining the swimming pool. You should also provide information on the features and specifications of the swimming pool, such as:
- The size, shape, depth, and volume of the pool
- The type, model, brand, and warranty of the pool
- The accessories and equipment included with the pool
- The safety measures and standards followed by the pool
Know Your Options for Alternative Financing
A final tip for appealing a claim denial is to know your options for alternative financing in case your appeal is unsuccessful. You should explore other ways to cover the cost of installing and maintaining a swimming pool, such as personal savings, home equity loans, or crowdfunding. You should also compare the costs and benefits of different options and choose the one that suits your needs and budget.