The various non-covered medical services created by hospitals are like a game of whack-a-mole. When a popular non-covered treatment becomes problematic and is blocked, another non-covered item is created. Even for ordinary illnesses that do not require non-covered treatments, patients are often recommended such services as much as possible. Doctors, insurance planners, and brokers even hold study groups to develop ingenious non-covered items. There are even rumors that a certain ophthalmology clinic in Gangnam, which hit the jackpot with cataract treatments a few years ago, made a lifetime's worth of money in less than five years. This is why everyone is jumping into the development of new non-covered services with fresh ideas.

When the medical logic for non-covered treatments is stretched too far, bizarre treatments can emerge. Recently, a domestic insurance company, B Insurance, received a shocking claim for actual expense insurance from a large hospital in Incheon, where manual therapy was being performed on an 8-year-old child, C, to correct flat feet. C visited the hospital due to inward bending of the ankle and received 23 sessions of manual therapy over about six months. Since it was the first time B Insurance had seen manual therapy for pediatric flat feet, they sought a medical consultation for an expert opinion on the treatment.

The result was a complete denial of actual expense coverage for the manual therapy. The consulting doctor replied, "Flexible flat feet should be treated with active exercise, not manual therapy," and recommended an investigation into the hospital's doctor. In the end, the child's parents, trusting only the hospital doctor's words, underwent manual therapy and were left with abnormal treatment and huge medical bills. A B Insurance representative said, "We only sought an expert opinion for a simple medical judgment, but the recommendation for an investigation by a fellow doctor shows how excessive this was," adding, "Cases of forcibly linking illnesses to non-covered treatments will continue in the future."

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There have also been cases where, after recommending unnecessary non-covered treatments to patients, doctors would subtly change the diagnosis on documents when the patient wanted a second opinion at a higher-level hospital. Kim Jiyeon, a housewife in her 30s, recently had a 3cm lump detected during a breast ultrasound and underwent a biopsy at D Surgery Clinic in Gwangmyeong, Gyeonggi Province. The doctor at D Clinic diagnosed her with atypical cell hyperplasia, saying the shape was not good and that there was a high risk of cancer, urging her to undergo Mammotome surgery quickly. The Mammotome is a device that uses ultrasound to guide a special needle to remove tumors and costs about 2 million won as a non-covered procedure.

Kim wanted a second opinion at a larger hospital, so she did not schedule the surgery and obtained a referral letter before visiting Gangnam St. Mary's Hospital. Upon re-examination of the biopsy at St. Mary's, she was diagnosed with a simple fibroadenoma that did not require surgery. The doctor at St. Mary's said, "It's not serious enough for surgery; let's just monitor it," and Kim asked to check the referral letter she had received from D Clinic. The letter, written in medical jargon and English, did not mention "atypical" and instead described the lump as having a good shape. D Clinic had verbally frightened Kim and pressured her into unnecessary non-covered treatment, but wrote a normal medical opinion in the documents to be checked by the higher-level hospital.

The prevalence of unreasonable non-covered treatments is due to the enormous profits they generate. Studies have shown that the higher the proportion of non-covered services, the higher the specialist's income. According to a paper titled "Correlation between Resident Application Rate by Specialty, Physician Income, and Non-Covered Service Rate (Jung Eunyoung, Na Younggyun)" published in the Korea Citation Index (KCI) in March, ophthalmology ranked first in average annual specialist income in 2020 at 458.37 million won. It was followed by orthopedics (402.84 million won), rehabilitation medicine (379.93 million won), neurosurgery (370.65 million won), and dermatology (302.63 million won). These top five specialties also had high proportions of non-covered services. As of 2021, rehabilitation medicine had the highest non-covered service rate at 42.6%, followed by ophthalmology (42.3%), orthopedics (36%), neurosurgery (35.3%), and pediatrics (25.3%).