Does health insurance cover dermatology?
“To sum it up…”
- Dermatology is a specialty involving skin and skin-specific conditions
- If treatment meets a medical necessity, dermatology should be covered by insurance
- It’s necessary to understand what is and isn’t covered by insurance before seeking care
Dermatology is a mainstream medical specialty. Thousands of people visit a dermatologist every day for common and uncommon skin issues. Like traditional health care, most services a dermatologist offers are covered by insurance. However, medications, procedures, and some conditions won’t be payable by health insurance.
The guideline insurance companies use to determine whether they will pay for a service or not is medical necessity. Medical necessity has been a controversial topic for decades, so it’s always a good idea to read your policy and refer to it several times a year.
If you’ve found this article, you’re probably considering visiting a dermatologist. Even more, you’re likely worried whether you can use your medical insurance to cover the visit.
Unfortunately, there isn’t a black and white answer as to whether your insurance will pay for the visit or not. The reasoning is some conditions may be eligible for coverage while others are considered cosmetic.
To help you find the answers you need, we’ll go over different situations below.
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Is a visit to the dermatologist medically necessary?
The first question you need to answer when trying to determine whether you can use your insurance or not is whether the visit to the dermatologist is medically necessary.
To be considered medically necessary, the visit must be to evaluate, diagnose, or continue treating a medical condition.
For example, if you are visiting a dermatologist to treat a skin condition, your insurance will likely cover the visit.
Dermatologic Procedures and Conditions Usually Covered by Health Insurance
Dermatologists spend most of their time treating more serious skin conditions. Most of the conditions and procedures listed below are considered medically necessary. A list of the most commonly covered conditions are listed below.
- Skin cancer
- Port wine stain removal
- Hemangioma excision
- Skin or fungal infections
- Skin allergies
- Keloid scars
A Note About Treatment of Acne and Microdermabrasion
Many years ago, most health insurance wouldn’t cover treatments, medications, or procedures used to treat acne. The reason acne treatments weren’t covered is because it wasn’t considered medically necessary.
However, lobbyists, patients, and physicians have lobbied to encourage insurance companies to cover these services because acne can lead to scar, skin infections, and other health complications.
For some scars due to acne can be disfiguring, permanent, and unpleasant, which can lead to detrimental effects on their physical and mental health.
One way this situation is resolved is through microdermabrasion. However, this procedure is not always covered.
Microdermabrasion is a procedure where layers of skin are removed. It’s often done to help with scar removal and many cosmetic procedures.
However, if your insurance covers acne and your doctor suggests microdermabrasion, it doesn’t guarantee that the procedure will be covered.
If your insurance will not approve the microdermabrasion, they may allow you to appeal the denial or advise you on procedures that are alternate to microdermabrasion.
If you find yourself in this situation, your insurance company and your physician’s office will have to work closely together.
What’s an elective dermatology procedure?
Now that you know what dermatology procedures are often covered by health insurance, it’s time to talk about what insurance won’t pay for. Usually, if your medical insurance won’t cover a dermatologic service or procedure, it’s because the code used to bill the health insurance was deemed cosmetic or an elective procedure.
In most situations, an elective or cosmetic procedure is not covered by health insurance because it is not medically necessary, which means a person’s overall health is not affected if the person does not receive the treatment. There may be exceptions, but it is very unlikely.
Usually, if your medical insurance won’t cover a dermatologic service or procedure, it’s because the code used to bill the health insurance was deemed cosmetic or an elective procedure.
Examples of elective dermatology procedures include:
- Botox injections
- Tattoo removal
- Chemical peel
Get Referrals if Necessary
Even if you are convinced that your insurance will cover your dermatology visit, you still need to make sure you have a referral, if needed. Some insurance companies require their subscribers to receive a referral from a primary care physician before seeing a specialist.
If a referral is not secured before a specialist visit, the dermatology appointment may not be covered or paid at a lower rate.
It’s also important to know if there will be more than one specialty involved in your care. For example, if your dermatologic plan involves scars, you may have a dermatologist and plastic surgeon involved in your care. If this is true, you’ll need a referral for each doctor that’s involved in your care.
Most often the one doctor will be the lead and his or her office will help you keep the paperwork organized.
What to do before you make an appointment?
If you’re currently seeing a dermatologist for a medical condition and are going to be switching insurance plans, it’s a good idea to contact your doctor office to find out what insurance plans are accepted.
Doing this before you make an appointment allows you to feel confident about coverage for your conditions. Unfortunately, if you visit a doctor not on your current insurance plan or an in-network physician, you’ll have greater out-of-pocket costs.
If you are referred to a dermatologist and already have insurance, you need to make sure the physician is covered under your plan before you make an appointment. If you can’t find a dermatologist in your area, you can contact the insurance company directly for a referral.
As mentioned above, if you need a written referral for your insurance coverage to be effective, it’s necessary to do that before your initial visit.
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