Does Insurance Cover Dermatology?
Yes, health insurance does cover dermatology, but only in certain situations. Most insurance companies will pay for services medically necessary to treat acute skin conditions like cancer, infection, hives, eczema, and warts. Conversely, insurers almost always exclude cosmetic procedures like Botox or chemical peels from coverage. Your coverage amount and limits will ultimately depend on your insurance carrier, plan type, and medical condition.
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Demystifying Dermatology Insurance Coverage
Dermatology is a specialized branch of medicine that focuses on skincare. Skin is the largest organ in the human body and essential to our overall health. Understanding whether or not your insurance covers basic dermatological procedures will ensure you receive the care you need should any condition arise or worsen that your primary care provider (PCP) cannot address.
Though dermatology can help with a spectrum of skin-related issues, insurers will only cover medically necessary treatments like steroid injections, surgery, and light therapy to address existing health problems. Non-medical procedures, such as tattoo removal, typically get categorized as “cosmetic” or “elective.” Operations of this nature seldom qualify for health insurance coverage.
How Does Insurance Coverage for Dermatology Work?
The range of your coverage depends on your insurer and the plan you have enrolled in. While some policies allow covered access to your pick of doctors, others will need a skincare referral from your PCP and may prohibit you from seeing doctors outside their approved healthcare networks.
Traditionally covered dermatological services such as skin cancer screenings, mole biopsies, and psoriasis treatment will still require members to share costs through copays, coinsurance, and deductibles. Conversely, the same patient would have to pay entirely out-of-pocket for uncovered procedures like cosmetic surgery or injections, varicose vein treatment, or scar revision.
Dermatology Services Commonly Covered by Health Insurance
If you have comprehensive health insurance, you can expect coverage for most medically necessary dermatological procedures, including the ones listed below.
Skin Cancer Screenings
The Skin Cancer Foundation recommends that all adults see a dermatologist once a year for a skin cancer screening. These screenings typically involve a quick visual examination of the entire body. If your doctor spots a suspicious lesion, they may remove a piece for a biopsy. Most health insurance companies will cover part or all of an annual skin cancer screening.
Skin Cancer Treatment
The most common types of skin cancer are melanoma, basic cell carcinoma, and squamous cell carcinoma. Depending on your condition, you may need surgery, chemotherapy, radiation — or a combination of the three to neutralize continued abnormal cell growth. Most insurance providers will cover medically necessary cancer treatment after you pay your annual deductible.
Though not all moles are cancerous, your doctor may require a biopsy to assess the chemical makeup and determine further treatment. This involves cutting off a piece of the mole and sending it to a laboratory for analysis. Usually, biopsies qualify for medical coverage as part of routine skin cancer screenings.
Most insurance providers will cover medically necessary acne treatment, especially for severe or painful cases. However, experimental acne removal procedures like chemical peels rarely qualify for coverage due to their lack of proven success. Likewise, patients would have to pay entirely out of pocket for cosmetic services focusing on acne scarring, such as laser surgery.
Eczema and Psoriasis Treatments
As with acne treatments, insurance companies only cover some eczema and psoriasis care. While most providers will pay for the phototherapy needed to remedy these conditions, dermatology insurance will not pay for over-the-counter creams and medicines typically affiliated with eczema and psoriasis care. However, depending on your policy details, you may still qualify for certain prescription drugs.
As with the treatments mentioned above, insurance companies usually cover any wart removal operation deemed medically necessary by a doctor. Remember that only some insurance providers will cover all the procedures listed above. Review your policy and check your coverage eligibility before making your next dermatologist appointment to ensure you receive proper financial support.
What’s Not Covered
Usually, health insurance for dermatology only applies to procedures a doctor prescribes as medically necessary. The following elective treatments rarely, if ever, qualify for coverage.
- Cosmetic Procedures: Operations and treatments explicitly utilized to improve one’s appearance, such as botox, facials, and skin fillers
- Tattoo Removal: Laser surgery to remove old, unwanted tattoos
- Varicose Vein Treatment: Chemical injections or laser surgery to hide unsightly, protruding veins
- Scar Revision: Surgeries employed to obscure physical scarring
- Permanent Makeup: Cosmetic tattoos that recreate looks otherwise accomplished with cosmetics
While some treatments for skin conditions like acne and eczema typically qualify for full or partial insurance coverage, many others do not. Check with your insurer to see how they set coverage limits and differentiate between eligible conditions.
Factors Influencing Dermatology Coverage
Ultimately, your level of dermatology coverage will come down to your insurance plan, medical necessity, pre-existing conditions, and the legitimacy of your selected treatments.
Every insurance plan approaches coverage eligibility differently. While HMOs tend to set more restrictive networks and require PCP referrals for dermatological care, POS and PPO plans allow more flexibility when seeing out-of-network specialists. People paying higher premiums for health insurance receive more comprehensive coverage, whereas the most affordable plans often exclude more elements of care.
Dermatology treatments vary in coverage eligibility based on medical necessity. For a procedure to qualify as medically necessary, a doctor must prescribe it as crucial in diagnosing or treating an existing illness or its symptoms. Purely cosmetic procedures, such as permanent makeup or Botox, seldom qualify for insurance coverage.
All ACA Marketplace, Medicare Advantage, and Original Medicare plans must cover medically necessary treatment, even for pre-existing conditions like a previous skin cancer diagnosis. However, the rules for this can vary with some Medigap plans. Repeat diagnostic tests on a late-stage and fully understood condition might also prove uncoverable.
Some insurance carriers will balk at covering newer treatments, such as chemical peels and gene therapy, that they view as experimental or investigational. Unfortunately, this directly affects individuals with rare or hard-to-treat skin conditions like Blau syndrome or rosacea. If no proven treatment methods exist, care will get classified as experimental and billed directly to patients.
How Much Does Dermatology Cost?
The cost of dermatology visits depends on the type of procedure you need, your level of insurance coverage, and your location. The average cost of a dermatology appointment without insurance typically falls between $100 – $300.
If you have a comprehensive health insurance plan and your procedure qualifies as medically necessary, insurance would likely cover the bulk of your medical bill. Insured patients must still share costs by meeting a set annual deductible and paying for 10-20% of their care through coinsurance or a set copay of around $20 to $30 with each appointment.
How To Get Dermatology Coverage With Your Insurance
Follow these instructions to secure the best dermatology coverage available through your policy:
- Examine your benefits and coverage. Every insurance policy has a “summary of benefits and coverage” (SBC) indicating included and excluded services.
- Consider plan deductibles, copayments, and coinsurance. Each plan sets varying patient out-of-pocket costs. Compare rates to select the optimal plan for you.
- Review your provider network. Ensure your selected dermatologist exists in your insurer’s medical network.
- Check prescription medication coverage. Review your insurer’s drug formulary to ensure it includes medications required to treat your condition.
- Evaluate coverage for specialized treatments. Ask your carrier if you need a referral to see outside specialists.
- Review coverage for out-of-network care. Your SBC will state coverage differences for in-network and out-of-network doctors.
- Understand waiting periods or pre-existing condition exclusions. Some companies will exclude or postpone coverage for individuals with specified pre-exiting conditions.
- Consult with a dermatologist. Finally, schedule an initial meeting with your dermatologist to determine the proper course of treatment.
If you cannot readily access this information, call your insurer with any further questions. If your current insurance for a dermatologist falls short, compare other options and switch to a policy with better-suited coverage.
What to Do If Your Insurance Doesn’t Cover Dermatology
If your situation does not qualify for dermatology coverage under your current insurance policy, explore the following options:
- Seek out-of-network providers. Even if you can’t find coverage within your insurer’s medical network, you might discover a more affordable specialist outside of it. Use the American Academy of Dermatologists’ search engine to find and compare doctors and secure the lowest possible out-of-pocket treatment costs.
- Apply for financial assistance program. Some dermatologists may offer payment plans or medical credit cards to uninsured individuals who need immediate medical attention.
- Negotiate with your dermatologist. Other dermatologists may discount costs for patients who must pay entirely out-of-pocket. Given your situation, ask politely if you might qualify for a price break.
Utilizing Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) For Dermatology
Many people use HSAs and FSAs as special medical savings accounts accessible for qualified expenses like prescription drugs, copays, and other out-of-pocket costs typically associated with doctor visits. These employer-sponsored accounts intake money pretax, meaning that utilizing these funds provides a cheaper alternative than spending the taxable income in your personal bank account.
As with insurance coverage, patients can only withdraw funds from their HSAs and FSAs to pay for medically necessary procedures. Sometimes, patients may even need to provide a “letter of medical necessity” signed by their dermatologist. Due to these limitations, patients cannot access these accounts for elective and cosmetic procedures like Botox or tattoo removal.
What This Means For You
If you have a concerning skin condition, remember that as long as the cause is medically necessary, health insurance will generally covers a dermatologist visit. Depending on your plan, you may need to see in-network doctors or receive a referral from a primary care physician for an out-of-network specialist. Proper skincare is crucial to our overall health, so talk to a trusted insurance agent to ensure you have the coverage you need to check for cancer, treat acne and eczema, remove warts, and much more.