Does Health Insurance Cover a Dermatologist

Fran
Dani Milton
June 9, 2020

Most people prefer to make an unforgettable impression when they step out into the world. They select amazing outfits and tailored suits that flatter their figures. Others select stunning designer purses and flashy watches to complement their style.

Some individuals, however, work for hours to disguise any perceived flaws that other people may notice, especially if they have a skin disorder. They may apply moisturizers and makeup to hide blemishes, pimples, and uneven, flaky patches.

People suffering from these health problems may feel frustrated, especially when they cannot easily control their condition with over-the-counter products. If you have acne, eczema, psoriasis, or other chronic skin problems, you should schedule an appointment with a dermatologist. This doctor can prescribe medicines and regimens that can improve your skin's health. But how can you pay for a visit with a dermatologist? In this article, we'll teach you how to finance your dermatology treatment using health insurance and other payment options.

What Is a Dermatologist?

Dermatologists are physicians that diagnose and treat benign and malignant disorders of the skin, hair, nails and mucous membranes. These doctors also perform surgeries, interpret biopsies and evaluate systemic and infectious skin diseases. Others treat cosmetic disorders such as scars, hair loss, wrinkles and age-related changes to the skin. Dermatologists generally specialize in a specific field. For example:

Pediatric dermatologists manage skin diseases, infections, and inflammatory processes in children.

Dermapathologists are doctors who interpret cellular scrapings, lesions and tissue samples.

Immunodermatologists treat immune-mediated skin disease, including lupus, Celiac Disease, bullous pemphigoid, Pemphigus Vulgaris and other conditions.

Finding a Dermatologist

You should only consult with a board-certified dermatologist for your treatment. Verify that your doctor received certification from either the American Academy of Dermatology or the American Board of Dermatology. This certification means they have completed the residency training, testing and educational requirements required by the American Board of Medical Specialties (ABMS). This umbrella organization oversees 24 approved specialty certifying boards, including dermatology. The primary accrediting board for training programs is the Accreditation Board for Graduate Medical Education (ACGME).

If you’re unsure where to start, ask your primary care physician for a dermatologist recommendation. Your doctor can also offer a referral for the specialist that may help you get your condition covered by an insurer if it’s medically necessary. You can also visit the American Academy of Dermatology or American Board of Dermatology to search for a professional in your area.

What to Expect During Your First Dermatology Consultation

Spend a few moments preparing for your first appointment before you see the dermatologist. Grab a clean sheet of paper and write down your skincare products and prescription drugs. This list should contain brands of cleansers, lotions, toners, sunscreens and moisturizers. Next, summarize your skincare regimen, explaining how you use each product during the morning, afternoon, and evening.

A Sample Morning Routine

  • Hydrating Cleanser for Dry Skin
  • Alcohol-Free Toner
  • Moisturizer
  • Benzyl Peroxide Spot Treatment for Acne
  • 30 SPF Sunscreen
  • 30 SPF Lip Balm

This info will enable your physician to identify products that may cause inflammation or allergic reactions. It will also help the doctor from prescribing treatments that can interact with your medications.

During an initial consultation, the dermatologist will ask about your medical history. The doctor will gather information about any symptoms and persistent skin issues that you currently have. Don’t be surprised when your doctor asks you to disrobe and dress in a gown.

Most dermatologists perform a full physical to check for other skin conditions. Your doctor will look for suspicious growths, moles and cysts that may indicate other health problems. He or she may take a biopsy or remove any lesions or cysts. Later, a physician assistant may take photos of your skin condition to track how well your treatments are working. At the end of your appointment, your dermatologist will prescribe medicines to treat your skin condition and order any necessary diagnostic screenings. You’ll need to return for follow-up appointments to find out if the doctor needs to adjust your treatment or if it hasn’t made a difference.

Is Your Dermatologist a Good Fit for You?

Most dermatologists treat their patients with genuine respect. They want to help improve their patient’s health conditions. There are several things to keep in mind when visiting with a dermatologist. Your doctor should have an exceptional bedside manner, meaning they are polite, friendly, and knowledgeable. When you speak about your health care issues, make sure the physician listens to you. The dermatologist should be patient and caring when you ask questions about your treatment. He or she must also be someone you're comfortable working with on a long-term basis.

Don’t be afraid to get a new doctor if you believe that the dermatologist isn’t the right one for you. Even if a professional has stellar credentials on paper, this person may not be the best one to manage your care.

Some warning signs include a doctor who is dismissive, rude, or demeaning when you speak about your skin issues. Additionally, if the doctor doesn’t listen or talks over you, find a new one. You can search through your insurance company’s database for another in-network provider, or ask your primary care doctor for another referral.

Before setting up an appointment, you can search through online reviews to learn about others’ experiences at that practice, and if the dermatologist works well with patients.

How Much Does a Dermatology Visit Cost?

Dermatologists charge their rates based on their reputation, specialization, and skill level. An expert that treats rare skin conditions will charge higher fees than those whose practices focus on general skin conditions. Your initial consultation will cost an average of $100 to $170 per visit, depending on where you live. More expensive specialists may charge $200 or more per visit. If you are unhappy with these rates, speak with the dermatologist’s business office to negotiate a lower price once you become a regular patient. Additionally, ask about payment options and financing plans if you don’t have any insurance.

Will My Private Insurance Cover My Dermatology Visits?

Insurers provide varying levels of coverage for dermatology visits. Most private, comprehensive healthcare plans only cover these services when they are a medically necessary treatment. The insurance industry has different opinions about which skin conditions qualify for this category. What Is a Medically Necessary Procedure?

Medically necessary is specialist care that people require because of a health-related issue. These may include autoimmune disorders, cancers, and chronic skin conditions that cause permanent damage or death. Here is a list of conditions that qualify for medically necessary treatment. They include:

  • Severe Acne
  • Allergies
  • Eczema
  • Skin cancer
  • Hemangiomas
  • Hives
  • Infections and rashes
  • Keloid scars
  • Poison Ivy
  • Port wine stain removal
  • Psoriasis
  • Rashes
  • Shingles
  • Warts
  • Other health-related skin issues

What Qualifies as a Cosmetic Procedure?

Some individuals may believe certain skin conditions require dermatology treatments because they look unappealing. Their insurance companies, however, may argue these services aren’t necessary, because these issues are merely cosmetic. For example, many insurers define treatment wrinkles, crows' feet, and smile lines as services that they won’t cover. Insurance companies consider cosmetic procedures as elective. These treatments help improve the appearance of a person but are not essential. They include:

  • Tattoo removal
  • Microdermabrasion (skin sanding that reveals smooth, undamaged skin)
  • Chemical peels
  • Wrinkle treatments
  • Botox injections

In rare cases, insurers may approve microdermabrasion procedures for patients that suffer from severe acne scarring. A few states also have passed legislation to mandate insurance coverage for laser treatments to remove port-wine stains. This disfiguring, congenital vascular malformations can cause medical complications and social stigmatization.

If your insurance company doesn’t offer coverage for dermatology appointments, you can search for a new health insurance plan using SmartFinancial’s app. Just complete our short application, and we’ll provide you with a list of quotes from insurance plans available in your area. You can compare options and select the one that’s right for you.

Do I Need a Referral to See a Dermatologist?

Does your insurance company cover dermatologist appointments? If so, ask their representative what paperwork you’ll need to qualify for coverage.

Are you enrolled in a managed health insurance option, like a Health Maintenance Organization (HMO) or a Point of Service Plan (POS)? These insurers require you to a referral from your primary care provider before you can see specialists. Once your doctor grants your request, you can set up an appointment. If you have an HMO or a POS, you should only select dermatologists within your provider network. Your insurer will likely only reimburse healthcare expenses from an in-network professional. These specialists have contractual agreements with your insurer to charge lower rates in exchange for referrals. Your insurer may not cover your doctor’s visit if you see an out-of-network provider. Even if you use an in-network doctor, you’ll still be responsible for some fees. These costs include deductibles, coinsurance, etc. For example, you must meet your deductible before your insurance company starts covering your appointments. Additionally, if your plan requires a copay, you must pay it on the day of your scheduled appointment.

You don’t need a referral to see a specialist if you belong to a Preferred Provider Organization policy. Next, call the dermatologist’s business office before you set up an initial consultation. Find out if they’ll accept your insurance coverage, and if they’re an in-network provider. If so, ask if your benefits will pay for the services you need.

Medicare Coverage for Dermatology Visits

According to a National Institutes of Health study released in 2017, there is a skin cancer epidemic in older patients aged 65 years and older.

Medicare Part B (medical insurance) can cover doctor’s visits when they are medically necessary to diagnose and treat your medical conditions, like suspicious moles. Your physician may refer you to a dermatologist if you have a skin infection that didn’t respond to conventional treatments. You can ask for a referral to a dermatologist that will accept your assignment. It means that your doctor will waive any fees they generally charge and accepts Medicare pricing. You can find a professional near your home who sees Medicare patients by using their Physician Compare tool. You’ll only need to enter your city, state, and “dermatology” into the search engine. Some Medicare Advantage programs (Part C) provided by private insurance companies may cover dermatology benefits. Specialists may charge you higher rates. For example, if your regular copay is $0 under your primary care doctor, you may have a $25 one to see a dermatologist. Medicare doesn’t cover cosmetic procedures, including treatments for wrinkles and skin elasticity.

Will Flexible Spending Accounts and Health Savings Accounts Pay for Dermatology Visits?

If your insurance doesn’t cover medically necessary skin treatments, you can use other payment methods. Some dermatologists accept payments from Flexible Savings Accounts and Health Saving Accounts. The federal government has some restrictions on what treatments qualify under these accounts. An FSA is a tax-deferred account that allows you to save money for out-of-pocket healthcare costs. The Internal Revenue Service’s FSA Eligible Medical Expenses Code, Section 213 (d)(1), has a list of eligible medical expenses and services. They only allow for medical care that diagnoses, cures, mitigates, treats, or prevents diseases that affect the body’s function.

Dermatology visits qualify as eligible expenses under this code (as long as they are medically necessary). These treatments include diagnostic tests, essential treatment, biopsies, and life-saving procedures. The IRS doesn’t allow for coverage of cosmetic procedures. Some conditions, such as acne, may qualify for reimbursement under FSAs. You'll need a Letter of Medical Necessity (LMN) for healthcare for medical conditions that an insurer may misconstrue as cosmetic treatment (such as eczema and psoriasis).

Health Savings Accounts allow you to set aside money on a pre-tax basis to reimburse qualified medical expenses. You can use your pre-tax dollars to pay off deductibles, copays, coinsurance, and other fees to lower your costs. Insurers generally pair HSAs with a High Deductible Health Plan (HDHP). HSAs won't cover cosmetic treatments but will pay for screenings for cancer, prescription, and other health conditions.

Do you need a great dermatologist to manage the treatment for your skin? SmartFinancial can help you find an insurance carrier who is right for you. Our company makes it easy for people to find excellent health plans with outstanding coverage. You won’t have to spend hours comparing options or searching for affordable premiums. We do all the leg work for you. All you need to do is complete our short application, and we’ll provide multiple quotes from local insurance companies within your area. You’ll have the option to buy your policy online, over the phone, or in person. It’s really simple and only takes a few minutes. Begin by entering your zip code.

Get a Free Health Insurance Quote Online Now.

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