Will My Insurance Plan Cover Dermatology Visits and Procedures?

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Dermatology should be covered by most health insurance plans, including HMOs, PPOs, EPOs and POSs if it is considered medically necessary. Dermatology procedures for cosmetic purposes, such as botox or tattoo removal, are usually paid completely out of pocket.. Depending on your plan, you may need a referral from a primary care physician in order to receive dermatology services.

Keep reading to see what falls under dermatological medicine, how much dermatology treatments cost and how to get coverage.

What Is Dermatology?

Dermatology is a branch of medicine that deals with the skin, hair, nails, oral and genital membranes and related structures of the body. It involves the diagnosis and treatment of a wide range of skin-related conditions, including skin cancer, acne, eczema, psoriasis and inflammation.

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.
  • Dermatopathologists 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.

These specialists use a variety of techniques to diagnose and treat their patients, including physical examination, biopsy and diagnostic imaging. Treatment options may include topical or oral medications, light therapy and surgery. Dermatologists may also provide advice on skincare and sun protection to help prevent skin problems from developing or worsening.

Dermatologists also play an important role in educating patients about skin cancer prevention and detection.

They can perform screenings and, if necessary, remove suspicious moles or growths. Early detection of skin cancer is crucial for successful treatment, so it's important to see a dermatologist regularly, especially if skin cancer has been recorded in your family’s medical history.

Is Dermatology Considered Medically Necessary or Elective?

Health insurance companies will typically cover dermatology procedures that are medically necessary, which refers to diagnosis and treatments of skin conditions that are causing or have the potential to cause serious health problems if left untreated. These may include services addressing autoimmune disorders, cancers, and chronic skin conditions that cause permanent damage or death. Here is a list of conditions that may qualify for medically necessary treatment:

  • Severe acne
  • Eczema
  • Hemangiomas
  • Psoriasis
  • Shingles
  • Port-wine stains
  • Allergies
  • Skin cancer
  • Hives
  • Rashes
  • Warts

Examples of elective dermatology would be procedures done for purely cosmetic purposes, such as botox and hair restoration, and are not covered by health insurance. These treatments are not strictly necessary for the patient's health, but may improve their appearance or self-esteem.

What Types of Dermatology Visits and Procedures Are Typically Covered?

Insurance coverage for a dermatology appointment or procedure can vary depending on the patient's insurance plan. Typically, your insurance company will cover visits and procedures considered medically necessary. Some examples include:

  • Skin cancer screenings: Dermatologists will examine the skin for any signs of skin cancer and remove any suspicious moles or growths that are found.
  • Treatment for skin diseases: Your insurance provider will usually cover the treatment of skin conditions such as eczema, psoriasis and other inflammatory skin conditions. This may include topical or oral medications, light therapy and surgery.
  • Biopsy procedures: Insurance will typically cover the cost of a biopsy if it is done to diagnose a skin condition or to determine if a mole or growth is cancerous.
  • Wound Care: Your insurance company will cover wound care procedures like debridement and wound dressings that are related to a medical condition or accident.
  • Acne treatment: Coverage will typically include the cost of treatment for severe acne, including prescription medications.
  • Rashes and skin allergies: Insurance will cover the cost of treatment for rashes and skin allergies that are caused by an underlying medical condition.

What Isn’t Covered?

Health insurance plan coverage for dermatology services will not include visits and procedures that are considered elective or cosmetic. These include:

  • Cosmetic procedures: Insurance typically does not cover procedures such as laser hair removal, botox injections and chemical peels.
  • Facial rejuvenation procedures: Procedures such as facelifts, eyelid lifts and other facial rejuvenation procedures will not typically be covered by your insurance provider.
  • Tattoo removal: Unfortunately, removing a spur-of-the-moment tattoo you got in your years is usually excluded from coverage.
  • Liposuction: Surgical removal of fat will not usually be covered by your health insurance plan.
  • Hair restoration: Insurance may not cover the cost of hair transplants.

What Type of Health Insurance Covers Dermatology?

Most health insurance plans, including Medicare and Medicaid, cover dermatology visits and procedures considered medically necessary. Below is a list of the common insurance types that should supply coverage:

  • Health maintenance organization (HMO): These plans contract with doctors and facilities so policyholders can receive care without incurring a deductible. HMOs require a primary care physician (PCP) to refer patients to specialists, including dermatologists.
  • Preferred provider organization (PPO): Members can seek medical care from doctors, hospitals and other healthcare facilities outside of their plan’s network. A referral by a PCP for a dermatologist visit is not necessary.
  • Exclusive provider organization (EPO): These are similar to HMOs in that you’re limited to your plan's provider network. However, you won't need a PCP referral to see a dermatologist.
  • Point of service (POS): Those with a POS will have more flexibility with who they can get care from, but a PCP referral will be needed for a dermatology visit.
  • Medicare: Part B of Original Medicare and Part C can help pay for medically necessary dermatology procedures. Depending on the type of plan you have, you may be able to get your dermatology services completely covered.
  • Medicaid: Low-income individuals will most likely be covered for medically necessary dermatology visits and procedures. You will need to check with your state Medicaid plan to verify coverage.

Do You Need a Referral To See a Dermatologist?

Depending on your plan and the type of procedure, you will need a referral before you can schedule an appointment with a dermatologist. If you have an EPO or PPO plan, you generally will not need prior authorization from your primary care physician to see a dermatologist.

Some health insurance policies require a referral from a PCP before seeing a dermatologist, such as HMO and POS plans.

How Much Does It Cost To Visit a Dermatologist With Insurance?

The cost of visiting a dermatologist with insurance coverage can vary depending on a number of factors, including the patient's insurance plan, the specific services provided and the location of the clinic. Dermatologist services typically range from $80 to $275. As discussed earlier, medically necessary visits are usually covered — however, certain plans will cover only in-network dermatologist services. You may still incur an out-of-pocket cost, such as a copay, coinsurance and deductible depending on your plan.

How Much Does It Cost Without Insurance?

Since your insurance company will not be paying a portion of your costs, you can expect a higher out of pocket cost depending on the service and the specific practice. For instance, a facelift can cost over $8,000 while breast reconstruction could be over $15,000.

Contact the dermatologist's office directly and ask for their fees. Dermatologists may give you a discounted price on treatment if you tell them you will be paying completely out of pocket. Payment plans may also be available if you can’t afford a single upfront payment. Third-party financing products and credit cards, like those offered by CareCredit, are another option, as well.

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How To Get Health Insurance That Will Cover Dermatology

There are several ways to get health insurance that will cover dermatology:

Insurance

Description

Employer-sponsored health insurance

Many employers offer health insurance benefits to their employees, which typically cover medically necessary dermatology visits and procedures.

Individual and family health insurance plans

These plans can be purchased directly from an insurance company or through the Health Insurance Marketplace.

Medicaid and CHIP

These are government-funded programs that provide health coverage to low-income individuals, children and families.

Medicare

Individuals who are 65 or older, or who have a permanent disability, may be eligible for Medicare, which covers certain dermatology visits and procedures.

COBRA

COBRA is a federal law allowing individuals who lose their employer-sponsored health insurance to continue their coverage for a certain time.

FAQs

Does Medicare cover dermatology?

Medicare Part B and Part C may cover medically necessary dermatology services.

Will my private insurance cover a dermatology visit?

Most private, comprehensive healthcare plans only cover dermatology visits for medically necessary treatments, such as consultations and screenings for skin cancer.

Can I use FSA/HSA to pay for dermatology?

Flexible spending accounts (FSAs) and health savings accounts (HSAs) can typically be used to pay for dermatology visits.

Key Takeaways

  • Dermatology is a branch of medicine that deals with the skin, hair, nails, oral and genital membranes and related structures of the body.
  • Whether your insurance will cover dermatology-related expenses will depend on if the treatment is medically necessary or elective.
  • HMOs and POSs will require a referral from a primary care physician (PCP) in order for patients to see a dermatologist while EPOs and PPOs allow policyholders to set up their own appointments without a referral.

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