Health Insurance Coverage for Dermatology Services
While many people think of skincare from a purely cosmetic angle, your skin is your body’s largest organ, and taking care of it is an important part of overall wellness. Regular visits with a dermatologist can help you identify early signs of skin cancer and treat various problems. While many avoid scheduling a visit with a dermatologist because they assume their medical bills will be expensive, health insurance covers this type of care.
How Much Do Dermatology Services Cost?
How much you pay for a visit with your dermatologist depends on your health insurance. To determine your out-of-pocket expenses, refer to your plan’s “Summary of Benefits” page and look at how office visits with a specialist are covered.
Depending on your plan, you may have to meet an annual deductible before health insurance covers any of the visits and treatment. You would pay for services out-of-pocket until you hit your annual out-of-pocket limit. At that point, services may be completely covered, or you may have a copay (which is a specific dollar amount that you pay for the appointment), or coinsurance (which is a percentage of the cost of the visit).
Other health insurance policies do not have annual deductibles, or they pay for specialist visits without requiring you to meet it before coverage kicks in. In most cases, you have a copay or coinsurance that you pay out of pocket.
When scheduling your dermatologist visit, make sure you find a doctor within your plan’s network. Getting out-of-network care generally results in higher cost-sharing responsibilities, if your health insurance covers the service at all.
When Does Health Insurance Cover Dermatology?
For your health insurance policy to pay for your dermatology visit, the service must be medically necessary. In other words, during the appointment, the dermatologist must evaluate your symptoms, make a diagnosis, or create or continue a treatment plan. The doctor must also be able to demonstrate how not getting the condition treated could affect your general health. In other words, it will not be covered if it’s a “vanity” desire. Like removing tattoos because you think they are ugly. That’s not going to be considered medically necessary, unless the tattoo looks suspicious to your medical provider and they want to biopsy the skin or treat the skin.
In some cases, your health insurance may pay for a specific treatment to treat one condition, but not another.
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Skin Conditions Most Likely Covered by Insurance:
- Acne
- Skin cancer
- Shingles
- Warts
- Moles
- Rashes
- Keloids
- Hives
- Skin infections
- Allergic reactions
- Eczema
- Rosacea
- Dermatitis
- Vitiligo
- Psoriasis
- Port wine stains (birthmark)
- Varicose vein treatment (when medically necessary)
To ensure that you do not end up with higher medical bills than you expect, it is always a good idea to verify exactly what your health insurance covers. A health insurance agent can help you review your policy and determine whether a specific service or treatment is covered.
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When Does Health Insurance Not Cover Dermatology?
While your health insurance policy generally covers any medical service that is deemed medically necessary, it does not cover elective or cosmetic procedures. Some services that your policy probably does not cover include:
- Facials
- Facelifts
- Chemical peels
- Botox injections
- Laser skin resurfacing
- Dermabrasion
- Microdermabrasion
- Dermal fillers
How Can I Make Sure My Health Insurance Covers My Care?
If you are seeking care from a dermatologist to address a medical condition, it is important to follow your plan’s rules for seeing a specialist. Depending on your plan, you may be required to get a referral from your doctor. If the procedure is not listed as a covered benefit in your “Agreement of Coverage” document, then it will not be covered.
Do I Need a Referral for Dermatology Services?
Whether you need a referral depends, once again, on your health insurance policy. Health Maintenance Organization (HMO), usually require you to get a referral from a doctor to see a dermatologist. If you have an Exclusive Provider Organization (EPO), or a Preferred Provider Network (PPO), you can likely schedule a visit with a dermatologist without getting a referral from your doctor.
When scheduling your appointment, determine whether the dermatologist you choose is within your plan’s network. If you see an out-of-network specialist, you may be required to pay a higher copay or coinsurance, or you may have to pay the entire cost out of pocket.
As always, it is a good idea to talk to a health insurance agent to find out what your plan covers and where you can go for care.
Finding Health Insurance with Nevada Insurance Enrollment
Without health insurance, necessary skincare services can be cost-prohibitive. At Nevada Insurance Enrollment, our licensed health insurance agents can help you find robust coverage that fits your budget and needs.
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