Even for the most basic of medical treatments, insurance coverage can be complicated. It can be difficult to determine if you are covered for specialty services such as dermatology. U.S. Dermatology Partners is happy to work with patients to determine coverage, and to maximize medical insurance coverage when possible.
This blog will cover the basics of dermatology and health insurance. Each office and individual dermatologists may have their own insurance benefits policies. You should speak with your local office to confirm if your insurance is accepted. You can get detailed information from our knowledgeable staff about your coverage.
What is Medical Insurance?
Individual patients or their employers pay a monthly premium to purchase medical insurance. Your insurer will pay a portion of the costs of any medically necessary treatment in exchange for your premium payment. Most cases, your insurer will require you to pay a copayment or deductible before your medical insurance benefits can cover treatment. Each year, your annual deductible is reset. If you have already paid your annual plan deductible for the year, the end of each year is a great opportunity to get additional treatment to maximize your benefits.
There are two types of insurance benefit plans available: PPO (preferential provider organization) plans and HMO (health maintenance organization) plans. A PPO plan will allow you to access a greater number of providers and procedures than HMO coverage. Each medical benefit plan is a contract between the insurers and the insured. These coverage agreements can change from year to year and from person to person. It is important to know your policy to maximize benefits.
Is Dermatology covered by medical insurance?
It is usually down to whether or not your insurance company covers dermatology treatments. Insurers have different definitions of medically necessary so make sure to check your policy or call your insurer to confirm your coverage.
What do I need to refer?
Nearly all HMO medical insurance plans require documentation to provide coverage for visits to a specialist practice, such as a dermatologist’s. Referrals are required for some PPO medical insurance plans, particularly for advanced treatments. Contact your insurance company to find out if you require a referral.
What should I do before my visit?
Before you make an appointment with one our dermatology staff, please take these steps to ensure that your visit to our office and payment for your treatment are stress-free.
- Check your policy. In most cases, the medical benefit plan will outline coverage in a policy document. This is a great place to start determining if dermatology services are covered.
- Before scheduling an appointment, contact your insurance company.
- You should determine if you require a referral. Before scheduling an appointment with a dermatologist, call your insurance company to ask if you need one.
- Verify that your insurance is accepted by the dermatologist. Once you have verified that your insurance covers the service you are interested in, contact your dermatologist to confirm.
- Ask your provider about other financing options. If your insurance does not cover the requested service or the dermatologist refuses to accept it, inquire about specials or payment plans.
What types of dermatology procedures are covered?
The specifics of each insurance company and individual benefit plan will determine the extent and availability of coverage. Most cases will cover treatments for chronic skin conditions. Insurance benefits usually cover conditions such as those listed below.
- Skin Cancer
- Rash
- Psoriasis
- Eczema
- Shingles
- Warts
- Poison ivy
- Scars from Keloid
- Skin allergies and hives
- Severe acne
- Fungal, bacterial or viral skin infections
Although these conditions are usually medically necessary, insurance may not cover some of the recommended treatments. Discuss all possible treatment options. Dermatologists want patients to be able to use treatment options that improve their skin and allow them to get the best coverage under their insurance.
What types of dermatology procedures are not covered?
Most insurance benefits do not offer coverage for treatments that aren’t considered medically necessary. This means that elective and cosmetic dermatology treatments are not usually covered. This applies to services such as Botox, dermal fillers and tattoo removal. Some treatments that were once considered cosmetic may be covered. Clients with acne might be eligible for coverage through insurance. Many insurers now offer coverage for laser port wine stain treatment. We recommend that you schedule a consultation with one our dermatologists to find out if insurance is available for your treatment.
How can U.S. Dermatology Partners help me fit treatment into my budget?
U.S. Dermatology Partners helps clients get the treatment they need and want at a cost that doesn’t exceed their budget. Many practices also offer payment plans and are willing to help you with your insurance claims. Our dermatology offices offer many treatment specials that cover services not typically covered by insurance. This includes elective and cosmetic procedures. Our offices will gladly accept payment through flexible spending accounts (FSA) and health savings accounts (HSA).
Our knowledgeable team is always available to answer any questions you may have about your insurance benefits. It’s easy to get started. Use our simple online request form to contact a U.S. Dermatology Partners location near you. We will contact you to confirm your insurance coverage and schedule your appointment.