What Dermatology Services Are Covered by Insurance? Use 2021 Benefits

November 17, 2021

health insurance coverage for dermatology services

As 2021 comes to a close, it may be time to make use of your available insurance benefits before you lose them. If you’ve been putting off a dermatology service, now is the time to schedule the procedure before the end of the year. According to Dr. Amreen Sitabkhan of U.S. Dermatology Partners in Dallas and Carrollton, Texas, “Many people know that their insurance benefits don’t necessarily carry over from year to year, but they don’t know that they may be missing out on an opportunity to utilize their coverage on dermatology services. If you have a chronic skin condition, need medical dermatology treatments, or it’s just time for your annual preventive skin cancer exam, your insurance may offer coverage for these services.” In this blog, Dr. Sitabkhan will discuss some of the dermatology services that are covered by insurance benefits and how to utilize your coverage before the end of the year.

Understand Your Insurance Benefit Plan

Before you schedule your dermatology visit, it’s important to understand what type of insurance you have and what dermatology services are typically covered by these types of plans. There are typically two types of health insurance plans – Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. HMOs are structured around medical care that is coordinated by one primary physician who provides referrals to specialists, like dermatologists, on an as-needed basis. PPOs typically offer more treatment flexibility and discretion to the individual who is covered by the plan. Depending on the PPO plan, you may not need a physician referral to visit specialists and receive coverage. Before you schedule your dermatologist’s appointment, make sure you understand whether or not you need a referral from your primary care doctor. In many cases, you may still be able to receive reimbursement coverage, but it’s typically easier to follow the policies outlined by your benefit provider if the plans require a referral or other procedures prior to covering treatment.

What Dermatology Services Are Covered by Insurance?

Insurance coverage is complex. No two insurance plans will be exactly the same. Insurance providers offer businesses or individuals a selection of plans. In many cases, your employer will make coverage elections, and you’ll be given a variety of coverage options at different price points to choose from. That means your coverage may not even be the same as other people in your office. According to Dr. Sitabkhan, “When people ask me whether or not insurance covers their dermatology services, I almost always have to give them the very frustrating answer – maybe. Insurance is genuinely an extremely complex thing. Your benefit plan may not have the same services covered as others, so it’s important to look into your benefit plan before you schedule a visit.”

While insurance coverage varies between insurance providers and individual benefit plans, it’s a good rule of thumb to think that medically necessary treatments will usually receive some coverage. Dermatology services considered medically necessary by many insurance providers include:

  • Acne treatments
  • Skin cancer treatment
  • Skin cancer removal
  • Dermatologic medications
  • Treatment for chronic skin conditions (eczema, psoriasis, rosacea)
  • Treatment for hives, warts, fungal infections, and other skin conditions
  • Annual or regular preventive skin exams

When it comes to insurance benefits for covered services, Dr. Sitabkhan reminds clients, “Coverage doesn’t necessarily mean that you won’t have to pay anything out of pocket for your dermatology appointment. It just means that your insurance provider will cover part of the cost of treatment. You may still be responsible for a deductible or co-payment. Deductibles usually reset at the end of the year, so if you’ve already paid all or part of your deductible for 2021, make sure to take advantage and schedule your dermatology visit before the new benefit year begins.”

How Can I Find Out if a Dermatology Service Is Covered by My Insurance?

Before scheduling your appointment at U.S. Dermatology Partners, we recommend calling your insurance provider and asking the following questions to ensure your dermatologist visit is covered:

  • Does my plan include dermatology services?
  • Can I visit any dermatologist or do I need a referral?
  • What services are covered?
  • What is my coverage and do I need to pay a co-pay or deductible?

Dr. Sitabkhan recommends, “Once you have your coverage details from the insurance provider, call the U.S. Dermatology Partners location you want to visit. Our dermatologists and individual practices may vary in what insurance benefits they accept. Make sure the location and provider you want to work with can help you maximize your benefits before you schedule a visit.”

Are There Ways to Make Dermatology Services Not Covered by Insurance Affordable?

In addition to insurance benefits, clients whose benefit plans include flexible spending accounts (FSA) or health savings accounts (HSA) can typically utilize these benefits to cover the out-of-pocket costs of treatment. Additionally, non-covered and elective dermatology procedures, including cosmetic dermatology, can usually be purchased using FSA and HSA funds, so this is a great solution if your insurance plan includes these options. Like insurance benefits, HSA and FSA funds may also reset at the end of the year, so if you have these funds available, now is the time to use them.

Some of the many dermatology services covered by FSA and HSA funds include:

  • Any co-pays or deductibles related to covered medical dermatology services
  • Acne treatments and medications offered in-office and for at-home use
  • Visit and treatment costs for common skin conditions like rosacea, eczema, psoriasis, and rashes
  • Botox for hyperhidrosis (excessive sweating)
  • Scar, wart, skin tag, and other lump or bump removal and treatment
  • Sunscreens and lip sunscreens purchased from the dermatologist
  • Retinoids, aloe vera, and other medicated or prescription skincare products

According to Dr. Sitabkhan, “We understand that it can be stressful and frustrating to plan for dermatology services only to find out that they’re not covered by insurance benefits. Our knowledgeable staff members can help you budget for the out-of-pocket costs of your treatment, so you’re not surprised by any unexpected expenses. Don’t hesitate to reach out if you have questions.”

Need to Use Your 2021 Insurance Benefits Before the End of the Year?

If you have insurance benefits or HSA and FSA funds you want to utilize on dermatology services before the end of the year, the U.S. Dermatology Partners team would love to hear from you. Don’t hesitate to reach out to your local practice if you have questions about covered services. You can also get started scheduling a visit any time by filling out our online scheduling request form. Once we receive your request, a member of our team will be in touch to finalize the details of your visit.

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