Insurance coverage can be very complicated for even the most basic medical treatments. But when it comes to specialty services like dermatology, determining if coverage is available can be more difficult. At U.S. Dermatology Partners, we are happy to partner with our patients to determine coverage and maximize available medical insurance coverage whenever possible.
In this blog, we’ll walk you through some of the basics regarding health insurance and dermatology. However, each office and even individual dermatologists have different insurance benefit policies, so you should work one-on-one with your local office to determine if your insurance is accepted. Our knowledgeable staff can provide you with detailed information about your specific coverage.
How Does Medical Insurance Work?
Medical insurance, like other types of healthcare benefits, is purchased by individual patients and/or their employers who pay a monthly premium. In exchange for premium payments, your insurer will cover a percentage of the cost of medically necessary treatments. In most cases, you will need to pay a copayment and/or deductible in addition to your monthly premium before your medical insurance benefits will cover treatments. The amount you pay toward your annual deductible resets at the beginning of each year. So, if you’ve already met your annual plan deductible, the end of the year is a great time to receive additional treatments to help maximize your benefits.
There are two main types of insurance benefit plans: preferred provider organization (PPO) plans and health maintenance organization (HMO) plans. In most cases, if you have a PPO plan, you will have access to a wider range of treatment providers and covered procedures than is available with HMO coverage. However, every medical benefit plan represents a unique contract between the insurer and the insured, and these coverage agreements can fluctuate from person to person and even from year to year, so knowing your individual policy is essential to ensure you can maximize available benefits.
Does Medical Insurance Cover Dermatology?
Whether or not a dermatology treatment is covered by your insurance provider usually comes down to the answer to one question, “Is this treatment medically necessary?” Insurers each have different definitions of what they consider medically necessary, so you’ll need to review your plan policy or contact your insurer to find out whether or not you have coverage.
Do I Need a Referral?
Almost all HMO medical insurance plans require documented referrals before they will offer coverage for visiting a specialty practice like a dermatologist’s office. Some PPO medical insurance plans also require referrals, especially for more advanced treatments. The best way to determine whether or not you need a referral is to contact your insurer.
What Should I do Before My Visit?
Prior to your appointment with one of our dermatology teams, you should take the following steps to ensure visiting our office and paying for your treatment is stress-free:
- Review your policy – in most cases, your medical benefit plan will outline the basics of coverage availability in a policy document or online. This can be a good place to get started determining whether or not dermatology services will be covered.
- Call your insurer – once you’ve determined what coverage should be available for dermatology services, call your insurer to verify these benefits before scheduling your appointment.
- Determine whether or not you need a referral – when you call your insurer, you should ask whether or not you need a referral from your general care physician prior to scheduling your appointment with a dermatologist.
- Make sure the dermatologist accepts your insurance – once you verify that your insurance benefits apply to the dermatology service you’re interested in, you should contact your dermatologist to determine whether or not they accept your insurance plan.
- Ask about alternative financing options – if the dermatologist doesn’t accept your insurance or your insurance doesn’t cover the desired service, ask your provider if they offer specials, payment plans, or other financing options.
What Types of Dermatology Procedures are Covered?
Coverage limitations and availability will vary depending on the specifications of the insurance provider and individual benefit plans. In most cases, treatments specific to chronic skin conditions will be covered. Conditions such as the following listed below are usually covered by insurance benefits:
- Skin Cancer
- Poison ivy
- Keloid scars
- Hives and skin allergies
- Severe acne
- Fungal, bacterial, or viral skin infections
While treating these conditions is usually considered to be medically necessary, some of the recommended treatments may not be covered by insurance benefits. Make sure to discuss all of your treatment options. Dermatologists want to help patients utilize treatment options that will improve their skin health while allowing them to receive the maximum coverage from their insurance benefit plan.
What Types of Dermatology Procedures aren’t Covered?
Most insurance benefits do not offer coverage for treatments that aren’t considered medically necessary. That means elective and cosmetic dermatology procedures are usually not covered. This includes services like Botox, dermal fillers, tattoo removal, and chemical peels. However, there are some treatments traditionally considered to be cosmetic that may now be covered in some cases. For instance, clients with acne may be eligible for insurance coverage on certain treatments. Additionally, many insurers are now offering coverage for laser port wine stain removal. Because there is so much complexity to determining individual treatment coverage eligibility, we always recommend scheduling a consultation with one of our dermatologists to determine whether or not insurance benefits are available and make a plan to budget for the cost of your treatment.
How Does U.S. Dermatology Partners Help Me Fit Treatment into My Budget?
At U.S. Dermatology Partners, we help our clients to get all of the treatments they want or need at a price that won’t exceed their budgets. Our offices are happy to process your insurance claims, and many practices offer payment plan options. Additionally, our dermatology offices often offer treatment specials for services that aren’t typically covered by medical insurance, including elective and cosmetic procedures. If your health care benefits include a Health Savings Account (HSA) or Flexible Spending Account (FSA), our offices would be happy to accept payment through these accounts.
If you have questions about your insurance benefits, our knowledgeable team members are always happy to help you get the information you need. Getting started is easy. Use our simple online request form to contact a U.S. Dermatology Partners location near you. One of our knowledgeable team members will be in touch to schedule your visit and verify your insurance coverage.
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