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Insurance and Your Dermatology Visit: How to be Prepared

Health insurance is a complex, often confusing, subject. In the U.S., individuals are faced with thousands of providers and plans based on their region, income level, employment status, age, and more. Additionally, most plans are filled with intricate details and caveats that yield more questions than answers. So, it comes as no surprise that most people are uncertain about whether their insurance covers dermatology visits, and to what extent. Considering the rising costs of healthcare, though, it’s crucial for people to know how their insurance factors into their skincare.

Let’s go over how you can prepare for your dermatology visit, keeping insurance in mind.

Get to Know Your Plan

Whether you receive health insurance through your employer or you purchase a plan on the market, you should always do your best to understand what is and is not included in your package. Ideally, you will conduct this research prior to picking a plan, but sometimes your choices are limited, and you have to choose the best plan available. Fortunately, most plans come with a detailed brochure or sheet with the details you’re looking for, such as premiums, deductibles, the types of procedures fully or partially covered, and more. Beyond this, you can call your insurance provider to clarify any specific questions and visit their website for more info regarding dermatology and everything else.

Pick the Right Dermatology Provider

Once you have a health insurance policy, keep in mind that not all healthcare providers will necessarily be in your plan’s network. In other words, you should choose a dermatologist that works with your insurance plan. Your insurance provider might be able to help you narrow your search via their directory. Or, if you would rather do it yourself, there are many online resources (such as Medicare.gov and Healthcare.gov) that can help you filter healthcare providers based on various parameters, such as insurance network, distance, rating, specialty, and more.

Call Your Dermatology Provider Ahead of Time

Even after you’ve found a dermatology provider in your network, it’s worth calling them prior to your visit to get more concrete information regarding your needs, insurance plan, etc. Being fully prepared is much better than getting to the office only to realize you owe a significant chunk out of pocket due to some oversight or misunderstanding.

You May Need a Referral

If you’re seeking special services that are outside the range of your primary care practitioner (including certain dermatological procedures), note that most health insurance plans require that you receive a written referral beforehand. This will usually be made clear to you prior to setting up an appointment, but, once again, the more prepared you are for these extra hoops, the better.

Cosmetic Dermatology: Not Always Covered

The field of dermatology covers a wide range of cosmetic, medical, and surgical procedures related to the skin’s health. However, cosmetic dermatology, in particular, often does not fall under the umbrella of “medically necessary” care, meaning most insurance plans won’t cover these types of visits. Your particular policy will determine what is and is not covered, but generally speaking, dermatology services/treatments not covered by most insurance include but are not limited to:

  • Dermal fillers
  • Botox
  • Laser tattoo removal
  • Chemical peels
  • Dermaplaning
  • Other cosmetic treatments and surgeries

As for what is covered by most insurance, these medically necessary dermatological services include:

  • Skin cancer examination and treatment
  • Eczema
  • Psoriasis
  • Warts
  • Shingles
  • Severe acne
  • Skin infections
  • Hives and allergies
  • Rashes
  • …and more

Find Out About Financing Options

The line between “medically necessary” and merely cosmetic is somewhat blurry, of course — after all, aesthetic concerns like mild acne, wrinkles, and unwanted tattoos can be detrimental to one’s mental health. That said, until health insurance policies evolve to incorporate some of these cosmetic services, prepare to pay out of pocket for some of your skincare needs. Costs will vary depending on the type of treatments you need, but if they are out of your price range, ask your dermatology provider about financing options. You may be able to pay for these non-covered services in installments to ease the burden.

Health insurance can be daunting. At Premier Dermatology Partners, we want to make it as easy as possible for you to get the care you need. Visit our insurance page for a list of providers and plans in our network. To learn more about us, our insurance parameters, and all the services we offer, contact us today.

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