Does Insurance Cover Dermatology? – Forbes Advisor – Technologist
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Taking care of your skin is often overlooked, but it’s an important part of your overall health. According to the National Institutes of Health (NIH), 1 in 3 Americans deals with skin issues at any given time. Additionally, 1 in 5 Americans will develop skin cancer—the most common type of cancer—at some point during their lifetime.
Fortunately, most health insurance plans cover in-office dermatology when a service or procedure is considered medically necessary, although it is less likely to cover care and procedures that are merely cosmetic in nature.
Learn when health insurance is likely to cover dermatology, and how to find out which dermatology procedures your plan will pay for.
Key Takeaways
- Dermatology can be divided into two types of care—medical dermatology and cosmetic dermatology.
- Health insurance is likely to cover most medical dermatology services, but is unlikely to cover cosmetic dermatology.
- Some insurance plans cover out-of-network dermatology services, but you will likely pay more out of pocket for such care. Other plans offer no coverage for these services.
What Is Dermatology?
Dermatology is a field of medicine that focuses on the health of your skin, which is the largest organ in the body. Dermatologists are responsible for diagnosing and treating skin disorders, and preventing skin diseases from occuring in the first place. Dermatologists also provide care for hair and nails.
There are two types of dermatology—medical dermatology and cosmetic dermatology.
Medical dermatology refers to the treatment of skin issues that can negatively impact a person’s overall health, such as skin cancer or psoriasis. Cosmetic dermatology includes procedures that are not medically necessary, such as facials and procedures that improve appearance through the use of injectables and lasers.
What Types of Dermatologist Procedures Are Covered by Most Insurance Plans?
- Annual skin exams
- Skin cancer screenings
- Acne treatment
- Eczema treatment
- Wart removal
- Prescription topicals
- Prescription medications
- Biopsies
- Steroid injections
- Skin infections or rashes
What Types of Dermatologist Procedures Are Not Covered?
- Neuromodulators, such as Botox
- Fillers
- Chemical peels
- Facials
- Laser skin resurfacing
- Microdermabrasion
- Microneedling
- Body contouring
- Tattoo removal
How Much Does a Dermatology Visit Cost?
The cost of a dermatology office visit varies widely across the country. On average, you could pay anywhere from around $75 to $165 for a single appointment, according to a survey of rates from health insurance company Sidecar Health.
However, you aren’t responsible for paying the entire cost out of pocket if you have health insurance. Your insurance plan will cover a portion of the cost and you will pay the difference in the form of copayments, coinsurance and deductibles.
How Can I Determine If My Insurance Covers Dermatology Treatment?
To find out if your health insurance covers dermatology, review the plan’s summary of benefits.
This will show you what types of dermatology visits are covered and the cost-sharing breakdown. The summary of benefits will also include a list of exclusions, so you can see which visits, treatments and procedures are not covered.
You can also contact your health insurance company to get a full explanation of the plan’s benefits and exclusions for dermatology. Find out if you need a referral from your primary care provider before you see a dermatologist.
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Dermatology Coverage FAQs
Do dermatologists accept insurance outside of any network affiliation?
Most health insurance plans work with a network of doctors and specialists (including dermatologists) that provide discounted services to plan members. Some dermatologists accept insurance that is out-of-network, but not all do.
If you see a dermatologist that doesn’t take out-of-network insurance, you have to pay the entire cost out of pocket.
Does insurance cover services provided by out-of-network dermatologists?
Sometimes. If you visit an out-of-network dermatologist and your plan covers out-of-network care, your benefits may be limited and the plan usually covers a smaller amount. It’s always more expensive to visit an out-of-network provider, even if your plan covers some of the cost.
Also, you might have to pay the entire bill at the time of your office visit and file a claim to get reimbursed for out-of-network dermatology services.
Is Medicaid coverage applicable to dermatology services?
Most Medicaid plans will cover medically necessary dermatology services, such as treatment for acne, skin cancer screenings and dermatological surgeries.
As with individual private health insurance plans, Medicaid usually doesn’t cover cosmetic dermatology. Because Medicaid plans are different in every state, it’s important to check your state’s Medicaid plan to see what it covers in terms of dermatology.
Which health insurance plan is most suitable for comprehensive dermatology coverage?
There isn’t a single health insurance plan that is the best for comprehensive dermatology coverage. Most health insurance plans will cover medically necessary dermatology, but the out-of-pocket costs, annual coverage maximums and referral requirements will differ between plans.
If you want a health insurance plan that provides excellent coverage for dermatology, review the summary of benefits to see what services are covered and how much your plan will cover.
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