Does Health Insurance Cover a Dermatologist?

October 7, 2022

Dermatology is a highly sought after service for people suffering from acne, skin issues, and cancer. Dermatologists can diagnose over 3,000 disorders, helping men, women, and children look and feel their best.

While dermatology is known for cosmetic procedures, including Botox injections, there are many necessary procedures they perform too. However, many insurance companies exclude dermatologic services, limiting them to what’s necessary.

What are Medically Necessary Dermatologic Procedures?

Like we said earlier, many insurance companies only cover dermatologic procedures that are medically necessary. So how do you provide it’s necessary?

It comes down to the issue and how the doctor codes it. Some common examples include severe acne, eczema, nail fungus, rashes, and changing moles.

If you have an issue you want to be seen by a dermatologist, talk to your insurance company about the issue to see what must be done to ensure it’s medically necessary.

Sometimes doctors must write a letter to the insurance company telling them why the procedure, treatment, or medication is necessary to get it covered.

Medical Insurance Options – PPO vs. HMO

The type of insurance you have determines whether dermatologic services are covered. For example, HMO policies usually have more restrictions than PPO policies.

With an HMO policy, you likely have to go through your primary healthcare provider to get a referral for a dermatologist. Your primary care physician will assess the issue and determine if it’s something he/she can treat. If not, or if the doctor tries but can’t help, you will receive a referral to a dermatologist.

Without the referral, you’d have a harder time getting the services covered.

PPO policies don’t have the same requirements. For example, you don’t have to go through your primary care physician to get a referral. However, sticking to a provider within the PPO network is in your best interest. If you don’t, you’ll pay a higher deductible and/or co-insurance because PPO providers have arrangements with PPO insurance companies. If you go outside the network, they don’t have the same agreements, so your costs are higher.

Before you go to the dermatologist, check what your plan will cover and whether you must see a specific doctor. If you’re unsure how it works, contact your insurance company directly to get guidance.

Who Must see a Dermatologist?

Many people think dermatologists are reserved for people with severe acne or anyone who wants Botox, but there’s much more that they do.

Most importantly, dermatologists can do full body screenings to check for any signs of skin cancer. The earlier you catch the signs, the more treatable it is, so in that aspect, everyone can use to see a dermatologist and should determine if their insurance covers it.

Final Thoughts

Your health insurance might or might not cover dermatology. Read the insurance policy or talk to your insurance representative to find out if it’s covered and what you must do to stay within the network to keep your costs down.