Are Dermatologists Covered by Insurance?
Your health insurance probably covers dermatology if you need it for medical reasons.
Treatments for acne, eczema, skin cancer and psoriasis are all examples of dermatology that is probably covered by insurance. But health insurance won't cover cosmetic procedures, like wrinkle treatments or facials.
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Does insurance cover dermatology?
If you need to see a dermatologist for a skin health problem, it will probably be covered by health insurance.
You may still pay for part of your visit, just like you would with any other doctor visit. If you see a dermatologist early in the year, you will probably pay more of the bill, since you likely haven't reached your deductible yet.
But if you see a dermatologist after you reach your deductible, you'll just pay a percentage of the bill, called coinsurance. And if you have already hit your yearly spending limit, called the out-of-pocket maximum, you shouldn't have to pay anything as long as the insurance company agrees that your appointment was medically necessary.
What kinds of dermatology are covered?
Dermatology can be split into two broad categories: medical and cosmetic.
Insurance usually covers medical dermatology, because it is related to the health of your skin. Cosmetic dermatology services aren't necessary to stay healthy, so you typically have to pay for them yourself.
Medical dermatology
Includes treatments for:
- Acne
- Biopsies
- Eczema
- Psoriasis
- Rashes
- Rosacea
- Skin cancer
- Skin infections
Cosmetic dermatology
Includes treatments like:
- Botox
- Cellulite reduction
- Chemical peels
- Fillers
- Hair removal
- Microneedling
- Skin resurfacing
- Tattoo removal
Even if your dermatology appointment and treatment are covered, your insurance might not pay for everything. You may have an office copay or have to split the bill with your insurance company.
Dermatology and step therapy
Insurance companies often require that you start with a cheaper treatment plan for skin conditions like eczema and psoriasis, before you move on to more expensive treatments. This is called step therapy.
For example, if you have eczema, your insurance company might not cover more expensive treatments like biologics until you've tried cheaper treatments, like topical steroids. That way, if the cheaper treatment works, the insurance company saves money.
But step therapy can increase medical costs for you if the cheaper treatment doesn't work. If you haven't reached your deductible yet, you may end up spending your own money on medicines and treatments that don't help. You should always discuss your treatment plan with your doctor. Knowing that step therapy may be required can help you understand the plan for your treatment.
How much does dermatology cost?
Dermatology costs an average of $221 per visit, but your cost will likely be different.
Averages can be helpful to get a sense of what you might pay, but costs change based on where you live, your dermatologist's rates and your medical situation. If you have insurance, you could pay less, depending on your plan. And if you are prescribed a treatment or medication, you'll pay for that as well.
What is the best insurance plan for dermatology?
There isn't a specific health insurance plan that is best for dermatology.
But you should consider your skin care needs, along with the rest of your health care needs, when you pick out a health insurance plan.
In general, try to match your medical needs with the plan level you buy. If you don't need much medical care, a Bronze plan could be a good way to save money. These plans are cheaper than other options, but you have to pay for more of your medical bills yourself.
But if you go to the doctor — including the dermatologist — often, a Gold or Platinum plan might be worth it. They are more expensive, but they pay for more of your health care costs. If you have a skin condition that requires expensive treatment, a higher-tier plan could save you money overall.
How to find a dermatologist who takes your insurance
The best way to find a dermatologist near you who takes your insurance is to check with your insurance company.
Most insurance companies have online tools you can use to find an in-network doctor. These tools aren't always completely accurate, though, so it's a good idea to also call each dermatology office you're interested in and ask if they are in your plan's network.
Frequently asked questions
Does Medicaid cover dermatology?
Medicaid programs aren't required to cover dermatology. But since Medicaid programs are run by the states, coverage varies depending on where you live. That means a state could choose to cover dermatology on its Medicaid program. If you need to see a dermatologist and you're on Medicaid, talk to your state's Medicaid Agency to find out what kind of coverage you might have.
Do you need a referral for a dermatologist?
It depends on the insurance plan you have. If your plan uses an HMO network, you will need to get a referral from your primary care doctor. But if your plan uses a PPO network, you don't need a referral.
Does insurance cover Accutane?
Health insurance might cover Accutane, but it depends on your specific plan. To have coverage, Accutane (isotretinoin) must be included on your plan's covered drug list, called a formulary. Some plans may require you to show that you've tried other treatments without success, or you may be required to try another drug before they will cover Accutane or a generic version.
Sources
American Academy of Dermatology (AAD), Anthem, Centers for Medicare & Medicaid Services (CMS), Molina Healthcare, the National Eczema Association (NEA) and original research from MDedge.
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