Is Dermatology Covered By Insurance

Dermatology is a mainstream medical specialty. Thousands of people visit a dermatologist every day for common and uncommon skin issues. Like traditional health care, most services a dermatologist offers are covered by insurance. However, medications, procedures, and some conditions won’t be payable by health insurance.

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The guideline insurance companies use to determine whether they will pay for a service or not is medical necessity. Medical necessity has been a controversial topic for decades, so it’s always a good idea to read your policy and refer to it several times a year.

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To be considered medically necessary, the visit must be to evaluate, diagnose, or continue treating a medical condition. Dermatologists spend most of their time treating more serious skin conditions. Most of the conditions and procedures listed below are considered medically necessary. A list of the most commonly covered conditions is listed below.

• Skin cancer
• Rashes
• Psoriasis
• Port wine stain removal
• Hemangioma excision
• Acne
• Skin or fungal infections
• Eczema
• Warts
• Hives
• Skin allergies
• Keloid scars
• Shingles

In most situations, an elective or cosmetic procedure is not covered by health insurance because it is not medically necessary, which means a person’s overall health is not affected if the person does not receive the treatment. There may be exceptions, but it is very unlikely.

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Even if you are convinced that your insurance will cover your dermatology visit, you still need to make sure you have a referral, if needed. Some insurance companies require their subscribers to receive a referral from a primary care physician before seeing a specialist. If a referral is not secured before a specialist visit, the dermatology appointment may not be covered or paid at a lower rate.

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If you are referred to a dermatologist and already have insurance, you need to make sure the physician is covered under your plan before you make an appointment. If you can’t find a dermatologist in your area, you can contact the insurance company directly for a referral.