Does Insurance Cover Dermatology

Does Insurance Cover Dermatology? Everything You Need to Know

Skin problems? You’re not alone. As many as one in three Americans may be affected by skin conditions at any given time, with 40 to 50 million Americans suffering from acne alone. 

If you’re seeking treatment for an irritating or unsightly skin condition, you’ll want to see a dermatologist—a specialized doctor who deals specifically with skin conditions. In the world of healthcare, the cost of booking a doctor’s appointment without insurance pitching in can be quite high. So, does insurance cover dermatology and visits to the dermatologist?

This page explores the answer to that question and provides an overview of everything you need to know as it relates to dermatology and insurance. After reading, you’ll know how to get help from a reputable dermatologist while paying as little out of pocket as possible.

In the future, be sure to work with a health insurance company that makes it clear what you are and aren’t covered for. With a transparent digital-first approach to managing your plan and receiving coverage for healthcare services, you can get the help you need faster, without experiencing unnecessary hassles or delays.

Find in this article:

Is Dermatology Medically Necessary or Elective (Cosmetic)?

Medically necessary is an important term when it comes to health insurance.

  • If a healthcare service is considered medically necessary by your insurance company, you may be able to receive full or partial coverage for the service.
  • If a healthcare service is not considered medically necessary by your insurance company, it’s likely considered an elective procedure, and it’s unlikely you’ll receive coverage for the service under a standard healthcare plan. Elective procedures are also sometimes called cosmetic procedures.

The terms get a little confusing when it comes to dermatology because certain procedures that are medically necessary will also improve the cosmetic appearance of your complexion.

Dermatology services that are usually considered medically necessary include serious ones like skin cancer, skin infections, keloid hives, eczema, and warts. Does insurance cover dermatology for acne? The answer is yes. Acne is usually considered medically necessary and therefore covered by most health insurance plans, especially if it’s moderate or severe.

Dermatology services that are usually considered elective include chemical peels, Botox injections, and dermal fillers. These services are seldom covered by traditional health insurance plans, similar to teeth whitening and LASIK.

Every insurance policy varies with regards to which services are considered medically necessary. Contact your insurance company before you book an appointment with your dermatologist to make sure you’re covered for the services you wish to access.

Does Insurance Cover Dermatology

What Type of Health Insurance Plan Is Best for Covering Dermatology?

Many different types of health insurance plans can provide sufficient coverage for dermatology services. The “best” health insurance plan for dermatology is one that gives you the most flexibility regarding who you can see and what you’re covered for while still being affordable.

Who you can see is dictated by the type of health insurance plan you have. Some types of health insurance plans, such as health maintenance organizations (HMOs), are fairly restrictive. In the case of an HMO, you are usually required first to see your primary care physician, then get a referral to a dermatologist, then go to a dermatologist who is in your approved network of healthcare professionals if you wish to receive coverage.

Other types of plans, such as point-of-service (POS) plans, may offer full or partial coverage if you choose to see a dermatologist outside of the approved network, which gives you greater flexibility. 

Regardless of the type of plan you choose, the scope of your plan is also important. More robust healthcare plans will offer coverage for a higher number of services, usually at the cost of a higher monthly premium (monthly payment). Before you enroll in a new healthcare plan, be sure you understand the specifics of your coverage to avoid surprises.

Do I Need a Referral to See a Dermatologist?

You technically have the option of seeing a dermatologist at any time, regardless of whether you have a referral or not.

However, if you wish to receive coverage, certain types of healthcare plans, such as HMOs, will require you to have a referral from your primary care physician before you book an appointment. 

Note that receiving a referral does not guarantee that you receive coverage—with some plans, you are also required to visit certain dermatologists in the approved network of healthcare professionals if you wish to receive coverage.

How Much Does a Dermatology Visit Cost?

How much a dermatology visit costs is variable depending on a variety of factors, including the type of consultation you need, the cost of living in your area, and more. Even before you book an appointment, you can call local dermatologists to get an idea of how much you’ll need to pay for your consultation.

In the United States, the average cost for a dermatology visit is $221, but that does not mean that you will pay exactly $221 for your visit. Your insurance company will usually pay for most if not all of that cost, and without insurance, you could pay more or less than $221 depending on some of the factors described in the paragraph above.

In general, dermatology visits are one of the more affordable healthcare services to access because in many cases, your dermatologist does not need to use any specialized equipment to help you with your problem. Certain conditions, such as acne, can often be resolved by the dermatologist by simply analyzing your skin and writing a prescription based on what they see.

Does Insurance Cover Dermatology

Are There Ways to Make Dermatology Services Not Covered by Insurance Affordable?

If you need to visit a dermatologist but you don’t have insurance, or you do have insurance but the service you wish to access is not covered by your current plan, there are a few ways you can reduce your out-of-pocket costs.

  • Use the American Academy of Dermatology’s search tool or the Skin Cancer Foundation’s search tool to find dermatologists in your area. Call each one and ask for an estimate on how much your required services will cost. Certain dermatologists charge more than others for different services.
  • If you don’t have insurance, be sure to mention that fact when you call. Some dermatologists will provide a discount if they know you’re paying for all costs out of pocket.
  • On a similar note, even without a discount, some dermatologists may offer to work with you in the form of payment plans. Instead of paying for the full cost right after your appointment, they may give you the option to separate it into a few smaller payments over a longer length of time. 
  • If your dermatologist does not offer payment plans, you have the option of seeking out your own payment plan in the form of a medical credit card. Over time, due to interest, you’ll pay more than you would if you paid in a lump sum, but the initial service will cost less out of pocket and therefore be more affordable.

What Is Teledermatology, and Is It Covered by Insurance?

In the past, if you wanted to see a dermatologist, you needed to find someone local, book an appointment, and physically go see the dermatologist in person.

With the rise of technology, other options, such as teledermatology, are now alternatives to the traditional way of seeing healthcare professionals. Teledermatology allows you to video conference with your dermatologist and get help with your problems from afar.

You can think of teledermatology just like a regular Zoom conference call, except you’re getting help with your skin problems from a qualified professional. Dermatology is unique in that it is well suited for a telehealth-based approach. Other healthcare professionals, such as chiropractors, are not as able to help with problems from afar. 

What Are the Benefits of Teledermatology?

The primary benefit of teledermatology is how it allows you to see any dermatologist in any part of the country. If you need help with a specific problem that your local dermatologist doesn’t specialize in, you can find a more suitable dermatologist with just a few clicks. 

Teledermatology is also helpful for individuals who live in suburban or rural areas which may be underserved by dermatologists. If you have to wait weeks, or even months, before you can see a local dermatologist, teledermatology can potentially get you an appointment within days.

The benefit of skipping the wait often compounds on itself to become even more helpful. This is because you will usually book multiple appointments with your dermatologist to continue assessing your skin after you begin the treatment regimen your dermatologist recommends. If you have to wait weeks or months for each appointment, your problem may be needlessly drawn out.

Does Medicare Cover Dermatology?

Medicare is a public healthcare plan used primarily by individuals who are age 65 or older. It is subsidized by the federal government to make it more affordable.

Medicare part B is fairly similar to a standard private healthcare plan in regards to which services are covered. Therefore, visits to dermatologists are usually covered, so long as they are deemed medically necessary.

Medicare does vary from private healthcare plans somewhat because individuals with Medicare may have different health concerns than those who make use of traditional private healthcare plans. 

For example, individuals with Medicare may want to get screened for skin cancer at a higher rate than those who have traditional private healthcare plans. However, with Medicare, skin cancer screenings still must be deemed medically necessary before they are covered.

Visit the official Medicare website to find a dermatologist near you who accepts patients with Medicare.

Does Insurance Cover Dermatology

Will Flexible Spending Accounts and Health Savings Accounts Pay for Dermatology Visits?

Flexible spending accounts (FSAs) and health savings accounts (HSAs) are special types of bank accounts that can help you pay for medical expenses, such as prescription drugs, copays, and other out-of-pocket costs associated with visits to healthcare professionals. Funds from your employer are deposited directly into these types of accounts before being taxed, meaning it’s cheaper to get healthcare services with funds from an FSA or HSA than it would be if you used funds from your ordinary bank account.

In regards to taxation and what the accounts can be used for, HSAs and FSAs are nearly identical.  The primary difference between the two is that HSAs provide more flexibility for the owner of the accounts, whereas FSAs are technically owned by your employer and therefore come with slightly less flexibility.

Both FSAs and HSAs are potentially attractive options to pay for dermatologist visits. If you have a FSA or HSA in conjunction with a more traditional healthcare plan that covers the majority of dermatologist costs, your account can be used to cover expenses like any copay required for each appointment and prescription pills and creams that your dermatologist may prescribe to treat your skin condition.

Note that FSAs and HSAs usually cannot be used for any medical procedure. Generally, the procedure must still be deemed medically necessary if you want to be able to use your FSA or HSA funds to pay for it. Therefore, FSAs and HSAs are attractive alternatives to traditional healthcare plans, but they usually can’t be used to pay for elective (cosmetic) procedures such as Botox injections.

Summary

  • Does health insurance cover dermatology? Visits to the dermatologist are usually either fully or partially covered by insurance if they are deemed medically necessary. Many skin conditions, ranging from mild acne to skin cancer, may be deemed medically necessary by your health insurance company.
  • To receive coverage for your dermatologist visit, you may need to get a referral from your primary care physician and/or visit a dermatologist in your health insurance plan’s approved network of healthcare providers.
  • The cost of a dermatologist visit is usually somewhat affordable, even without insurance, and you have a variety of options to reduce costs and/or get help paying for costs.
  • Teledermatology is a potentially attractive alternative to in-person visits, especially if you live in an underserved or rural area and need to wait weeks or months for an appointment.
  • Medicare covers dermatology in the same way that private health insurance plans do—only if your services are deemed medically necessary.
  • FSAs and HSAs are non-traditional forms of private healthcare that can partially or fully cover dermatologist expenses, including both the consultation copays and any follow-up prescriptions your dermatologist recommended to treat your skin condition.

Tired of complicated insurance plans? In the future, be sure to work with a transparent and trustworthy company that puts the convenience of the patient first. When all of your covered services are clearly spelled out, you’ll know exactly what you are and aren’t covered for, saving you time and helping you get the care you need as quickly as possible.

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