Your Dermatologist and Insurance

A dermatologist is a medical doctor with extensive training, experience, and dedication for keeping skin, hair, and nails healthy—and healthy-looking—throughout your lifetime.

SHOULD I SEE A DERMATOLOGIST?

A dermatologist is uniquely trained to look at your skin with their eyes and other tools. Dermatologists can spot possible problems and diagnose medical conditions ranging from minor to life-threatening. Once a diagnosis is made, your dermatologist can determine the safest, most effective treatment for you.

Advances in research and technology allow today’s dermatologist to protect and care for your skin with the latest medical, surgical, and cosmetic treatments. Dermatologists can impact the lives of patients of all ages – an infant with a red birthmark, a child with eczema, a young woman with acne, a middle-age man with hair loss, and a baby boomer with skin cancer – treating their conditions and making them look and feel their best.

Whether your dermatologist provides general medical care for your skin, or focuses on a specialized area of medical, surgical or cosmetic dermatology, they can be your trusted partner in maintaining the health of your skin, hair, and nails.

WHAT TYPE OF TRAINING DO DERMATOLOGISTS HAVE?

After earning their four year medical degree and completing an internship, dermatologists receive three more years of training dedicated to the skin, hair, and nails. This training includes general dermatology, dermatopathology

(a combination of dermatology and pathology that involves diagnosing diseases by looking at samples under a microscope), pediatric dermatology, surgery, and cosmetic procedures.

Some dermatologists gain additional training and expertise, and may develop practices specializing in these areas.

Diagnosing and treating disease

Dermatologists devote their skills and energy to treating medical conditions of the skin, hair and nails, such as acne, skin cancer, psoriasis, eczema, hair loss, rashes, rosacea, warts, and nail fungus. Dermatologists also treat many other skin problems such as excessive sweating or itchiness.

Providing surgical solutions

All dermatologists can do surgery on the skin, but some choose to specialize in this area. They use techniques invented and perfected by dermatologists. Examples include:

• Mohs surgery, a specialized treatment for removing skin cancer;
• The use of lasers for the treatment of birthmarks, blood vessels, scars, sun damage, tattoos, unwanted hair, and wrinkles; and
• Tumescent liposuction, a technique developed by dermatologists that removes fat deposits and requires only local

Enhancing your skin’s beauty

Some dermatologists improve the health and appearance of your skin with a variety of cosmetic treatments, including filling in or smoothing out wrinkles and scars, eliminating spider veins or skin discolorations, laser and light treatments to improve the appearance and texture of your skin, and removing or replacing hair. Your dermatologist can also help you evaluate the many skin care products, procedures, and claims being promoted to improve your skin.

WILL MY INSURANCE COVER A VISIT TO THE DERMATOLOGIST?

Contact your insurance company and ask them if an appointment with a dermatologist or a specific treatment will be covered. Your dermatologist has limited access to information about what your insurance covers. It is important to know that your insurance company cannot guarantee coverage until the insurance claim is filed and reviewed.

WHAT IS A CO-PAY?

A co-pay is the money that you must pay each time you receive medical care. Co-pays vary depending on your insurance and type of doctor you see. You may have different co-pays to see your primary care doctor, consult a specialist such as your dermatologist, or visit an emergency room. Since co-pays can change annually, you should contact your insurance company to determine the co-pay required to visit your dermatologist. You will need to pay the co-pay at each visit with your dermatologist.

WHAT IS A DEDUCTIBLE?

A deductible is the amount of money that you must pay each year before your insurance company begins to pay. Your dermatologist will bill your insurance company first. You will owe any money that must be paid toward your deductible. To determine your deductible and current balance, call your insurance company. Be aware that your deductible starts again on a specified date each year as stated in your insurance contract.

WHAT IS THE DIFFERENCE BETWEEN A COSMETIC PROCEDURE AND A MEDICAL TREATMENT?

A medical treatment is considered medically necessary. Examples include surgery to remove skin cancer and treatment for a skin condition such as psoriasis.

Cosmetic procedures are performed to improve a person’s appearance. These are not considered medically necessary.

Health insurance generally does not cover the cost of a cosmetic procedure, so you would have to pay the entire cost. Insurance companies vary somewhat in how they define cosmetic and medically necessary procedures. A call to your insurance company can determine what your insurance covers.

WILL MEDICARE COVER MY VISIT TO THE DERMATOLOGIST?

Medicare, just like other insurance, will cover some treatments and not others. You can learn more about what Medicare covers by visiting medicare.gov.

Typically, Medicare does not cover cosmetic procedures, such as treatment to remove unwanted facial veins, age spots, skin tags, or moles for appearance reasons. Medicare also does not cover the removal of benign (non-cancerous) growths, such as seborrheic keratoses, especially if they do not bleed or interfere with your day-to-day activities.

Liposuction, fillers, and skin peels are also considered cosmetic procedures and are not covered by Medicare.

WHAT IS AN ABN?

If you have Medicare, your dermatologist will ask you to complete an Advanced Beneficiary Notice form. The purpose of this form is to help you make an informed decision about whether or not you want to receive the treatment or medication, given that you might have to pay for it.

HOW DO I KNOW WHAT COVERAGE I HAVE FOR PRESCRIPTIONS?

If you are concerned about prescriptions that might not be covered by your insurance, call your insurance company. Then, when you see your dermatologist, you should bring the list of medications that your insurance covers. This will allow your dermatologist to select medications that may be covered by your prescription plan.

Before heading to the pharmacy to fill a prescription, be sure you have all your insurance cards with you. The pharmacist will be able to provide you with the most-up-to-date information about what prescriptions are covered by your insurance and give you the cost of the prescription.

WHAT SHOULD I DO IF MY INSURANCE DOES NOT COVER A TREATMENT OR PROCEDURE?

You should discuss this with your dermatologist and determine if there are alternative treatments covered by insurance or if you are willing to pay for the cost of the treatment. Even though your insurance does not cover a treatment, you may find it cost effective to allow your dermatologist to provide a quote for an out of pocket amount, not billed to insurance, and discuss payment options.

A board-certified dermatologist is a medical doctor who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. To learn more, visit aad.org or call toll free (888) 462-DERM (3376) to find a board-certified dermatologist in your area.

All content solely developed by the American Academy of Dermatology.
Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology
P.O. Box 1968, Des Plaines, Illinois 60017
AAD Public Information Center: 888.462.DERM (3376)
AAD Member Resource Center: 866.503.SKIN (7546)
Outside the United States: 847.240.1280
Web: aad.org
Email: [email protected]