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.
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.
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
- Port wine stain removal
- Hemangioma excision
- Skin or fungal infections
- Skin allergies
- Keloid scars
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.
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.
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.