Whether or not dermatology is covered by insurance is a tough question to answer without knowing the details of your insurance coverage. How much or even if your insurance will assist in covering costs depends on what insurance company you use, what type of insurance plan you have, and what type of dermatology services you are receiving.
Dermatology is usually split into three categories: Medical, Surgical, and Cosmetic. Insurance coverage often looks at whether or not a visit is medically necessary, and will base coverage on that criteria. Medical and surgical dermatology services will be billed to insurance, though coverage is pending on your insurance carrier, coverage type, and medical necessity. Cosmetics are rarely, if ever, covered by insurance, we do not bill insurance for cosmetic services. We offer consults prior to cosmetic services to review the scope of what is to be done and the costs, so there are no surprises.
Verify Coverage With Your Health Insurance
An important part of dealing with health insurance coverage comes with verifying whether or not your planned procedures will be covered. Most health insurance websites have a good resource database of coverage for your insurance plan online. The alternative is calling and talking to a representative at your insurance company to discuss with them what your options are for dermatology coverage.
Find an In-Network Provider
The best way for you to save with insurance is by finding an in-network provider. These are the “preferred” providers for your health insurance plan that you should look for. Your insurance company will typically have a searchable database of these in-network doctors to make it easier for you to find affordable care, but you can also always call them to find this information.
Avoid Out-of-Pocket Costs
It’s important to verify coverage with your health insurance because it can help you avoid out-of-pocket expenses for dermatology services. Insurance providers may offer different options of coverage depending on what services are rendered under your specific insurance plan, so it’s vital to know which of these apply for you. Some insurances require prior authorizations before they will cover a visit.
Copay and Deductible Information
A covered service is still subjected to copays and deductibles. A deductible is the set amount that the patient pays out of pocket before the insurance carrier starts paying for services. Deductibles restart on a yearly basis. Deductibles are determined by your insurance carrier based on the benefit plan you or your employer group selected. Copayments are set amounts that the patient pays at the time of a medical service, such as an office visit, procedure, or for medication. Co-pays are set by the insurance provider and vary depending on benefit plan selections. For many plans that reset on January 1st each year, out of pocket deductible expenses are higher until they are met. Many patients have higher expenses in the first part of the year for this reason.
Insurance Tasks Before Visiting
If insurance seems overwhelming to you, you’re not alone. When you bring insurance to Southwest Michigan Dermatology, you are responsible for your plan’s provisions and must seek appropriate approval prior to your services. This means that an insurance carrier may require prior authorization for a service. If authorization is not obtained, you will be responsible for the cost of the unauthorized services. Certain dermatological diagnoses are not considered medically necessary, like hairloss, and therefore do not cover the visit. While we do our best to give you advanced notification, it is your responsibility to verify with your insurance carrier before a service is performed. Our team can try to help you through this process as best we can, so our Business Office (269-321-0971) is available if you have any questions.
What Insurance We Work With
While this is not our complete list, below are some common carriers you may recognize. Sometimes insurance carriers that we participate with will add different lines of business that we do not participate with, feel free to contact the Business Office at (269-321-0971), for more information.
- Blue Cross Blue Shield of Michigan
- Blue Care Network of Michigan
- United Healthcare
- Priority Health
- Medicare
- Medicaid
- Aetna
- Cigna
- Medicare for Railroad
- Workers and Their Families
- MultiPlan
- PHCS
- Cofinity
What If You Don’t Have Insurance?
If you don’t have health insurance for medically necessary dermatology services, we can still help! Insurance is not required to receive services at Southwest Michigan Dermatology, and anyone who comes for service can self pay to cover the costs of their treatments. Whether you’ve had a surgical procedure with us or simply need consultation, everything can be self paid if that is your preferred option.
Do you offer Payment Plans?
Southwest Michigan Dermatology offers payment plans for self pay and expenses left after insurance pays their portion.
Improve Skin Health with Dermatology Treatments
Once you’ve found your provider, preferably in-network, then you can start saving on medical dermatology depending on what your plan offers.
Services Typically Covered
Medical and surgical dermatology is often covered by insurance because it involves the diagnosis and treatment of skin conditions. Because these are usually classified as medically necessary services, most major insurance providers will have some language in their health insurance plans that discusses coverage for them. Some common skin issues that are often covered by insurance include:
- Acne Treatment: Acne treatments usually include things such as topical treatments or oral medications.
- Skin Cancer Treatment: From skin cancer screenings to treatment and removal, skin cancer is a serious concern that is addressed as soon as possible through services such as:
- Skin cancer screenings and testing.
- Removal procedures such as Mohs surgery, excision, or cryotherapy.
- Necessary reconstructive surgery.
- Radiation therapy or chemotherapy (if required).
- Skin Infections: Surface level infections such as fungal infections can be dealt with at your dermatologist and are treated using topical and oral medications.
- Chronic Skin Conditions: Some insurance covers diagnosis and treatment for skin conditions such as eczema, psoriasis, and other skin troubles.
Although these are not all the medical conditions that can be covered by health insurance, most insurance companies, if they provide coverage for dermatological services, should have at least some of these as part of their plan.
Trust in a Dermatology Office that Accepts Medicare
Southwest Michigan Dermatology is proud to provide the highest level of dermatology treatments. We accept most major insurances, including Medicare and a variety of Medicaid plans. We believe that every patient in search of bright and healthy skin shouldn’t have to break the bank to receive service. Through our care and your insurance-covered services, you’ll start your skin health journey the right way: with professionals who best know how to help you. Reach out today to your health insurance provider to see if medical dermatology is covered, and reach out to Southwest Michigan Dermatology to schedule services!