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Does Health Insurance Cover A Dermatologist

A dermatologist is a physician who specializes in the diagnosis and treatment of conditions related to your skin, nails and hair. According to the American Academy of Dermatology (AAD) Association, these specialists are trained to recognize and remedy over 3,000 disorders.

Dermatologists also perform cosmetic procedures like facials and Botox injections. Though cosmetic work can significantly impact a person’s self-esteem, health insurance plans typically exclude it. Most health insurance companies cover only services and products deemed medically necessary. 

The type of plan you have will indicate what you need to do to ensure your health insurance plan covers your visit to the dermatologist.

Types of health insurance plans

The two most common health insurance models are:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)

When comparing plans, weigh your priorities relative to flexibility and cost because there is typically a tradeoff.

PPO versus HMO

PPOs usually offer an expansive provider network. When you use health care providers outside the network, you may still receive benefits but to a lesser extent. With out-of-network providers, you can incur a higher deductible, copayment or coinsurance. PPOs typically cover specialists without a referral.

HMOs tend to be more restrictive. Often, the network is smaller, and benefits are contingent upon the use of network providers. Health care emergencies would likely be an exception. It is common for HMOs to stipulate that your primary care physician refer you to a specialist if needed. The upside is that these requirements enable the insurance company to control costs. So if you are in full compliance, you can enjoy minimal out-of-pocket medical expenses.

Before you schedule a dermatologist appointment, check your plan’s directory of network providers. Your insurance company may have provided a printed copy, but it is usually best to check online through the company’s website. New providers can be added or removed from the plan at any time, so be sure you have the most current information. Also, verify whether or not your plan requires referrals for specialists. 

Medically necessary dermatology

Review your plan materials to confirm your understanding of the plan’s definition of medically necessary services and supplies. Here are examples of health conditions that may warrant medical attention:

  • Acne
  • Athlete’s foot
  • Cold sores
  • Eczema
  • Hair loss
  • Moles that change in any way
  • Nail fungus
  • Rashes

When to see a dermatologist

Some people think of going to a dermatologist only when there is a problem with their skin, hair or nails. But the AAD Association encourages regular cancer screenings as a proactive measure. These screenings entail a full-body visual inspection that should only take about 10 minutes. 

Contact the AAD Association to find out how you can get a skin cancer screening at no cost. The organization states that with early detection and appropriate treatment, the cure rate for the most common forms of skin cancer is about 95%.