Does Insurance Cover Dermatology?
Dermatology is the branch of medicine that specializes in diagnosing and treating conditions related to the skin, hair, and nails. From acne to skin cancer, dermatologists address a wide range of health concerns. However, many patients are unsure whether dermatology is covered by insurance—and the answer depends on several factors.
Let’s break it down.
Cosmetic vs. Medical Dermatology
The key distinction that affects insurance coverage is whether the service is considered cosmetic or medically necessary.
Medical Dermatology (Usually Covered by Insurance)
Insurance typically covers treatments that are deemed medically necessary. These include:
- Acne
- Eczema
- Psoriasis
- Skin infections (e.g., herpes)
- Rashes and allergic reactions
- Suspicious moles or skin cancer
- Hair loss due to a medical condition (e.g., thyroid disease or autoimmune disorders)
- Nail fungus and other nail disorders
That said, even when a visit is medically necessary, not all treatments may be covered. For example, some insurance plans may pay for the evaluation of acne but not cover every prescribed medication or procedure.
Cosmetic Dermatology (Not Covered by Insurance)
Cosmetic treatments are procedures done to improve appearance rather than to treat a health issue. These typically are not covered by insurance. Examples include:
- Botox for wrinkles
- Fillers
- Laser hair removal
- Skin tag or benign mole removal for cosmetic reasons
- Chemical peels for skin rejuvenation
Some areas are gray zones. For instance:
- Hair loss caused by a thyroid disorder may be covered, while male pattern baldness is usually not.
- Chemical peels for acne may be covered under some plans, but not others.
The bottom line? Coverage depends on both the diagnosis and the treatment.
How Do I Know if My Insurance Covers Dermatology?
To determine your specific coverage:
- Check if the dermatologist is in-network. Use your insurance company’s website or call them directly.
- Verify whether you need a referral from your primary care provider before booking your appointment.
- Ask the dermatologist’s office which services are likely to be covered and which are not.
- Clarify why you’re being seen. Insurance may pay for a visit to evaluate a rash, but not to remove a mole just for cosmetic reasons.
Many people don’t realize that they can get their acne or eczema treated by a dermatologist with insurance, but instead spend hundreds of dollars on facials and spa treatments—often without the results that prescription medication or medical procedures can provide.
Also, even with insurance, some services might be limited or excluded. For example:
- Your plan might limit how many visits you’re allowed per year.
- A procedure like a chemical peel for acne may be covered by one plan and not by another.
- You may need prior authorization for certain prescriptions or treatments.
How Much Is a Dermatologist Visit Without Insurance?
Without insurance, a dermatology visit may be less than you think. Price depends on the doctor, location and your reason for visit. It’s best to call and ask the particular office you are looking to visit.
Additional costs may include:
- Biopsy or lab testing
- Prescriptions
- In-office procedures (e.g., freezing a wart, injecting a cyst)
If you don’t have insurance, ask if the dermatologist offers self-pay rates or discounted packages. Some practices may also offer direct pay models that bypass insurance altogether.
FAQ: Does Insurance Cover Dermatology
How do I find a dermatologist in my network?
Check your insurance provider’s website or call their member services. You can also contact the dermatologist’s office and ask if they accept your insurance plan.
Do you need insurance to see a dermatologist?
No, you can pay out of pocket if you don’t have insurance. But insurance can significantly reduce the cost of medically necessary visits.
Is cosmetic dermatology covered by insurance?
Generally no. Cosmetic procedures are not considered medically necessary and are typically not covered by insurance.’
What is patient responsibility in medical billing?
Just because you have full health insurance coverage for a particular service does not mean that you will not have out-of-pocket expenses. Many services include a copay, deductible or coinsurance. This is the part of the medical bill that under a particular insurance plan that the patient is responsible to pay if the service is covered.
Final Thoughts: Does Insurance Cover Dermatology?
Dermatology may have a reputation for not being covered by insurance, but most dermatologists actually do participate in insurance plans—especially when it comes to medical dermatology.
To avoid surprises, check with your insurance plan and your dermatologist’s office ahead of time. Clarify whether your visit is for a medical concern or a cosmetic one, and ask which treatments will be covered. Remember, you do not have to use insurance to see a dermatologist.
Understanding your coverage can help you get the care you need—and avoid paying out of pocket for services that might be covered under your plan. At Aglow Dermatology we participate in a variety of health insurance plans. We are also happy to see you as a self-pay patient if insurance is not an option. Contact us to set up your consultation.
