So, you have a skin issue (acne, eczema, psoriasis, skin cancer, rosacea – anything skin-related). You need to visit a dermatology office. So you go online and Google, “dermatologist near me.” You find an awesome dermatology clinic with a perfect 5-star rating and several hundred amazing reviews on Google (like Dermatology West in Farr West, UT).
You visit their beautiful website, click on the “Schedule Online” button in the top right corner, and within a minute you’ve scheduled an appointment to see them within the next day or two.
The next question that pops into your mind is, “Will insurance cover my dermatology visit?”
Great question.
Top Questions About Dermatology Insurance Coverage
However, this question actually consists of two separate questions:
1. Is your chosen dermatology provider in-network with your insurance plan?
– AND –
2. Does your insurance plan consider the specific reason for your visit or procedure to be “medically necessary?” (Spoiler alert: Unless your reason is wrinkles, or a very narrow other select few cosmetic reasons, the answer will be yes.)
There is a hidden third question that technically has nothing to do with insurance “covering” your visit, but can be very helpful to clarify:
3. Will I have to pay anything out-of-pocket for my dermatology visit? This can’t be explained here, but will be “covered” in an upcoming blog post (pun intended). (Another spoiler alert: That question can be VERY complicated. Don’t worry, we will help you through it.)
How to Check If Your Dermatologist Is In-Network
Anyway, to answer the first two important questions: You visit your insurance company’s member portal or app, and type in the name of the Dermatology provider you intend to see. You specify your plan, and it will quickly and easily tell you “in-network” or “out-of-network.”
For example, if you’re searching for Dermatology West in Northern Utah, you will find that we’re in-network with virtually all commercial and government insurances, including Select Health, Regence Blue Cross Blue Shield, Motivhealth, Aetna, Cigna, PEHP, DMBA, EMI, United, Optum, U of U, Molina, Humana, Tricare, Medicare, Medicaid, etc., etc.
If you can’t get a solid answer online about in-network versus out-of-network, your next step will be to look on the back of your insurance card and call the member services number in order to ask. Get ready to wait on hold for a bit (sorry, maybe you’ll get lucky).
To answer question two, consult with your dermatology provider (or if you were able to get past the hold time and have your insurance company on the phone, you could ask them too). A good dermatologist should be able to quickly fill you in on insurance coverage for a given visit or procedure.
What “Covered” Actually Means
READ: “In-network” + “medically necessary” = “covered.” All “covered” means is that your insurance company is bound to apply the costs of the visit and/or procedure to your insurance plan.
BEWARE: This says nothing about your exact out-of-pocket cost. Not even the insurance company will be able to tell you the exact out-of-pocket cost until after the visit. It’s a complicated question that has to do with deductibles, copays, coinsurances, dates of service, out-of-pocket maximums, coordination of benefits, etc., etc. ad infinitum. Don’t worry, we will cover this in a future blog post as well.
Need Help Verifying Your Insurance?
At Dermatology West, you can quickly and accurately give you information about whether your insurance will cover your visit or procedure by calling us at (801) 917-6177, texting us at (385) 308-5133, or reaching out to us via our contact form.
REMEMBER: “Covered” does not equal “free” or “no out-of-pocket cost.” For the solution to that Gordian knot, stay tuned to our future blog posts…