Finding the right dermatologist who accepts your insurance can feel overwhelming. While most Board-Certified Dermatologists accept various insurance plans, coverage depends on several factors, including your specific plan and the type of treatment needed. At AboutSkin Dermatology and Aesthetics, we want to help demystify insurance coverage for dermatology services in the Denver area.
Understanding Insurance Coverage for Dermatology
Your access to dermatological care in Denver largely depends on whether you have an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) insurance plan.
HMO plans focus on preventive care and managing costs through a structured network of healthcare providers. With an HMO, you select a primary care physician who coordinates all your medical care, including specialty visits. Before seeing a dermatologist, you need a referral from your primary care doctor. This referral process helps ensure you receive appropriate, coordinated care.
- HMO plans typically have lower monthly premiums and out-of-pocket costs, but they only cover treatment from providers within their network. If you see a dermatologist outside your HMO network, you’ll likely be responsible for the full cost of care.
PPO plans offer greater flexibility in choosing healthcare providers. You can schedule an appointment directly with any dermatologist without obtaining a referral. While PPO plans maintain a network of preferred providers, you have the option to see out-of-network doctors. Staying within the network usually means paying less, as PPO plans cover a higher percentage of in-network care costs.
- If you choose an out-of-network dermatologist, the plan may still cover a portion of the treatment, but you’ll pay more out of pocket. PPO plans typically have higher monthly premiums than HMOs, but many people find the additional cost worthwhile for the added flexibility and choice in providers.
Both types of plans may require you to pay a copay at the time of your visit or meet an annual deductible before insurance coverage begins. Some plans also include coinsurance, where you pay a percentage of the total cost of care even after meeting your deductible.
To fully understand your insurance coverage, you should contact your insurance provider and ask the details about coverage for the treatments and services you are considering, but we can cover some general guidelines for most insurances:
When Does Insurance Cover Dermatology Services?
Health insurance plans typically cover dermatology care that is considered medically necessary. This includes a wide range of diagnostic services, treatments and procedures that address legitimate health concerns.
Insurance coverage often begins with the initial diagnosis and treatment of common skin conditions. These medical concerns generally qualify for coverage under most health insurance plans:
- Persistent acne
- Managing chronic eczema
- Psoriasis outbreaks
- Unexplained rashes
Preventive care is another key component of covered dermatology services. Many insurance plans include coverage for routine skin cancer screenings, which can help detect potential issues early. During these screenings, our team examines your skin for suspicious moles, lesions or other concerning changes that could indicate skin cancer.
When dermatological surgery becomes necessary, insurance typically covers these procedures as well. This includes medically required surgeries like:
- Removing skin cancers
- Performing diagnostic biopsies
- Addressing problematic cysts
The coverage usually extends to both the surgical procedure itself and any necessary follow-up care.
For patients managing chronic skin conditions, insurance often covers ongoing treatment plans. This might include:
- Regular monitoring visits
- Prescription medications
- Specialized treatments like phototherapy
Similarly, patients dealing with serious skin infections can typically rely on their insurance to cover both the immediate treatment and any necessary follow-up care to prevent recurrence. We work with patients and their insurance providers to maximize coverage for necessary medical treatments while maintaining the highest standard of dermatological care.
When Does Insurance Not Cover Dermatology Services?
Health insurance plans generally do not cover dermatology treatments that are considered cosmetic or elective in nature. These are procedures primarily aimed at improving appearance rather than addressing medical conditions.
Many common aesthetic treatments fall into this non-covered category, including:
- Anti-aging procedures like Botox or similar injectables
- Dermal fillers for wrinkle reduction
- Laser treatments for skin rejuvenation
- Chemical peels for improving skin texture
- Microdermabrasion for exfoliation
- Treatment of cosmetic concerns like age spots
While these treatments may be performed by Board-Certified Dermatologists and can significantly improve appearance, insurance providers classify them as elective procedures. Some aesthetic concerns that typically aren’t covered include:
- Fine lines and wrinkles
- Age-related skin changes
- Sun damage
- Uneven skin tone
- Minor scarring
- Spider veins, when not medically necessary
Even when a treatment can be used for both medical and cosmetic purposes, coverage depends on the specific situation. For example:
- Laser therapy might be covered for treating precancerous lesions
- The same treatment would not be covered for reducing sunspots
- Injectables might be covered for treating excessive sweating
- They would not be covered to reduce wrinkles
At AboutSkin Dermatology and Aesthetics, we provide transparent information about insurance coverage and offer various payment options for non-covered cosmetic procedures. We help patients understand which treatments their insurance will cover and which ones they’ll need to pay for out of pocket.
Working With Out-of-Network Dermatologists
Some Denver dermatologists may accept your insurance even if they are not in your plan’s network. In these cases:
- You pay the full cost upfront
- You submit the claim to your insurance
- Your insurance may reimburse a portion based on out-of-network benefits
- You pay higher out-of-pocket costs than with in-network providers
At our office, we accept the following out-of-network insurance providers:
Aetna EPO — Anthem CHP+ — Anthem CU plans — Anthem HMO Select — Anthem MediBlue HMO — Anthem Select — Anthem UCHealth plans — AvMed Insurance — AXA Equitable — BCBS HPN — BCBS MediBlue — Blue Cross and Blue Shield South Carolina FEP — Bright Health — CHP+ (Medicaid) — CHP+ SMCN — Christian Care Ministries — CICP — Cigna Care Network — Cigna Connect Network — Cigna Direct Network — Cigna Healthcare for Seniors – Arizona Medicare — Cigna Local Plus — Cigna Open Access Plus Denver Public Schools — Cigna Select — Cigna SureFit — Cigna Vantage — Colorado Choice Health Plans — Colorado Health Neighborhoods — Coventry Health Care National Net — CU Exclusive networks — Denver Health Medical Plan — Elevate (Denver Health) — Evolve Health — Evolve w/ Coventry — First Health Now — Friday Health Plans of Colorado — Friday Health Share plans — Fringe Benefit Group — GPA — GPM Health and Life Insurance Company — Health First Colorado — Health Payment Systems, Inc. — Healthcare Solutions Group — HealthEZ/Cofinity — Highpoint HMO — Highpoint POS — Humana HMO X — Hylton Payroll — Independence American Insurance — Lucent Health — Medicaid — Optima Health PPO — Oscar Insurance — Payer Fusion — PPOM — RMHP — Solidarity — Special Insurance Services — Standard Life and Accident — The Empire Plan — The Health Plan — Tufts Health Plan — UHC Dual Complete
Please note that this is not a comprehensive list. If you have questions about coverage, you can contact our office to learn more about how we interact with your insurance.
Getting Dermatology Care in Colorado
The Board-Certified Dermatologists at AboutSkin Dermatology and Aesthetics accepts most major insurance plans and government programs. Before your appointment, we recommend verifying your insurance coverage, checking if you need a referral, and confirming payment options for any non-covered services. Contact us today to discuss your insurance coverage and schedule a consultation for your skin care needs.
