FAQ’s About Insurance, Newsletter Spring/Summer 2015

Many of our patients are concerned with yearly skin checks not being coded, billed, as “routine or preventive care”. Unfortunately Dermatologists do not perform these services. As much as we do encourage skin checks for our patients, we can only bill an office visit to your insurance company.   These are the rules implemented by the Departments of Labor, Health and Human Services. The preventive care rules are designed to make preventive health services accessible and affordable by requiring coverage of recommended preventive health services that have strong scientific evidence of their health benefits. The American Academy of Dermatology has tried unsuccessfully to get a skin check approved as a preventive service. The law is written in such a way that they are unable to provide clinical evidence that a skin check can be categorized as a preventive service. I would also like to remind patients to know and understand their medical insurance policies. Specifically what your deductible is, as most medical procedures performed here are applied to a patients surgical deductible.


What is a co-payment?

A patient’s payment of a portion of the cost at the time the service is rendered. This could be on office visit only or on any encounter at a physician’s office.


What is co-insurance?

This is the amount a patient owes after insurance has been filed. For example: most insurance companies only cover 80%, 85% or 90% of allowed charges and the patient is responsible for the balance.


What is a deductible?

A deductible is the fixed amount you pay for covered benefits out of pocket before a health insurance plan begins to cover health care costs.


What does In-network mean?

In-network refers to health care providers that have agreed to provide services to a health plan’s members at a negotiated rate. Plan members usually pay less when using an in-network provider because the cost to the health plan is lower.


When is a procedure considered cosmetic?

Insurance companies rely on physicians to submit claims on procedures, which in their opinion, are medically necessary. Cosmetic procedures could be but are not limited to-benign moles, skin tags, acne/milia extractions and seborrheic keratosis. Laser treatments to improve appearance or to treat acne are also considered cosmetic.


What is an EOB?

An Explanation of Benefits is mailed to the patient and provider,

showing amount billed, amount adjusted off, amount paid (if any) or amount applied to deductible.


Please remember to contact your HR department or insurance company for questions concerning your policy. By understanding your policy better, you are an advocate for yourself!