A dermatologist is very likely the first person that comes to mind when we have a troubling skin condition. However, many people do not know what exactly a dermatologist does. Also, because the skin is very much the first point of contact when it comes to cosmetic appearance, there is some doubt as to which skin conditions insurance covers as many insurance schemes do not cover conditions considered as cosmetic. These are the questions we will be addressed, starting with “What exactly does a Dermatologist do?”.

Dermatology is the branch of medicine that has to do with the skin, hair, and diseases that are associated with them. This specialty has both surgical and medical components. The individual that practices dermatology is called a dermatologist. In other words, a dermatologist is a doctor that focuses on the treatment of diseases of the skin, scalp, hair and the nails. There are all kinds of skin conditions that dermatologists treat. Examples are :

  • Acne – Acne is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms. Whiteheads, blackheads, pimples, cysts, and nodules are all types of acne. It is the most common skin condition in the United States (possibly in the world), affecting up to 50 million Americans yearly. It commonly occurs during puberty, when the sebaceous glands activate, but it can occur at any age. It is not dangerous, but it can leave skin scars.
  • Actinic Keratosis – also known as solar keratoses, are rough patches of skin caused by damage from years of sun exposure.
  • Birthmarks – In a very limited number of cases, birthmarks occasionally need to be removed because they are growing too quickly, are growing on an internal organ, or are related to another medical condition.
  • Blisters – A blister is a small pocket of fluid that forms in the upper layers of the skin.
  • Cherry Angiomas – They look like little red moles, but they’re actually growths of blood vessels.
  • Cold Sores – They are tiny, fluid-filled blisters on and around the lips, mouth, and nose. They are caused by a contagious virus called herpes simplex virus (HSV).
  • Dry Skin – If dry skin persists despite frequent and effective moisturizing, it might need to be treated or else it could crack and lead to an infection.
  • Eczema –  This is a condition that causes a person’s skin to become inflamed, itchy, red, cracked, and rough.
  • Fungal Nail Infections – This occurs commonly in the toenails and it causes the nails to become thickened, discolored and unsightly.
  • Melasma – is a common skin condition of adults in which light to dark brown or greyish pigmentation develops, mainly on the face.
  • Moles – are small patches on the skin that form due to collections of cells called melanocytes, which produce the color (pigment) in the skin.
  • Psoriasis – is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.
  • Rashes – Any sort of inflammation and/or discoloration that distorts the skin’s normal appearance. It could be itchy or non-itchy.
  • Rosacea – This is a skin condition that affects parts of the face. Symptoms can include facial flushing, facial redness, spots, thickening of your skin, swelling, pimples.
  • Scabies – This is a contagious skin condition caused by tiny mites that burrow into the skin causing extreme itching.
  • Scars – This is the mark left on the skin after the healing of a cut, burn, or another type of injury.
  • Shingles – This is a painful rash caused by an infection of a nerve underneath the skin with the varicella-zoster virus.
  • Skin Allergies – also known as Contact Dermatitis is a type of inflammation of the skin. It results from either exposure to allergens or irritants.
  • Skin Cancer – This is one of the most common types of cancer and there are different types of skin cancer.
  • Vitiligo – is a persistent or chronic condition in which areas of skin lose their normal pigment and become very pale or pink.
  • Warts – These are small fleshy growths or bumps that appear on the skin.

        Is a Dermatologist covered by Insurance and Medicaid?

Most Dermatology procedures and treatments for skin conditions are actually covered by Insurance schemes including Medicaid. However, every case is treated individually and is dependent on which parts of the scheme you are part of. Full body exams for abnormal moles or ‘sunspots’ are often not considered preventive by many insurance policies so they might not completely cover a visit to the dermatologist for a full body check-up.

What Medicaid does not cover for a fact are cosmetic surgeries that have no health indications and some conditions that require long-term or life-long care. Some policies can pay for one-off costs for your chronic condition like a hospital stay, but ongoing costs like medication or regular follow up appointments are not usually included.

Retinoic acid, a cream that is used to treat various skin conditions including acne is often covered for children but is usually not covered for adults. The dermatologist will not know what is or is not covered by your insurance, so you cannot find out that information from them.  What you need to do is as soon as the dermatologist prescribes a medication, you should call your local pharmacy or your Pharmacy Benefits Manager ( their number should be found on the back of your insurance card) and ask them if the medication is covered and what it will cost.  If it is too expensive or if it is not covered, you should call back your dermatologist and let them know.  They typically can treat your condition with an alternative cream that is less expensive or covered by your insurance.

It is good to note here that Medicaid does cover certain parts of skin cancer management. It could actually cover all parts of care depending on the insurance plans that you are on. It is always good to call and check beforehand if unsure about which aspects of care are included in your plan.

Finally, when you have any skin condition that requires medical attention, do not hesitate to see a dermatologist near you as chances are that the treatment and overall care will be covered by your insurance policy.

References

Black, M. and Marshman, G. (2010). Dermatology and pemphigus vulgaris: Association or coincidence?. Australasian Journal of Dermatology, 52(2), pp.e11-e14.

Greenberg, S. (2014). Sustained autoimmune mechanisms in dermatomyositis. The Journal of Pathology, 233(3), pp.215-216.

Lam, C. and Vleugels, R. (2012). Management of cutaneous bruises. Dermatologic Therapy, 25(2), pp.112-134.

Scadden, D. and Srivastava, A. (2012). Advancing Stem Cell Biology toward Stem Cell Therapeutics. Cell Stem Cell, 10(2), pp.149-150.