Are Acne Medical Procedures Typically Covered by Insurance?

Almost everyone suffers from minor acne at some point in their lives. It is the most prevalent skin ailment in the United States, according to the American Academy of Dermatology.

Many individuals and healthcare providers rely on over-the-counter and prescription drugs to treat acne as well as the scarring that can sometimes accompany it. When such choices fail, people may resort to particular medical procedures and treatments. Finding the correct therapy, however, is only the first step; the next step is determining how to pay for it. Here’s what you should know about insurance and medical procedures for acne and acne scars.

The most prevalent acne treatment methods

The following are examples of popular in-office acne treatments:

  • Steroid injections: A cortisone injection can flatten a deep, painful nodule or cyst and remove redness within two to four days. A patient without insurance will have to pay between $25 and $100 for every shot.
  • Laser/light therapy: By exposing your skin to different types of light (red, blue, or a mix) or pulsed light and heat, the germs that cause breakouts can be eliminated. Most individuals require numerous treatments to produce benefits that last between two and four months. Because most health insurance companies consider this treatment experimental, they do not cover it. Expect to spend between $40 and $60 every session.
  • Chemical peels: Although most health insurers consider superficial chemical peels to be experimental or exploratory (meaning they will not be reimbursed), they can help manage some forms of acne and improve skin look. The procedure, which helps to unclog pores and remove dead skin cells, may range in price from $75 to $5,000. In general, the deeper the peel, the more expensive it is.
  • Microdermabrasion: One approach for reducing acne scars is microdermabrasion. Your doctor will use a tiny portable instrument to gently remove the outer layer of your skin during this operation. Insurance companies consider it a cosmetic operation, so plan to spend at least $130 each session. For the greatest results, you may require five to twelve sessions.
  • Surgery: Your doctor may recommend surgical excision or extraction to drain and eliminate a tenacious lesion in specific situations. This sort of surgery is frequently considered medically essential for the treatment of acne by health plans, which means it is usually covered by insurance.

Insurance policies that may or may not cover certain treatments

While your doctor can provide these therapies in the office, your health insurance may or may not cover them. The majority of the time, coverage is determined by whether the insurer believes the therapy is medically required.

If your private health insurance plan deems a procedure medically essential, you will most likely be liable for the visit or operation’s copay. This depends on whether you see your primary care physician or a specialist such as a dermatologist or cosmetic surgeon.

Coverage for acne procedures is less probable if you have a Medicare health plan. Patients must continue pay 20% of the cost for skin disorders that are covered by Medicare (for example, psoriasis) after their deductible is reached.

How to Determine Insurance Coverage

Examine your plan’s Summary of Benefits and Coverage to determine what is and isn’t covered (or SBC). This document, which is needed for all health plans, details the services that the plan covers and how much they cost. You can get it via your patient portal or by phoning your insurance carrier.

You may utilise your health plan’s online provider search tool to ensure that the clinician you wish to see is part of its network of insured doctors.

If you don’t have access to the internet, contact the number on the back of your insurance card and inquire about your specific coverage as well as if the provider you want to see is in-network. In-network implies that your health plan will cover a visit to that physician.

What should you do if the operation is not covered?

If a procedure indicated by your doctor is not covered by your insurance, talk to them about other options. If you’ve exhausted all other possibilities, inquire at your doctor’s office about any discounts that may be available to you. Some clinics, for example, offer a discount if you pay for the operation in advance.

If paying in cash isn’t an option, ask your provider to set up a payment plan ahead of time. To qualify for a monthly payment plan, most practises need an upfront deposit.

Finally, many medical practises collaborate with third-party finance companies. If you’re thinking about going this route, make sure to read the tiny print, especially concerning late penalties and interest rates.