Skin conditions: Why insurers won’t cover some of the prescriptions 

Question: What is payable under skin conditions and why are sunscreens and moisturisers not covered yet they have been prescribed by the dermatologist? 

The field of dermatology encompasses a vast array of skin conditions, ranging from common ailments like acne and eczema to more complex diseases like psoriasis and skin cancer.

Regardless of the severity, timely access to dermatological care is essential for maintaining skin health and overall well-being.

However, navigating the realm of dermatology insurance coverage can be complex and overwhelming for both patients and healthcare providers. For the most part, dermatology is broken up into two categories:

Cosmetic dermatology vs medical dermatology

Cosmetic dermatology involves procedures aimed at improving the appearance and health of the skin, addressing issues like ageing, sun damage, and scarring.

Medical dermatology, on the other hand, focuses on skin conditions that require medical treatment. Skin diseases include all conditions that clog, irritate or inflame the skin.

Often, skin diseases cause rashes or other changes in one’s appearance. Certain lifestyle factors can lead to the development of skin disease. 

Underlying health conditions may affect the skin too. Your dermatologist can determine whether your condition is medically necessary or if cosmetic procedures are needed.

Each insurance policy differs in terms of which services are deemed medically necessary. Before scheduling an appointment with your dermatologist, check with your insurance company to ensure that the services you want are covered.

What types of dermatologist appointments and procedures do most insurance plans cover?

Dermatology services that are deemed medically necessary are typically covered by health insurance plans.

Acne, psoriasis, eczema, skin infections, and skin cancer are examples of skin conditions that can be treated.

When deemed necessary by a healthcare professional, coverage may extend to diagnostic tests, consultations, medications, and surgical procedures.

What is not covered?

Procedures such as dermal fillers and laser treatments for wrinkles or scars, which fall under the realm of cosmetic dermatology.

Unlike medically necessary treatments, these procedures are elective and primarily sought for cosmetic purposes, aiming to enhance one’s appearance.

What is the difference between sunscreen and moisturiser?

A moisturiser creates a barrier over the skin to lock in moisture, and sunscreen protects the skin from sun damage.

Why are sunscreens and moisturisers not covered yet the dermatologist prescribes them?

Sunscreens and moisturisers are typically not covered by insurance because they are considered over-the-counter products, meaning they can be purchased without a prescription, and insurance companies only cover prescription medications.

They are not considered essential medications for a variety of reasons. To begin with, they are rarely used to treat a specific medical condition.

Instead, they are used to protect skin from sun damage. Second, they are reasonably priced, allowing most people to purchase them without insurance.

Remember that individual insurance policies can differ, so it is critical to review your specific plan and understand its coverage provisions.

Understanding the coverage options and limitations in dermatology can help you make informed decisions about your skin health and financial considerations.

Bundi and Ondiek can be reached at [email protected] & [email protected].