WHY DERMATOLOGISTS ARE SPECIALISTS
We strongly encourage all patients to contact their health insurance provider prior to their appointment to confirm their specialist office visit benefits, copays, and deductible status.
DERMATOLOGISTS ARE MEDICAL SPECIALISTS
Because Dermatologists are medical specialists, insurance companies require us to bill all patient encounters using Evaluation and Management (E/M) or diagnostic procedure codes. Even if you visit us with no specific complaints for an annual full-body skin check, insurance rules classify this as a specialist medical evaluation, not a routine wellness physical.
Under insurance guidelines (including Medicare and commercial carriers), preventive care benefits are strictly reserved for Primary Care Providers (PCPs)—such as your family doctor, internist, or pediatrician.
Preventive Care vs. Diagnostic Care:
Care Category
Definition
Billing & Coverage Impact
Preventative Care
Routine services performed by a Primary Care Provider to maintain baseline health and screen for general conditions before symptoms appear (e.g., annual physicals, routine vaccines, blood pressure checks).
Under the Affordable Care Act, eligible preventive services with your PCP are often covered at 100% with no copay or deductible.
Diagnostic & Specialist Care
Evaluation, diagnosis, or treatment performed by a Specialist, or services triggered by a specific symptom, mole, rash, history of skin cancer, or targeted exam. (e.g., full skin exam).
Subject to standard specialist copays, co-insurance, or deductible balances required by your individual insurance plan.
What This Means for Your Visit:
- Procedures carry separate diagnostic charges: If during your visit the dermatologist identifies an abnormal spot and performs a biopsy, removes a lesion, or prescribes medication, these procedures are billed as diagnostic medical services. Additionally, if you have a biopsy performed, the tissue specimen will be sent out to an external pathology laboratory for processing and analysis, which will result in a separate billing charge from the lab.
We strongly encourage all patients to contact their health insurance provider prior to their appointment to confirm their specialist office visit benefits, copays, and deductible status.