What Are Some of the Most Common Skin Treatments?
Skin treatments can be required for health reasons, or to improve the appearance of your skin. The range of skin treatments is broad and goes from minimally invasive to more comprehensive treatments. The most common minimally invasive procedures include Botox injections, laser skin resurfacing, intense pulsed light therapy, chemical peels, ambulatory phlebectomy, laser hair removal, micro pigmentation, soft-tissue fillers, microdermabrasion, injectable hyaluronic acid, micro-needling, and cryosurgery.
Many of these procedures are used both for medical purposes as well as cosmetic purposes. As an example, cryosurgery can remove potentially hazardous skin growths as well as treat early-stage skin cancer or squamous cell carcinoma. Intense pulsed light therapy can treat hyperpigmentation, rosacea, and facial veins, along with dark spots, wrinkles, and enlarged pores. Ambulatory phlebectomy is a procedure that treats severe varicose veins, while micro-needling can not only minimize enlarged pores and improve skin texture, but it can also reduce the appearance of scars. Micropigmentation is a treatment that also helps reduce the appearance of scars by “filling in” with pigments.
Are Skin Treatments Covered by Insurance?
When it comes to skin treatments, your biggest impediment to getting the treatment approved by your insurance company is whether it is a cosmetic procedure or a medically necessary procedure. Few insurance companies will cover cosmetic procedures, deeming them “elective,” rather than medically necessary. Since many skin treatment procedures can be used both medically and cosmetically, your doctor may need to clarify this if your procedure was denied. If you have scars on your face that cause emotional trauma and prevent you from fully living your life, then treatment is medically necessary even though it could be considered a cosmetic procedure. Laser treatment for a port wine stain on your face would likely be approved, while laser treatment for lines on your face would probably not.
What if Your Insurance Company Won’t Approve Treatments for Dermatitis, Psoriasis, Eczema, or Other Skin Disorders?
Chronic skin issues like psoriasis, eczema, or dermatitis may benefit from topical as well as oral medications. Topical therapies can include corticosteroids, retinoids, calcineurin inhibitors, salicylic acid, coal tar, and anthralin. Drug therapies can include biologics, Apremilast, Cyclosporine, oral retinoids, Methotrexates, or certain drugs used “off-label.” Biologics can be expensive and are often denied by insurers.
An insurer may require you to try many other cheaper alternatives before approving a biologic drug or may deny it altogether. Biologics like Dupixent, Enbrel, and Remicade interact with the body’s immune system to treat psoriasis. Unfortunately, even the least expensive online price for either of these is around $6,000, with an approximate $1,800 co-pay for four doses. Because biologics are relatively new, your insurer may claim the drug is “experimental,” or “investigational,” even though patients have seen good results.
Why Are Some Skin Treatment Claims Denied?
If your insurer denies your skin treatment claim—and it is not due to an error in the submission—the reason is likely to be either that the treatment is not medically necessary or that it is still experimental. An insurance company can make you and your doctor jump through a long series of hoops, trying one skin treatment after another to prove to the insurance company that the treatment is medically necessary in your case. In reality, the insurance company is likely balking at the price of the skin treatment that will actually help your medical condition. Your doctor can re-submit your claim along with an explanation as to why the treatment is necessary for you.
What Should You Do if You Receive a Skin Treatment Insurance Denial?
If your doctor re-submits your claim with an explanation and the claim is still denied, you may need to file an appeal. Your insurer must deny your claim in writing with an explanation of why it was denied. The insurer must also outline the appeal process and the time deadlines associated with the process. You will first file an internal appeal, asking your insurance company for a full and fair review of the adverse decision. If your case is urgent (i.e., your health could substantially deteriorate during the appeal process) then the insurance company is required to accelerate the process.
If your internal review is not successful, you have the right to take your appeal to an independent third party for review. This is known as an external review, meaning your insurer no longer has the final say over whether a claim is paid. You can also file a lawsuit against your insurer to force it to pay for your skin treatment. While any insurance company can deny a claim, companies like Anthem Blue Cross, Blue Shield, Health Net, Kaiser, UnitedHealthcare, Aetna, and others may do so for California residents.
How Attorney Scott Glovsky Can Help with Your Skin Treatment Insurance Denial
If your insurance company won’t approve dermatitis treatment or you have received a skin treatment insurance denial, you may feel frustrated and overwhelmed. At the Law Offices of Scott Glovsky, we are passionate about fighting to make sure America’s most powerful insurance companies hold up their end of the bargain. Attorney Scott Glovsky and his legal team are ready to fight for you, understanding that the system has left you discouraged and unsure of how to secure the best treatments for your health. We believe the work we do is important and will continue to advocate for those who are faced with healthcare treatment denials. Contact the Law Offices of Scott Glovsky for a consultation regarding your denial.
