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Medical versus Cosmetic

posted Mar 30, 2011, 8:40 AM by Michael Sobik

A frequently asked questions by patients is, “why won't my insurance pay for this?”. Dermatologists tend to field this question more than say, an internist, since they deal with the skin and the cosmetic issues that frequenlty arise from it's care.

The basic issue is that medical insurance covers medical issues, and not cosmetic issues. If you have a mole or spot on your skin that's perfectly healthy, but you don't like the way it looks, your dermatologist is contractually forbidden by your insurance company for billing for it's removal. Billing insurance for cosmetic treatments is insurance fraud, is illegal, and can send your dermatologist to jail.

Determining the medical necessity of the removal of a spot is left totally at the discretion of the physician. If your dermatologist agrees to bill insurance for the removal, it means they have a medical reason to do so. Dr. Wyatt is quite adamant about medical necessity and must document in your medical record the reasons for removing a lesion. She absolutely will not bill your insurance if she determines the lesion in questions is healthy and does not require medical treatment. She is happy to treat cosmetic issues on a cash pay basis.