Business Insight Covered or Not? Patients always have problems recognizing what services are covered under their insurance and which ones are not. Granted, it may not be such an easy task to read through pages of explanations that insurance companies make very complicated and misleading. There is no rule that can apply to all. Each insurance may develop their own, policy-based set of uncovered services. The easiest way to explain the issue is to follow Medicare. Medicare (not a Medical substitute) has a very well established set of rules and they are quite simple: if you see a medical provider for a medical diagnosis that is a disease, it is covered. It has to be a standard medical provider so, for instance, alternative medicine doctors are not covered. Usually, when you visit a doctor, the end of the visit includes 'plan of treatment. That plan specifies if the diagnosis is medically necessary or it is simply some condition that may be uncomfortable to you but does not need to be treated. As usually, dermatological examples are the most simple for me to cite. We see a lot of patients who come because they identified'a mole' or 'a lesion; or 'a spot: First of all, it is great that thy are coming. Skin cancer has been an upward trend for years and the decision to see a doctor is a very smart one. Secondly, anything showing up on the skin needs attention of a provider skilled in differentiating 'bad' moles from 'just a spot' moles. You can do it using your expertise by just looking at it and, if you are a good practitioner, you can say a lot about the spot. However, if you are not sure, a biopsy is done, taking a small sample of the mole/ spot, in order to check it for pathological features. Usually, it takes between 7 to 10 days to receive a pathology reading back. Your doctor then determines the next steps based on the diagnosis. presented by Arlington Dermatology There are some 'spots' that look very alike, but are totally different. Seborrheic keratosis is the most common mole associated with the process of skin aging (anybody over 40), but it is totally benign and will not turn into skin cancer. Removing SKs (as we call them) is a semi-cosmetic procedure and it is not covered by any insurance. Although you may not like the looks of SKs, they are a normal type of growth and you can live with them with no problems. However, their close 'sisters, actinic keratosis are not totally benign. They may not be very different but they form pre-cancerous lesions and should be treated to prevent skin cancer. Thus, they are covered by insurance companies. Can you distinguish between AKs and SKS? Not really. A dermatologist with experience can. And if not sure, a biopsy will help to make the diagnosis. But a removal of it may be a patient's responsibility and you need to be prepared to pay for it. One of the most common requests for removal are, so called, skin tags. They tend to grow in chronically and a re-growth is quite common. They are not covered by any insurance. While most patients hate having them, their removal is considered to be cosmetic. It is a very quick and simple process to have them removed but you need to be prepared to pay for it. Of course, this is a very short and simple example of comparing covered and non- covered services. If you have more questions, you can always reach out to us to talk about it in more details. Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight Covered or Not ? Patients always have problems recognizing what services are covered under their insurance and which ones are not . Granted , it may not be such an easy task to read through pages of explanations that insurance companies make very complicated and misleading . There is no rule that can apply to all . Each insurance may develop their own , policy - based set of uncovered services . The easiest way to explain the issue is to follow Medicare . Medicare ( not a Medical substitute ) has a very well established set of rules and they are quite simple : if you see a medical provider for a medical diagnosis that is a disease , it is covered . It has to be a standard medical provider so , for instance , alternative medicine doctors are not covered . Usually , when you visit a doctor , the end of the visit includes ' plan of treatment . That plan specifies if the diagnosis is medically necessary or it is simply some condition that may be uncomfortable to you but does not need to be treated . As usually , dermatological examples are the most simple for me to cite . We see a lot of patients who come because they identified'a mole ' or ' a lesion ; or ' a spot : First of all , it is great that thy are coming . Skin cancer has been an upward trend for years and the decision to see a doctor is a very smart one . Secondly , anything showing up on the skin needs attention of a provider skilled in differentiating ' bad ' moles from ' just a spot ' moles . You can do it using your expertise by just looking at it and , if you are a good practitioner , you can say a lot about the spot . However , if you are not sure , a biopsy is done , taking a small sample of the mole / spot , in order to check it for pathological features . Usually , it takes between 7 to 10 days to receive a pathology reading back . Your doctor then determines the next steps based on the diagnosis . presented by Arlington Dermatology There are some ' spots ' that look very alike , but are totally different . Seborrheic keratosis is the most common mole associated with the process of skin aging ( anybody over 40 ) , but it is totally benign and will not turn into skin cancer . Removing SKs ( as we call them ) is a semi - cosmetic procedure and it is not covered by any insurance . Although you may not like the looks of SKs , they are a normal type of growth and you can live with them with no problems . However , their close ' sisters , actinic keratosis are not totally benign . They may not be very different but they form pre - cancerous lesions and should be treated to prevent skin cancer . Thus , they are covered by insurance companies . Can you distinguish between AKs and SKS ? Not really . A dermatologist with experience can . And if not sure , a biopsy will help to make the diagnosis . But a removal of it may be a patient's responsibility and you need to be prepared to pay for it . One of the most common requests for removal are , so called , skin tags . They tend to grow in chronically and a re - growth is quite common . They are not covered by any insurance . While most patients hate having them , their removal is considered to be cosmetic . It is a very quick and simple process to have them removed but you need to be prepared to pay for it . Of course , this is a very short and simple example of comparing covered and non covered services . If you have more questions , you can always reach out to us to talk about it in more details . Michael Bukhalo , MD Arlington Dermatology 5301 Keystone Court Rolling Meadows , IL 60008 Tel . 847 392 5440 | www.arlingtondermatology.net