Skin Treatments And Insurance: What’s Really Covered?

If you require any treatment for skin conditions, insurance will cover you if it is a medical necessity, not otherwise. This is an important difference one needs to understand when it comes to dermatological treatments and insurance.

What Is Covered, What Is Not

“Under most of the comprehensive health insurance policies, dermatological treatments are covered when they are deemed medically necessary. This typically includes dermatological procedures which are required for reconstruction following an accident, burn, cancer, or other clinically indicated medical condition (e.g., any adverse drug reaction leading to hospitalization),” says Santosh Puri, head,  underwriting, TATA AIG General Insurance.

“However, treatments such as laser hair removal, anti-aging procedures, chemical peels, pigmentation correction, or cosmetic mole removal are usually excluded. Insurers draw a clear line between “restoring health” and “enhancing appearance,” says Sarita Joshi, head of health and life insurance, Probus.

Why Skin Claims Get Denied

Many claim denials in dermatology are due to a lack of medical necessity. For example, a mole excision may be denied if there is no indication of possible cancer in the discharge summary. Additionally, if the patient did not declare that they had pre-existing skin conditions at the time of purchasing the policy, the patient may face claim denial later.

“In addition to these, waiting periods on claims are common for patients with chronic conditions. Policyholders should fully disclose any previous treatments for skin conditions, request a full copy of their medical records, and get approval from their insurer before undergoing any procedures,” says Joshi.

Plan Beyond Insurance

As the cost of advanced techniques in skincare grows, it is imperative for families to understand that there is a limit to what will be covered under reimbursement. “Procedures that are cosmetic or elective in nature are more of a lifestyle decision and therefore need to be planned out financially. Many families may find it helpful to set aside the money they would normally spend on dermatological expenses in a separate, medically focused financial contingency account that contains approximately six months of household expenses to cover these types of expenses,” says Joshi.

The larger financial prioritization lesson is that the insurance industry was designed to protect against large, unexpected events, such as hospitalization, not to cover what is considered planned aesthetic expenses.