Insurance & Billing

Billing for Skin Cancer Screenings:

• Dermatology visits, including skin cancer screenings, cannot be billed as “preventative medicine screenings.”
• Medicare and most insurance companies specifically exclude dermatology from preventive billing codes.
• While skin cancer screenings are preventative in nature, medical coding requires a comprehensive exam to evaluate and treat all chronic medical conditions for a visit to be considered preventative.
• Some insurance companies indicate coverage for skin cancer screenings but require the screening to be done by a primary care physician, not a specialist.
• As a result, your visit will be billed as a specialist office visit with “evaluation and management” codes, and will be subject to your specialist office visit copays and deductibles.
• This billing practice is consistent across dermatology practices, not unique to our office.

Insurance Plans Accepted:

• Medicare: Accepted, including supplemental policies whether listed or not.
• Medicare Advantage Plans: Accepted only if we are contracted with the specific company.
• Blue Cross of Idaho Medicare Advantage Plans (HMO and PPO): Requires a referral through the BCI Provider Portal prior to scheduling.
• United Medicare Advantage (HMO) Plans, including all AARP (HMO) Plans: Require a referral through the United Provider Portal prior to scheduling.
• Medicaid: Requires a referral prior to scheduling.
• Tricare Prime: Requires a referral prior to scheduling.
• VA Patients: We cannot accept without a referral from the VA. The VA will only issue a referral if a dermatology appointment is not available within a reasonable time. This applies even if you have secondary insurance, as it will not cover the visit if primary insurance is denied due to a lack of referral.
• Kaiser Insurance: Not accepted.
• Worker’s Compensation Patients: Not currently accepting new patients.
• Out-of-State Blue Cross or Blue Shield Plans: Usually accepted if the plan allows members to see providers with any direct BC/BS contract (which we have). However:
  • Some out-of-state plans restrict patients from being seen outside their home state or require referrals.
  • You must verify your plan requirements prior to your visit.
  • As we are contracted only with Idaho state plans, we cannot verify out-of-state member benefits.

Important Considerations:

• Dermatology emergencies: Rarely fall under an emergency exception if we are not in-network. Check with your insurance for out-of-network coverage exceptions if you have a dermatology emergency, as you may need to visit urgent care or an ER.
• Other Insurance Plans: If your plan is not listed, please verify coverage prior to scheduling. Some plans allow visits at any office, but we cannot research policy limitations on your behalf.
• Due Diligence: Please ensure you confirm your insurance requirements before your appointment.