Keeping yourself properly covered during winters to keep the flu away or saving yourself from heatstroke in scorching summers of the gulf is not all that there is to staying healthy. There are several other small and big ailments that we tackle in our everyday life. One such ailment is the varied skin conditions that drop a damper in between. Skin diseases are some of the most commonly existing health conditions in the UAE which is understandable considering the extreme environmental conditions of the gulf. Getting these skin conditions treated can lead to huge medical bills. Given the expenses, it is natural to seek cover for dermatology treatments in your health insurance policy. Let’s figure out if health insurance plans cover dermatology and what are the basic underlying terms and conditions for the coverage.
In short, yes, health insurance does cover dermatology treatments on a case-by-case basis. This means that not all dermatology treatments are covered by health insurance but the coverage exists. As the base rule of health insurance policy goes, anything deemed medically necessary is covered by health insurance policies under dermatology and skincare treatments. The exact terms of dermatology treatment coverage may differ for every provider and as per the type of network your plan is based on. The best way to figure out the exact benefits for dermatology treatments covered by your plan is by reading policy wordings or by talking to the service providers.
Since dermatologists are from the specialist category, many health insurance policies may require you to get a referral from your primary care physician. This generally applies when your health insurance plan requires you to choose a PCP from the list available with them as network doctors. Even when you do not have to choose a PCP for your health insurance policy, services and benefits related to dermatology may still need a referral from a primary care physician of your choice. This term is often highlighted in the policy wordings of your plan as well. You will find it under the specialist consultation section.
HMO and PPO are the most basic kind of network plans you will find in the UAE. HMO or the health maintenance organization plans are the basic levels of health insurance plans. They are the least flexible in terms of network hospitals and primary health care providers. If you are required to choose a PCP and a hospital while buying an insurance plan, your health insurance policy is most probably an HMO plan. Naturally, you will need a reference from your PCP to get dermatology consultations and treatments covered here. PPO or preferred provider organisation plans are more flexible. You have access to a larger network of hospitals and do not have to choose a PCP beforehand either. However, referrals still may be required to get dermatology special benefits and services covered. There may be some PPO plans that do not require a referral. Most basic and comprehensive health insurance plans are based on these two modules only.
Both HMO and PPO plans are a good choice depending on the requirements of the policyholder. If you need a budget insurance plan that covers all the basic benefits and emergency treatments, you can go for HMO plans. Since they are more rigid than other kinds of health insurance plans, the price is relatively as well. People who need more freedom for choosing healthcare providers and doctors, along with more benefits can try and get a PPO health insurance policy. They cost a little more than HOM basic plans but offer a better range of benefits and covers. Compare health insurance in the UAE to find out a suitable plan from the category of your choice. When you compare health insurance in UAE, you must also take some time out to examine secondary factors such as claim process and customer service.
All medically necessary treatments can be covered by your health insurance policy when it comes to dermatology. Given below is the complete list:
The most common exclusions of dermatology treatments are cosmetic surgeries, procedures and treatments. Any dermatological procedure performed to improve aesthetics is categorized as a cosmetic treatment. Since the concerned skin condition is not affecting the health of the person directly or indirectly, the insurance companies do not cover them. A fine example here can be treatments taken for wrinkles, age spots, smile lines, etc. Botox, tattoos (application and removal), chemical peels, microdermabrasion, etc.
Dermatology claims can be submitted either as direct claims for cashless treatments or as reimbursement claims. Direct claims are submitted at the time of surgery itself. You may need prior approvals though. Check your health insurance policy to understand the direct claim approval process. Reimbursement claims are filed after you have already undergone the procedure. There is a deadline for reimbursement claims to be filed. It can range anywhere between 30 to 180 days. Check this deadline and submit the reimbursement form accordingly. You can get the form directly from the provider. Fill it, attach it with all required documents and submit via available means. Documents required can include your consultation records, doctor’s record, lab tests and other reports of the condition, payment receipt for every service claimed in the form, and other specifically required documented proof by the provider.
In a Nutshell
Dermatology treatments are typically a part of your basic health insurance policy as long as they are medically necessary. Even the most comprehensive plans probably won’t cover cosmetic treatments and procedures unless specified otherwise. You must compare your options properly to get a hold of the best possible health insurance policy for your needs. Use the online comparison platform of Policybazaar UAE to compare health insurance in the UAE ideally finding the perfect plan for your skin treatment and procedure. Make sure that you buy from authentic and safe sources only and give careful consideration to both price and features when choosing your health insurance policy.