Understanding Your Insurance and Your Dermatology Bill

Key Insurance Terms

Premium: The amount you pay each month for your insurance. This is payed TO your insurance company.

Co-Pay: A fixed amount you pay at each visit with Dr. Beasley (e.g., $25 for an office visit). This is due at each medical appointment at Check Out.

Deductible: The amount you must pay out of pocket each year before your insurance starts contributing. *This applies most commonly in Dermatology when your are having a procedure done. The patient will pay the full cost of any and all procedure until the deductible has been met. Example: If your deductible is $2,000, you pay the first $2,000 in medical costs yourself before your insurance will pay for any procedures.

Co-Insurance: A percentage you pay for services after your deductible is met. *This applies most commonly in Dermatology when your are having a procedure done. The patient will pay the full cost of any and all procedures until the deductible has been met, then will pay a percentage of each proceudre after. Example: After meeting your deductible, you may pay 20% of a procedure and insurance covers 80%.

Out-of-Pocket Maximum: The highest amount you will pay in a year for covered services. Once you reach this, insurance pays 100% of your medical bills.

In-Network vs. Out-of-Network Providers

• In-Network: Dr. Beasley has a contract with your insurance. Usually costs less for the patient.

Out-of-Network Providers

• No contract with your insurance
• May have higher co-pays/co-insurance
• Some services may not be covered

Always check whether a provider or facility is in-network for your specific plan.

3. Prior Authorization (PA)

Some services — like certain medications, injections, imaging, or surgeries — may require insurance approval before they are covered.

  • Your doctor’s office submits medical documentation

  • Approval can take days to weeks

  • Insurance may deny coverage if criteria are not met, even if treatment is medically recommended

4. “Medical Necessity” vs. Coverage

Your doctor may recommend a treatment that is medically appropriate.

Insurance decides whether it is covered based on:

  • Diagnosis

  • Policy rules

  • Step therapy requirements (trying cheaper options first)

A denial does not mean the treatment is unnecessary — it may simply mean your plan does not cover it.

5. Explanation of Benefits (EOB)

After your appointment or procedure, you’ll receive an EOB — not a bill.

It shows:

  • The service provided

  • What insurance paid

  • What you may owe

Review it for accuracy.

6. Understanding Your Costs

Health insurance cost-sharing might include:
✔ Deductible payments
✔ Co-pays
✔ Co-insurance
✔ Non-covered services
✔ Tiered medication pricing

If something seems unclear — call your insurer and ask:

  • “Is this in-network?”

  • “Has my deductible been met?”

  • “What will my co-insurance be?”