0

I go to a dermatologist for UVB phototherapy for plaque psoriasis. It's a first-line treatment and is accepted by basically any insurance company. The standard price set by a dermatologist is around $100, the treatment need not be conducted by a doctor or nurse, and takes less than 5 minutes of my time in a UV box, and less than 30 seconds for the operator (an untrained assistant) to turn the box to the correct setting and go.

It's about the easiest treatment I can imagine for a dermatology practice to administer, and yet I'm charged a specialist copay of $50 and a 20% coinsurance of another $20 or so every time I go, which is daily. This seems a bit odd considering my doctor usually isn't even in the building when I come for treatment, and she sets the regimen for the next month when I see her once a month or so.

Can I be charged specialist copay and co-insurance daily for this?

  • 1
    That would depend on the terms of your insurance policy, but dermatologists are specialists so I would imagine the answer is yes. I don't think we can answer it any better than that since it's more of a legal/insurance question rather than medical. – Carey Gregory Dec 2 '16 at 23:09
  • Yep. Your insurance contract decides what is and isn't a specialist visit. This is one way they limit people's use of services that are by nature ongoing--mental health counseling, physical therapy, etc. They don't say "we don't cover this;" they simply charge a large co-pay. They refer to "office visit" rather than using the words "physician" or "doctor." Insurance is a separate issue, though, from the oversight that the physician has over the treatments. Be informed and confident that the person administering your treatments knows what they are doing. – Katherine Lockwood Dec 7 '16 at 2:39
  • @KatherineLockwood the doctor overseeing the treatment is considered a leading expert in the field, and the use instructions for the assistant administering the treatment are as simple as typing in the dosage in the doctor's prewritten treatment plan, and hitting the start button. I'm assuming the assistant is paid around $25 an hour, and the electricity for the machine can't cost more than 50¢, so my five minutes there costs them under $1, and I pay over $70 for it AFTER insurance. That's what bothers me. – Tim Jan 8 '17 at 8:15

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Browse other questions tagged or ask your own question.