We are in-network providers for the following insurance plans:
- Aetna
- Anthem BCBS
- Federal BCBS
- Carefirst Blue Choice
- Cigna
- United Healthcare
- GEHA
- UMR
- Tricare
- Humana
- MultiPlan
- Medicare
Insurances REQUIRED to have an insurance referral:
- Cigna HMO
- United Healthcare Optimum Choice Plan
- United Healthcare MDIPA
- All HMO Plans
We cannot guarantee that we accept your specific plan as an In-Network provider; it is your responsibility to verify your insurance benefits and coverage prior to your visits. Co-pays and any outstanding balances are due upon check-in. We are out-of-network for all other health insurance plans and do not submit claims for out-of-network insurances. Payment for all visits which are not submitted to insurance is due in full at the time of service. We accept Visa, MasterCard, Discover, and American Express credit cards. We do not accept checks.
If your insurance requires a referral in order for your services to be covered, you must obtain these prior to scheduling. If your insurance requires a referral for your visit and it is not processed and received by our office prior to your visit, you will likely need to reschedule your appointment.
We use third-party labs for biopsies, blood work, and cultures. If your insurance requires use of a specific lab in order for laboratory fees to be covered, you must notify us about this prior to your visit.
If you have questions about your bill, please contact our office at 1-703-356-5111 and ask for the billing manager.
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Insurance and Billing FAQs
Understanding Your Dermatology Visit and Insurance Coverage
Common Questions We Hear From Patients:
- “Why did I get a bill? I just had my annual skin check—shouldn’t that be covered 100% by insurance?”
- “Why isn’t a dermatology visit considered preventive care, like my annual physical with my primary care doctor?”
- “Can’t my skin check be billed as a preventive visit instead of a medical one?”
We completely understand the confusion, and those are excellent questions. Let’s clarify why dermatology visits, including routine full-body skin exams, are billed differently than preventive care visits with your primary care provider.
Preventive Care Is Reserved for Primary Care
Insurance companies, including Medicare, have specific guidelines for what qualifies as preventive care. These visits—like annual physicals or wellness exams—are designed to be performed by primary care providers (PCPs), such as family medicine or internal medicine physicians.
Preventive visits use special billing codes that are often covered in full by insurance, meaning no out-of-pocket cost to you. However, these codes are only intended for use by PCPs – not specialists.
How Dermatology Is Different
As board-certified dermatologists, we are considered specialists. Our role is to diagnose, evaluate, and treat conditions affecting your skin, hair, and nails.
Because of that, dermatology visits are classified as medical evaluations, not preventive care even when your visit is routine or focused on a full-body skin check. This is not determined by us, but by how insurance companies define and categorize care.
The Billing Codes We Must Use
Dermatologists bill visits using Evaluation and Management (E/M) codes—such as 99203 or 99213. These codes reflect:
- The reason for your visit
- The extent of the exam performed
- Any diagnosis, discussion, or treatment plan
Even if you’re coming in “just to be safe,” a full skin exam involves medical decision-making, and in many cases, we identify or monitor issues that require follow-up care. That’s why the visit must be billed using E/M codes—not preventive care codes.
Why We Can’t Change the Code to Preventive
We’re often asked if we can simply change the billing code to one used for preventive visits to help reduce patient costs. Unfortunately, we legally cannot.
Preventive codes are restricted to primary care visits only. If we were to use one for a dermatology visit, your insurance would most likely deny the claim entirely; meaning you’d be responsible for the full cost out-of-pocket.
We are required to use billing codes that accurately reflect:
- The type of provider (specialist vs. PCP)
- The nature of the visit
- The services provided
Even if your insurance representative tells you to “just have the doctor change the code,” it’s important to understand they may not be familiar with medical coding rules. While codes can be edited in a billing system to correct errors, they cannot be changed simply to reclassify the visit as preventive if it doesn’t meet the criteria.
What If I’m Just Getting a Skin Check?
We know a full-body skin exam can feel like a preventive visit. And in many ways, it is preventive—we’re checking for early signs of conditions like skin cancer, which can be life-saving.
However, because these exams involve a medical evaluation and clinical decision-making, insurance classifies them as medical visits rather than routine preventive care.
Questions About Your Coverage?
Every insurance plan is different. If you have questions about how your visit was billed or what your plan covers, we encourage you to reach out to your insurance company, or contact our office and we’ll help clarify anything we can.
Our priority is always to provide the best care while keeping billing transparent and aligned with insurance rules.
Pathology Billing & Lab Responsibility: What to Expect After a Biopsy
Why You May Receive a Separate Bill from Fairview (Minnesota)
If a biopsy or other skin procedure is performed during your visit, the tissue sample is often sent to a lab for pathology review—which is a critical part of diagnosing skin conditions, including cancer.
In many cases, our office sends these samples to Fairview Laboratories in Minnesota for expert dermatopathology analysis.Here’s what you need to know:
- You may receive a separate bill from Fairview for the lab/pathology services.
- This bill is NOT from our office, but from the lab that performed the analysis.
Fairview will bill your insurance directly, and any remaining balance (like a deductible or co-insurance) may be billed to you. Even if the biopsy was done in our office, the pathology portion is billed separately by the lab that interprets it.
This is a standard practice in dermatology, as pathology services are performed and billed separately by the laboratory. While we’re happy to explain why a specimen was sent out and what it was for, any billing questions or balance inquiries must be directed to Fairview Laboratories using the contact information provided on your statement.
Please note that our office cannot adjust, collect, or resolve charges related to their services.
Lab Network and Patient Responsibility:
We always do our best to send pathology specimens to labs that are in-network with your insurance plan. However, lab coverage varies by insurance, and network participation can change. It is the patient’s responsibility to know which laboratories are covered under their insurance policy.
If your insurance plan requires the use of a specific lab, please let our team know at the time of your visit. While we make every effort to honor these requests, there are times due to medical urgency, specimen type, or specialized testing requirements when we may need to send specimens to the lab best equipped to handle the analysis.We understand how frustrating surprise bills can be. That’s why we encourage all patients to check with their insurance provider in advance and stay informed about lab coverage.
