Some background: I've been in dermatology for about 10 years now, 5 years as RN and about 4-5 as NP. For years insurers have been paying for Intralesional steroid injections for the autoimmune condition Alopecia Areata (AA).
It has come to my recent attention that despite whether you are a board certified dermatologist, an NP, or PA, only the first series of injections to treat Alopecia Areata will be covered under insurance and the rest of the follow-up injections are cosmetic.
While I wouldn't normally be so passionate regarding healthcare justice in terms of covering procedures (because let's face it insurers don't want to pay anything), a big population I treat is the Medicaid population. From what I understand from my biller is that Medicaid was the first group to start denying IL Kenalog injections as they say it's for a cosmetic condition. Commercial insurers followed suit.
I think what is upsetting is that unlike male and female pattern loss, AA is very treatable and while it can resolve itself, it can otherwise continue to spread and affect one's self esteem moreso than traditional loss. Medicaid used to cover it too for years in dermatology, so now these low income individuals are forced either pay out of pocket or deal with crippling patterns of hair loss.
The same billing code is also for keloids! And which population is most affected? Persons of African, Southeast Asian and Hispanic descent, all populations who feel their skin type is being neglected in dermatology according to most studies. Where I live Medicaid has been serving these minority groups well and now it's just one more thing taken away.
While this is partly a rant: Can anyone else in derm across the United State confirm/deny this billing code denial trend? Again more specifically, "Only the initial diagnosis and first injection series will be covered, after that it's out of pocket."
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