Getting seen

Verify board certification

“Dermatologist” is not a protected term in the way people assume, and skin checks are offered by a wide range of practices. The American Academy of Dermatology maintains a Find a Dermatologist directory, which is the simplest starting point. Certification itself can be confirmed independently through the American Board of Dermatology, or through the certification-verification service of the American Board of Medical Specialties. That is worth doing, since a directory listing and a current board certification are not the same thing.

Dermoscopy is a learned skill, and the difference between a trained eye behind the lens and an untrained one is the entire value of the appointment.

What to say when you book

How you describe the reason for the visit changes both how quickly you are seen and how it is billed.

• If you have a specific spot, say so, and say what changed. “I have a mole on my back that has changed color over about three months and bled once” is a different booking from “I’d like a skin check.” The first is a problem visit and is usually scheduled sooner.
• Ask to be put on the cancellation list. Dermatology practices have high cancellation rates and many will call people who have asked. This routinely turns a three-month wait into a two-week one.
• Ask whether a full-body exam is included or whether it is a separate appointment. Practices differ, and finding out when you arrive is a wasted visit.
• Ask about cost up front. See below.

What it costs

There is no single answer, and anyone who gives you one is guessing. What is worth knowing is the structure:

• A visit prompted by a specific concern is usually billed as a diagnostic visit and is generally handled like any other specialist visit under your plan.
• A routine whole-body screening in someone with no symptoms is treated differently by different insurers, partly because of the USPSTF Grade I finding. Preventive-care coverage often keys off task force ratings, so this is exactly the kind of visit that can come back as a surprise bill.
• A biopsy, and the pathology on it, are billed separately from the visit. The pathology often comes from an outside lab, which is a second bill from a name you do not recognize.
• Total body photography is generally not covered at all.

The useful move is a single phone call to your insurer before the appointment, asking specifically how a screening skin examination is covered and whether the practice and its pathology lab are in network.

Teledermatology

Remote review has become a normal part of dermatology, and for triage it can work well: a clinician looking at a good photograph can often tell you whether something needs to be seen in person, and how soon. Two limits are worth holding on to. A photograph cannot be examined with a dermatoscope, and it cannot be biopsied. Teledermatology is a way of getting onto the schedule faster and at the right priority; it is not a substitute for the in-person exam when something is actually suspicious.

If you cannot get an appointment

• Start with your primary care doctor. They can examine the spot, and a referral from them frequently moves you up a dermatology waitlist that you could not move yourself.
• Try practices outside your immediate area. Wait times vary enormously between neighboring towns.
• Ask about physician assistants and nurse practitioners within a dermatology practice. Availability is often much better and the practice’s dermatologist is on hand.
• Look for a free screening event. The AAD and various academic centers run them periodically. They are triage rather than a full exam, and triage is what you need.
• Keep photographing it while you wait, using the consistent method. If it changes materially, call back and say so. Documented change is the thing that reprioritizes an appointment.