Does Aetna cover dermatology?

Wondering if Aetna covers dermatology? Whether you’re dealing with acne, eczema, psoriasis, skin cancer screenings, or chronic rashes, knowing what your insurance includes is essential. But deciphering insurance policies can be confusing. In this guide, you’ll learn what dermatology services and prescriptions Aetna generally covers (and what it doesn’t), how prior authorization works, why coverage may be denied, and how to improve your chances of approval. We’ll also explore affordable alternatives if your treatment isn’t covered.

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Does Aetna cover dermatology?

Yes. Aetna generally covers dermatology services as long as they’re considered medically necessary. These services typically include procedures and treatments necessary to diagnose, manage, or prevent a medical condition affecting the skin, such as skin cancer or a skin infection. Members often have direct access to in-network dermatologists without needing a referral. Covered services may include office visits, biopsies, lesion removal, phototherapy, laser treatments approved by the U.S. Food and Drug Administration (FDA), and prescription medications that are on your plan’s formulary.

However, Aetna typically does not cover cosmetic or investigational procedures. Understanding the difference can help you avoid unexpected out-of-pocket costs.

What types of dermatology does Aetna cover?

Medically Necessary Treatments

Aetna uses clinical policy bulletins to determine whether a service is medically necessary or cosmetic. Covered treatments may include:

• Diagnosis and biopsy of suspicious moles or lesions.
• Removal of benign lesions (such as skin tags, seborrheic keratoses, small nevi under 1.5 centimeters) only when medically necessary, such as for bleeding, itching, disfigurement, or suspicion of malignancy.
  
• Phototherapy (like narrowband UVB) for psoriasis, eczema, and vitiligo. PUVA may be covered for psoriasis, but is often considered investigational for vitiligo and alopecia areata.
• Laser treatments, such as excimer lasers for psoriasis or lasers for acne keloidalis nuchae, are covered only when FDA-approved, clinically indicated, and pre-authorized.
• Dermoscopy and total body photography for patients at high risk for melanoma.
• Skin grafts and wound care for burns or diabetic ulcers when supported by clinical evidence and FDA guidelines.

Prescription Medications

Aetna may cover FDA-approved topical and oral dermatologic medications, including corticosteroids, retinoids, isotretinoin, and biologics, depending on your plan’s formulary, prior authorization requirements, and medical necessity.

What types of dermatology are not covered by Aetna?

Cosmetic procedures

Aetna usually does not cover treatments deemed cosmetic, such as:

• Dermabrasion for acne scars (except when used to treat actinic keratoses or skin cancer).
• Laser resurfacing or chemical peels for wrinkles, pigmentation, or melasma.
• Laser hair removal or acne scar treatment without a medical indication.
• Cosmetic mole removal that lacks clinical justification.

Experimental or unproven therapies

The following are typically considered investigational and not covered:

• Cadaveric skin substitutes for non-burn-related skin loss.
• Computerized mole-mapping or gene-expression patch testing.
• Home-use lasers or devices lacking clinical evidence.
• Other dermatologic treatments that are not supported by FDA approval or peer-reviewed data.

Eligibility criteria for Aetna coverage for dermatology

To have treatments covered, you usually must:

1. Be enrolled in a plan that includes dermatology (commercial, Medicare Advantage, etc.).
2. Use an in-network provider to minimize out-of-pocket costs.
3. Obtain medical necessity documentation: your dermatologist must justify the need based on symptoms, failed therapies, or clinical risk.
4. Gain prior authorization, when required, especially for treatments like biologics or advanced therapies.
5. Submit documentation of past treatment attempts, lab work, and clinical notes—commonly required for advanced treatments like phototherapy or lasers.

How to know whether my Aetna covers dermatology?

1. Log in to Aetna’s member portal to review your plan’s Evidence of Coverage (EOC) and formulary.
2. Use Aetna’s “Find a Doctor” tool to check which dermatologists participate in your network.
3. Contact Member Services with questions about your coverage limits, copays, prior authorization needs, or referral rules.
4. Ask your dermatologist’s office. Their administrative staff often know Aetna’s protocols and can help navigate the process.

Does Aetna cover dermatology prescriptions online?

Yes, Aetna typically covers dermatology prescriptions issued through telehealth services. Many virtual dermatology platforms partner with Aetna or work with mail-order and retail pharmacies to streamline online prescriptions. After a licensed dermatologist evaluates your skin condition and sends an electronic prescription, it can often be filled through Aetna’s mail-order pharmacy or a participating online pharmacy.

However, coverage varies depending on your plan. Some treatments—especially biologics or other specialty injectables—may require pick-up from a specialty pharmacy. Your Aetna formulary will outline specific requirements, such as prior authorization, step therapy, or quantity limits, that may apply.

Why Aetna might deny dermatology medication coverage

Aetna may deny coverage if:

1. The drug is off-formulary or deemed not medically necessary.
2. Step therapy requirements haven’t been met (e.g., requiring cheaper topicals/ orals first).
3. Prior authorization was not obtained or submitted incorrectly.
4. Documentation is incomplete, like missing failed prior treatments or lab results.
5. The drug is used for cosmetic purposes, not treatment.

Tips for improving your chances of dermatology medication approval

While many dermatology services are covered as long as you meet eligibility and follow the documentation requirements, there are still steps you can take to help the process go smoother and avoid unexpected fees. Including: 

• Get accurate coding and justification from your dermatologist. Be sure your dermatologist submits the right diagnosis codes and treatment history.
• Pre-submit medical records or treatment logs. Documentation should highlight how prior conventional therapies have failed.
• Follow step therapy. Before escalating to advanced or injectable treatments, try lower doses or generics.
• Use peer-to-peer reviews. You can ask your dermatologist to directly discuss your case with Aetna’s medical director.
• Submit appeals promptly if initially denied. Typically, you should appeal within 30–45 days and submit additional medical records and a letter of medical necessity.

Alternatives & savings options if Aetna doesn’t cover dermatology medication

If Aetna denies coverage for your dermatology services or medication, you can try: 

• Generic versions or therapeutic equivalents—ask if a cheaper alternative exists.
• Patient assistance programs—many pharma companies offer income-based aid.
• Coupons or copay cards—especially for injectables.
• Use a compounding pharmacy for customized topical creams at a lower cost.
• Seek clinical trials—some patients qualify for free or low-cost biologics.
• Switch to out-of-pocket paid dermatology visits—some treatments may be more affordable than insurance, despite no coverage.

How to get prior authorization from Aetna for dermatology medication

In most cases, your provider will handle the prior authorization process for you. Here’s how it usually goes: 

1. Your dermatologist submits a request through Aetna’s portal (via fax or online).
2. Include patient data: diagnosis, failed treatments, severity, clinical measurements, and relevant lab tests.
3. Specify dosage/duration and the drug’s FDA indication.
4. If needed, accelerate urgent requests for severe cases.
5. Once submitted, Aetna reviews with a clinical timeline of typically a few days to 2 weeks.
6. You and your provider are notified—if denied, prepare medical documentation to support the appeal.

Aetna often covers dermatology, even online 

Aetna covers a wide range of dermatology services and medications, but only for medically necessary treatments using in-network providers. Telehealth platforms can make this process more convenient by offering quick access to board-certified dermatologists, digital documentation, and streamlined e-prescriptions. Virtual visits can help speed up approvals by ensuring the prescription follows your formulary and includes the necessary medical notes. Cosmetic or experimental procedures aren’t covered, but for eligible conditions, telehealth can simplify getting the care and medications you need.

Book an appointment on Klarity Health

Need help navigating Aetna’s dermatology coverage? Klarity Health makes it easy. Book a telehealth visit with a licensed, board-certified dermatologist who accepts Aetna insurance. You’ll get help with documentation, insurance verification, and prior authorization—all from the comfort of your home. Schedule an appointment now.

Not sure if your insurance covers dermatology care?

Licensed providers on Klarity Health can assess your skin concerns and offer guidance on treatment options that may be covered.

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