Congenital nevi are present at birth.
Moles, or nevi, are clusters of cells with dark pigment or melanin, and most are harmless. Some are unsightly or in a location that is a nuisance; others may be large, raised or embarrassing. If you want to have a mole removed and have the procedure paid by your health insurance company, you need to discuss the procedure with your dermatologist or primary care provider. Health insurance policies cover some medical procedures for mole removal, but the policy provisions and the procedure define whether insurance coverage applies.
Medically Necessary
Medical procedures must be "medically necessary" under most health insurance policies. Insurers interpret and pay procedures by medical codes. Your doctor will have to code your condition as one that is medically necessary, or you will not have health insurance coverage for mole removal. Cosmetic surgery is not medically necessary. Elective procedures are not often covered. Health insurance will not cover a "vanity" mole removal.
Monitoring Moles
Malignant melanoma, the most significant of the skin cancers, may develop at or near a pigmented area of skin. If your doctor has been watching a pigmented area of your skin for a potential malignancy, your health insurance coverage may pay to cover the excision of the nevi. Some health insurance coverage requires a biopsy, but if the procedure is minor, it may be easier to remove the mole first, rather than biopsy and then remove the mole. The doctor may perform a shave excision, where he numbs the area and removes the pigmented area and the area just under the pigment with a sharp blade. The physician sends the removed tissue to the lab for biopsy. If there is no malignancy, the wound heals without sutures. Your health insurance may not pay for the procedure if there is no sign of malignancy, but the procedure is less expensive than excisional surgery and may be under your deductible amount.
Health Risk
If you have a mole that may be malignant, your health insurance may cover the biopsy. Your health insurance covers the excision of the mole, if the biopsy reveals malignancy or a precancerous condition and the physician's office codes the procedure correctly. Excisional surgery requires removal of the mole and the surrounding tissue. The surgeon uses a scalpel or punch device. This process usually requires sutures to close the wound.
Health Insurance
Your health insurance policy terms and declarations of coverage control whether the insurer pays for your treatment. Group insurance policies usually cover more than individual health insurance policies. Review your insurance policy and copy the exact language of the policy relating to cosmetic procedures or medically necessary procedures for your physician. Ask your physician's office to submit the procedure for approval before scheduling so that you know whether the insurer will pay. Once you receive approval for the procedure, schedule your surgical appointment.
Tags: health insurance, health insurance, insurance coverage, insurance policies, medically necessary, health insurance coverage
