Aetna

Blue Cross Blue Shield - Empire, NY

Anthem Blue Cross Blue Shield

Blue Cross Blue Shield (Anthem) Ind & Small Group Exchange Plans (Pathway X Plan)

CIGNA

Connecticare

Conventry Health Care

Firsthealth

GEHA

Guardian

Harvard Pilgrim

Humana

MagnaCare

Medicare

Medicare Railroad

MultiPlan

MVP Healthcare

Optum Network of Connecticut 

Oxford (Liberty and Freedom Plan + Medicare Advantage)

PHCS

Stirling Benefit

Tricare

United Healthcare

UMR

Wellcare

Credit card payments in person or on our patient portal are accepted.

The address of our practice is 38 East Ave, New Canaan, CT 06840. Parking is behind the building. Get directions >

At Elite Dermatology Physicians, we seek to see patients as quickly as possible. If you feel that you are having a true skin emergency, please call our office directly to see if we can accommodate you sooner.

It’s a great question—and the answer has to do with how insurance companies define preventive care versus specialist care.

Preventive Care Is used in Primary Care

Insurance carriers (including Medicare) only classify certain services as preventive.

These include annual wellness visits, physicals, and immunizations—services typically performed by primary care providers (family medicine or internal medicine doctors). Because dermatologists are specialists, our visits are not considered preventive, even when you’re coming in for something routine like a yearly skin check. Instead, dermatology appointments are billed as medical evaluations.

When you see us, we use Evaluation & Management (E/M) codes—such as 99203 or 99213—rather than preventive codes.

These codes reflect:

• Why you came in

• What we examined or treated

• Any discussion, diagnosis, or follow-up plans

Even if your visit feels like “just a check,” it still involves a detailed medical evaluation, so it must be billed as such.

Why We Can’t “Switch the Code”

Sometimes insurance representatives suggest asking your doctor to “just change the code to preventive.” Unfortunately, that’s not possible for specialists.

Yes, codes are editable in a billing system when errors occur—but if we change a dermatology visit to a preventive care code, it will still be rejected because it doesn’t fit the guidelines for specialists. That leaves you responsible for the entire bill. So while the rep isn’t technically wrong that codes CAN be changed, they are often unaware of the consequences of doing so incorrectly.

If we submit a preventive code for a dermatology visit, your insurance will almost certainly deny the claim—meaning they won’t cover anything, and you could be responsible for the full bill.

We’re legally required to bill accurately and follow strict coding guidelines. Using the wrong code, even with good intentions, could create a bigger financial burden for you.

What About Skin Checks?

A skin exam might feel preventive, but it’s considered a medical visit because we’re actively looking for and addressing conditions such as skin cancer, rashes, or other concerns. That’s why it’s billed differently than your annual physical with a primary care doctor.

Still Have Questions?

Insurance coverage can be confusing and varies by plan. If you’re unsure about how your visit was billed, we encourage you to:

• Call your insurance company for details about your benefits

• Reach out to our billing company, Clarity Billing at 502-480-1940

Our goal is always to provide excellent care while keeping the billing process clear and transparent.

We know it can be difficult to understand insurance information. We always encourage our patients to call their insurance company directly to discuss their policy in detail. It is very important to review your insurance contracts every year to know what services are covered and how much you may owe.

Deductible

• The amount you pay out-of-pocket each year before your insurance starts covering most services.

• Example: If your deductible is $1,500, you pay for medical bills until you’ve spent $1,500. After that, your insurance begins to share the costs.

Co-Insurance

• After meeting your deductible, you and your insurance share the cost of care.

• Shown as a percentage.

• Example: If your co-insurance is 20%, you pay 20% of the bill and insurance pays 80%.

Maximum Out-of-Pocket

• The most you will pay in a year for covered services.

• Includes your deductible, co-pays, and co-insurance.

• Once you reach this limit, insurance pays 100% of covered services for the rest of the year.

• Example: If your max out-of-pocket is $6,000, you won’t owe more than that for covered care in a year.

• Copays are a fixed amount you pay for certain office visits, including follow-ups.

• Even though it’s not your first visit, insurance treats follow-up visits as separate evaluation and management (E/M) services, which is why a copay applies.

• Surgeries and procedures are billed differently and may instead count toward your deductible or co-insurance.

• Think of it as your share of the cost for the provider’s time and care during any office visit, not just the initial appointment.