Is Mole Removal Covered by Insurance?

Question

I have a mole bigger than the size of a pencil eraser above my butt. Someone please tell me the cost to remove it. I have Medi-Cal and not sure if that will help or not.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Surgical procedures for aesthetic 
purposes, to improve appearance, are not covered by insurance. 
Typically, these as well as complications resulting from such procedures
 are the responsibility of the patient. Procedures that are meant to 
correct functional issues and those which cause health-related issues 
should be covered by your insurance as a medical necessity, with proper 
examination and documentation.  Some insurance plans have exclusion 
criteria for certain procedures.  Also, it is an obligation of the 
surgeon not to attempt to authorize purely cosmetic procedures through 
insurance.  Excision of suspicious lesions may be covered.Discuss your issues and 
complaints with a board-certified plastic surgeon to discuss these as 
well as to examine and assist you in deciding which procedure(s) will be
 the best for you. A discussion of the advantages and disadvantages will
 take place along with the risks and benefits. Insurance companies will 
vary on coverage and is always reasonable to discuss your issues with 
your surgeon and primary care. It would behoove you to get as much 
information as possible and even call your insurance yourself. 
Certainly, pay in advance prior to your surgical procedure and options 
such as financing are available if you qualify. Hope that this helps! 
 Best wishes!

Sam Naficy, MD, FACS · Answer

A mole removal can be covered by insurance if there is medical necessity for removal.  If there is concern of it being cancerous, this can be covered.

Raffy Karamanoukian, MD, FACS · Answer

Mole removal is often covered by insurance if there is a medical need to remove the mole, such as suspicion for cancer. Benign moles are not covered as often. I see many patients with insurance based mole removal in Los Angeles and have not had a problem with insurance reimbursement. Surgery90210

Anil R. Shah, MD · Answer

Each insurance company and policy will cover different medical conditions and procedures based on the guidelines of the plan signed up for.  Mole removal may or may not be based on your policy.

Michele S. Green, MD · Answer

Each insurance carrier and plan has different rules about what is considered medically necessary and covered.  You have to check with your individual plan.  Cosmetic mole removal is generally not covered by any plans.

Gregory J. Vipond, MD, FRCSC · Answer

Mole removal may be covered by insurance, depending on its characteristics, your skin history, and family history for skin conditions. If it is a cosmetic concern, often the excision will not be covered but you should be able to discuss this with your surgeon and your insurance provider.

Gary Goldenberg, MD · Answer

Mole removal is usually covered by insurance, especially if your dermatologist is worried that the mole is abnormal. If the spot is wanted to be removed for cosmetic reasons, the procedure is usually not covered.

Robert L. Kraft, MD, FACS · Answer

Generally, if a lesion is suspicious or has a history of growth,bleeding or irregular borders, it will be covered,. Your plastic surgeon should confirm the applicable rules established by your insurance company prior to the procedure to alleviate any financial concerns. Some carriers require preauthorization which is a simple matter for an experienced office staff.

Lisa Benest, MD · Answer

Insurance typically covers mole removals under certain circumstances. For example, if a mole is suspicious looking or changing or getting irritated, they will cover the removal. If you want to remove a mole for purely cosmetic reasons (in other words you just don't like the way it works), you will have to pay out of pocket.

Barry L. Eppley, MD, DMD · Answer

Every insurance company has their own criteria as to whether mole removal is covered by insurance. That always has to be initially determined by a process known as pre-determination. Many physicians, however, do not take insurance for mole removal due to the very low reimbursements for doing it. Even in those who do, most physicians will not remove more than one or two at time as insurance stops paying for more than one or two at a single treatment session. From a cosmetic fee standpoint, most moles can be removed for a few hundred dollars apiece in most practices.

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