Do You Need a Referral to See a Dermatologist?

Your skin does more than just cover your body; it protects you, helps regulate your temperature and allows you to experience the world through touch. As the body’s largest and most visible organ, your skin deserves expert care when something doesn’t look or feel right.

That’s where a dermatologist comes in. These skin care specialists diagnose and treat a wide range of conditions, from everyday issues like acne and rashes to more serious concerns such as eczema, hair loss and skin cancer.

While your AdventHealth primary care physician (PCP) can treat some skin concerns, they may recommend a referral to a dermatologist for further evaluation, a confirmed diagnosis or advanced treatment tailored to your skin’s unique needs. Let’s explore when you should see your PCP vs. a specialist for skin conditions.

Do I Need a Referral for a Dermatologist?

A dermatologist is a doctor who focuses on diagnosing and treating conditions affecting the skin, nails and hair in people of all ages, from infants to adults. They can prescribe medications, perform cosmetic procedures like chemical peels, and also provide different types of tests and preventive health screenings.

While your PCP can treat very mild skin issues, such as mild rashes and hives, fungal infections like athlete's foot or minor scrapes and burns, they may provide you with a dermatologyreferral if they suspect you have a skin-related condition that requires more skin-specific care.

Before you can schedule with a dermatologist, you might need to take a few extra steps depending on your situation.

Insurance Considerations

Before you can see a dermatologist, your health insurance provider may require a referral from your PCP and expect you to meet certain criteria for dermatological care.

What is expected differs between the types of insurance coverage:

• HMO plans: Typically require a referral from a PCP.
• PPO plans: Often allow direct access to a skincare specialist without a referral.
• Medicare/Medicaid: May have different referral rules depending on coverage and the state you live in.

Because every health insurance company is different, it's always important to review your policy or call your insurance provider before scheduling a dermatology appointment.

Health Care Provider Requirements

Even if you have a PPO plan that does not require a referral to see a dermatologist, the dermatology office itself may still want a referral. Some hospital systems and specialty clinics may also have different policies regarding dermatology referrals.

It's always best to call the dermatology office you want to visit to find out their exact requirements for care.

State and Regional Differences

In addition to the requirements of your health insurance provider and dermatology office, you may also need to meet requirements set by the state you live in.

Your PCP or dermatology office can provide you with the information you need to make sure you can be seen by a skincare specialist.

Do I Need a Referral to See a Dermatologist with Medicaid?

Yes, with Medicaid, you will normally need a referral from your PCP for dermatological care. However, this may be different depending on which state you live in and what type of plan you have. It's important to check your Medicaid policy or call your provider to find out the exact requirements before scheduling a dermatology appointment.

Do I Need a Referral to See a Dermatologist with Medicare?

Whether or not you need a dermatologyreferral depends on the type of Medicare plan you have. Generally, the original Medicare Parts A and B do not require a referral, but Medicare Advantage plans normally do. It's always best to check your Medicare policy or call your Medicare provider to find out what's required before making a dermatology appointment.

When Should You See a Dermatologist?

There are a number of reasons you may want to see a dermatology specialist, especially for more severe skin conditions that require prescription medications, surgery or special treatments, such as laser treatment.

Common skin, hair and nail concerns that may require dermatology services include:

• Chronic rashes such as rosacea
• Cosmetic treatments for hyperpigmentation, age spots, wrinkles and scars
• Severe dry skin conditions such as eczema or psoriasis
• Hair loss or scalp issues
• Nail fungus
• Persistent acne or severe breakouts
• Skin infections or unexplained irritation
• Skin cancer screening or concerns
• Unusual moles or skin growths
• Moles that change size, color, shape or texture

It's important to see a dermatology expert every year to have your skin checked for the presence of skin cancer, especially if you have any risk factors, such as:

• Fair skin with light-colored eyes and red or blonde hair
• History of blistering sunburns during childhood
• Over 50 years old
• Past tanning bed use
• Several moles
• Spending a lot of time outdoors

Some insurance plans cover an annual dermatology visit as part of a preventive care plan. Reach out to your insurance provider to understand what’s included in your plan so you can make the most of those valuable screenings.

How Your Primary Care Provider Works with Your Dermatologist

Your AdventHealth PCP will normally be the first doctor to diagnose any skin issues you may have. They can treat and provide education for minor skin problems such as mild acne, minor rashes and dandruff.

However, if your PCP suspects you may have a more serious skin condition, or you require cosmetic skin procedures or biopsies, they will provide you with a dermatology referral.

Your PCP and dermatologist can collaborate to diagnose your skin issue and come up with the best possible treatment plan. Both your PCP and dermatology expert will take part in the coordination of your care, providing education for both you and your loved ones, as well as information on any lifestyle changes you may need to make.

How to Get a Referral to See a Dermatologist

There are a few easy steps to follow to obtain PCP referrals for any type of medical specialist.

• Step 1: Schedule an appointment with your AdventHealth Primary Care+ provider.
• Step 2: Come to your appointment prepared to discuss your skin concerns and medical history.
• Step 3: Your PCP will provide a full examination to determine whether a dermatology referral is necessary.
• Step 4: If needed, your PCP provides an in-networkreferral and helps coordinate the next steps.
• Step 5: Contact your selected dermatology office to schedule your appointment.

Take Charge of Your Skin Health

Your skin is your body’s first line of defense from damage — and it plays a crucial role in regulating your body temperature and other critical functions.

Such an important organ requires a lot of care. While your AdventHealth primary care provider can help look after your skin’s health, sometimes you may need a referral to see a dermatologist for more specialized care.

If you have a skin concern that needs specialist attention, make sure to schedule an appointment with your AdventHealth PCP to share your concern and start the referral process. We’ll help you get the right care you need as soon as possible.