Navigating Barriers to Patient Access and Reimbursement in Mohs Micrographic Surgery

Aimee E. Krausz, Jamie R. Manning, Gian L. Vinelli, David H. Ciocon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND: Insurance companies have implemented new policies including excessive prior authorization (PA) requirements, high-deductible plans, and complicated billing structures in an effort to curb rising health care costs. Studies investigating the real-time impact on providers and patients are emerging, but few within the field of dermatology have been published. OBJECTIVE: To assess the impact of cost-cutting policies on patients and physicians. METHODS: A survey was electronically distributed to members of the American College of Mohs Surgery (ACMS). RESULTS: The majority of respondents (78.2%) practiced in a private setting, with no other demographic differences. The majority of respondents (70%) dedicated 1 to 2 employees to obtaining PAs. Fifty percent reported an average time of 30 minutes spent per PA. Fifty-six percent of respondents obtained PA from private insurance before Mohs surgery, whereas only 24.5% obtained PA from Medicare. Forty-nine percent of practitioners provided patients with a financial disclosure prior to Mohs surgery. Moreover, many practitioners reported screening patients for high-deductible policies and request an advanced deposit against the deductible. Sixty percent reported difficulty obtaining payment for service in the absence of an advanced deposit. CONCLUSION: The burden of restrictive health care policies will have long-term consequences for the patient-provider interaction and patient outcomes.

Original languageEnglish (US)
Pages (from-to)599-604
Number of pages6
JournalDermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
Issue number5
StatePublished - May 1 2020

ASJC Scopus subject areas

  • Surgery
  • Dermatology


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