Mission of the NCDA
The mission of the North Carolina Dermatology Association is to bring into one federated organization the dermatologists of North Carolina so that they may interact for the purposes of professional education, advocacy for quality patient care and advancement of the practice of dermatology.
NCDA Executive Board Issues Position Statement on Health Insurance Carrier Practices
The Executive Board of the North Carolina Dermatology Association holds the following positions, and demands health insurance carriers to abide thereby. The following practices lead to significant delays in care, denial of necessary treatments, and increased physical, emotional, and financial burdens on patients, caregivers, and medical providers:
- Automatic Downcoding of Evaluation and Management (E&M) Codes Must Cease Immediately
Automatic downcoding of evaluation and management (E&M) codes for outpatient visits is inappropriate and should stop immediately. This practice, often employed by insurers to reduce payments, disregards the clinical complexity and time invested by physicians in patient care. Downcoding devalues the cognitive effort required to diagnose and manage complex conditions, forcing rushed visits, misdiagnoses, or inadequate follow-up, leading to poorer health outcomes and increased long-term costs.
- Denial of Treatment Claims Within the Global Period Allows Disease Progression and Must Stop Immediately
Denial of claims for treatment of biopsy-proven cancers within a global period is inappropriate and leads to delays in care and allows malignancies to progress unchecked. The global period, intended to streamline post-procedure care, should not be exploited to deny necessary treatments for life-threatening conditions. Denying claims for life-saving cancer treatments within the global period exploits a technicality to avoid payment, directly endangering patient lives and violating the principle of beneficence.
- Prior Authorizations Delay Care and Overutilization Must Stop Immediately
Prior authorizations (PA) for medications on the published formulary should stop immediately, as it leads to delays and abandonment of care. Requiring pre-approval for medications already listed on an insurer’s formulary creates unnecessary bureaucratic hurdles and allows worsening of symptoms or complications due to delays or abandonment due to frustration with the authorization process. This practice disproportionately harms vulnerable populations, introduces unnecessary barriers to care, and prioritizes administrative control over patient health.
- Step Therapy Protocols Delay Access to Effective Treatments and Must Stop Immediately
"Fail first" step therapy, also known as step therapy, is a practice requiring patients to try and fail cheaper or insurer-preferred treatments before accessing the physician-recommended therapy, even when evidence supports the latter as more effective. This practice harms patients in several significant ways, and prioritizes cost over clinical appropriateness, disregarding physician expertise and patient-specific needs, and can lead to preventable harm.
- Arbitrary Medical Necessity Denials Ignore Evidence-Based Care Standards and Must Cease
Denial of claims by deeming treatments "not medically necessary" through use of internal guidelines that conflict with physician recommendation directly harms patients by ignoring evidence-based standards. These denials prioritize cost savings over patient care, leading to significant harm through delayed treatments, prolonged suffering, and increased health risks. AI driven, often arbitrary denials based on opaque criteria undermine clinical decision-making and patient autonomy, prioritizing profits over evidence-based care.
Call to Action
To protect patients and preserve the integrity of healthcare delivery, insurers must cease placing profits before patients- ending cost-cutting practices that compromise clinical necessity is essential to protect lives and preserve the integrity of our healthcare system. We advocate for:
- Immediate cessation of automatic E&M code downcoding.
- Elimination of claim denials for biopsy-proven cancer treatments within the global period.
- Removal of prior authorization requirements for formulary medications.
- Cessation of step-therapy protocols that serve only to delay care.
- Cessation of denials based on arbitrary and outdated standards of medical necessity.
- Transparent and fair reimbursement policies that reflect the true cost and value of physician services.
- By addressing these issues, insurers can reduce barriers to care, prevent disease progression, and improve patient outcomes. Failure to act perpetuates a system where financial considerations supersede human lives, ultimately harming the very individuals the healthcare system is meant to serve.
If you have questions or feedback regarding this position statement, please contact ncderm@ncmedsoc.org.
2025 Summer Meeting a Big Success!
Over the three-day NCDA Summer Meeting, attendees engaged in a wide range of educational sessions covering cutting-edge dermatological treatments, health policy updates, and professional development strategies. Day 1 featured clinical pearls, including updates on hormonal acne management, novel treatments for melasma, tinted sunscreens, microneedling for scar therapy, and the latest on JAK inhibitors like deucravacitinib. Attendees also explored over-the-counter options for hyperpigmentation, updates on photoprotection technologies, and procedural advances like photodynamic therapy and fractional lasers.
Days 2 and 3 focused on practice management, emerging therapies, and resident contributions. Highlights included guidance on coaching versus counseling in practice, new treatments for atopic dermatitis (e.g., delgocitinib and OX40 inhibitors), and AI applications in dermatology as well as a debate on Mohs surgery versus SRT. Day 3 addressed HR best practices, modern vein treatments, and coding changes for 2025, with emphasis on reimbursement strategies and audit preparedness. Residents presented notable research, including insights on no-show rates, rare disease misdiagnoses, and surgical follow-up. The meeting concluded with conflict resolution strategies for team leadership and a notice regarding the termination of NC State’s Clear Pricing Project, which may affect future payments and practice planning.
Poster Session and Resident Abstract Winners
Resident Abstract Winner
Sabah Osmani, MD (UNC) - An Unexpected Comorbidity & A Valuable Lesson
Poster Winners
2nd place ($150) - Jessica Liu, BA (Medical Student) Duke University School of Medicine - Quantifying landing zone needs from dermatology e-consults
2nd place ($150) - Sarah Rimmer, MD (Resident) Wake Forest Dermatology - Parvovirus B19-Induced Acute Generalized Exanthematous Pustulosis in a 15-Year-Old Male
1st place ($300) - Alice L. Mikulinsky, BA (Medical Student) Wake Forest School of Medicine - Assessing the Adherence and Clinical Outcomes of Multiple Topical Acne Products vs a Single Combination Product
Save the Date for the 2026 Annual Meeting!
Make plans now to join us in Pinehurst for the 2026 Annual Meeting!
The North Carolina Dermatology Association’s 2026 Annual Meeting promises a dynamic blend of professional development and world-class golf. Held at the historic Carolina Hotel at Pinehurst Resort—home to some of the most iconic fairways in the country—this year’s meeting offers dermatology professionals, including practicing dermatologists, residents, fellows, and medical students, an enriching educational experience in an inspiring setting. Learn more on the meeting website...
Accommodations:
The NCDA has reserved a block of rooms for attendees at a rate of $269 per night. Reserve your room online [use group code BKG2525 and password 11917581] or call 844-330-1669 and mention that you will be attending the 2026 NCDA Annual Meeting. The deadline to make your reservations in our room block is December 23, 2025. Space is limited, so you are urged to make your reservation promptly.
Exhibitor Information:
Healthcare organizations, pharmaceutical companies, insurance companies, and other vendors are invited to participate as exhibitors and supporters of the meeting. The NCDA extends opportunities for tabletop displays, sponsorship of specific aspects of the meeting (such as resident participation), and CME speaker underwriting during the meeting. Learn more about supporting opportunities and apply today!
Save the Date for the
2026 NCDA Summer Meeting
